Pt aged 45yrs,male , non smoker ,occasional taking alcohol.... ..having this partial ptosis in one left eye which is reversible after few minutes , frequency abt once or twice a week since abt 3months. No other compliant except occasional headache .occuring in anytime of the day or evening . No vertigo Non diabetic non hypertensive . No weakness of any limb.



Reversible ptosis suggests myasthenia....though the frequency of ptosis in this patient is very less. even then it's better to investigate him fully . 1. In clinic, fatigue test,ice test can be done. 2. cogan lid twitch sign can be noted 3. full ptosis work up including all readings of MRD1, LPS action, PFH etc should be noted. 4. If anything comes positive and if patient agrees ...other tests like RNFST, Neostigmine test, SMFT test can be done

Does he need MRI brain rule out any intracranial lesion .

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myasthenia is the first diagnosis that comes to my mind. workup up will include 1. complete ptosis evaluation along with pattern of ptosis (diurnal variation ) 2. ice test highly sensitive(98%) and specific(95%), sleep test can also be tried 3. neostigmine test in the OT in case ice test is positive 4. rule out other autoimmune disorders like thyroid and diabetes which can be associated

how is ocular movement and pupillary reaction.... Pls describe the character of headache..... another differential diagnosis is ophthalmoplegic migrain....though most important is to look for myasthenia and thyroid disorder...

Headache quite unrelated ...with this ...ocular movement n reaction r normal

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Is there pupillary dilatation of the left eye,work up for thyroid related disorders,diabetes,vascular etiology,do Mri brain with Mra and RNS test too for myasthenia.Ask for diurnal variation,diplopia

Pupillary reaction normal ,no Dilatation ..diurnal variation is there,no Diplopia ,only prebyopia with heaviness of lt eye when ptosis increases or is significant .....MRI brain normal ...vague tenderness is there in left forearm muscles ....thyroid profile n Ach autoantibodies r awaited .

He may working of computer screen for a long time. Dryness of eye or lazy eye Tab Omega 3 fatty acids OD for 60 days. Tab Neurobion forte OD. Eye drops artificial tear

No dryness ....

Localised causes leading to mechanical ptosis or pseudoptosis should be ruled out eg a simple boil on forehead can cause irritation and lead to pseudoptosis.

If headache is also on the left side than irritation and blepharospasm can lead to decreased lid opening and headache

you should rule out Horner's syndrome,could be a panacost tumor of the lung,or benign multinodular goiter.mysthenia also to be considered

in horner syndrome, ptosis is permanent and not temporary.moreover it is associated with miosis also

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we can also ask for other autoimmune diseases like thyroid. we should also note ocular movements very closely and saccades

Proceed with a CT chest ,look for thymoma sir.

mild form if ocular myasthenic syndrome...

Unilateral ....

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