An otherwise healthy 22-year-old woman presented with a ptosis of the left eye and a contralateral lid retraction (Figure 1). Passive opening of the left eye induced a relaxation of the retracted right lid (Figure 2A and B; a video is available at http://www.archneurol.com). The remainder of the neurologic and neuroophthalmologic examination revealed no other contributory conditions. Magnetic resonance imaging with gadolinium did not show any lesion in the brain or in the eye muscles. The results of laboratory tests, including antinuclear antibodies, serum VDRL, and thyroid function (free triiodothyronine, free thyroxine, thyrotropin, thyroid peroxidase, thyroglobulin, and thyrotropin receptor antibodies) were negative. Intravenous administration of edrophonium chloride, 1.0 mg, markedly resolved the left ptosis and the right retraction (see the online video).
Bandini F. Pseudo Plus-Minus Lid Syndrome. Arch Neurol. 2009;66(5):668-669. doi:10.1001/archneurol.2009.37