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JAMA Ophthalmology Clinical Challenge |

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

Alison B. Callahan, MD; Joseph F. Rizzo, MD
JAMA Ophthalmol. 2013;131(3):401. doi:10.1001/jamaophthalmol.2013.52a.
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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.

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Figure 1. Clinical photographs. Anisocoria greater in dark (A) than in light (B), indicating a miotic right pupil. There is also suggestion of engagement of the right frontalis to compensate for right-sided ptosis (B).




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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