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JAMA Ophthalmology Clinical Challenge
March 2013

Twenty-four–Year-Old Woman With a Droopy Eyelid—Quiz Case

JAMA Ophthalmol. 2013;131(3):401. doi:10.1001/jamaophthalmol.2013.52a

A 24-year-old woman presented to the Massachusetts Eye and Ear Infirmary with transient diplopia and a droopy right eyelid. The double vision occurred 2 days before presentation and lasted only seconds. The ptosis had been fluctuating in severity over the last month. Her medical history included systemic lupus erythematosus and antiphospholipid antibody syndrome with multiple thrombotic complications.

The examination revealed visual acuities of 20/20 OD and 20/50 with pinhole improvement to 20/25 OS. Pupils demonstrated slight anisocoria greatest in the dark (the right pupil measured 3 mm in the light and 4 mm in the dark, while the left pupil measured 4 mm in the light and 6 mm in the dark). Both pupils responded normally to light stimulus. Engagement of her right frontalis masked a 2- to 3-mm right ptosis (Figure 1). Extraocular movements were full. Anterior segment, fundus examination, and intraocular pressures were normal. Confrontational fields were full.