Kevin L. Shen; Kimberly G. Yen, MD


March 18, 2016

Clinical Presentation

A 10-year-old Hispanic boy was brought to the pediatric ophthalmology clinic by his mother for evaluation of his left eye. The mother reported that the patient had been unable to elevate his left eye since birth. She also reported drooping of the eyelid on the same side for as long as she could remember. The patient had been given glasses 2 years ago to "strengthen his eye muscles" but had never received any patching treatment. He did not wear the glasses consistently.

On examination, the patient's visual acuity was 20/20 in the right eye and 20/150 in the left eye. Refractive error was +1.00 in the right eye and +5.00 in the left eye. His vision did not improve with refractive correction.

On ocular examination, the patient had impaired elevation and ptosis of the left eye. Elevation was impaired in both the abducted and adducted positions of gaze. The patient had good alignment in primary gaze, with a minimal chin-up head position (Figures 1 and 2).

Figure 1. Photograph of the patient in primary gaze, demonstrating left-sided ptosis and a slight upward head tilt.

Figure 2. Photograph of the patient attempting upward gaze, demonstrating an inability to elevate the left eye.


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