Ptosis:

Please examine the Cranial Nerves of this 43 year old lady who has blurred
vision and proceed as appropriate

Clinical Examination:

Classical Signs Additional Signs

- Drooping upper eyelid (unilateral or
bilateral)
- ‘Down and out’ eye, may have a
dilated pupil (CN III palsy)
- Small pupil (Horner’s syndrome)
- Fatigability (Myasthenia Gravis)
- Frontal balding, wasting of
temporalis and masseter muscles
(Myotonic Dystrophy)

Common discussion topics:

Causes of unilateral and bilateral ptosis
Investigations
Treatment

Quick Revision:

Levator palpebrae superioris is supplied by both the sympathetic and

parasympathetic nervous system and so ptosis can occur due to damage to both.

Causes of unilateral ptosis Causes of bilateral ptosis

- Third nerve palsy: - Myasthenia gravis

- Horner’s syndrome - Myotonic dystrophy
- Myasthenia gravis - Ocular myopathy
- Idiopathic - Mitochondrial dystrophy
- Bilateral Horners syndrome
(syringomyelia)