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57 year old woman who complains "The lids are somewhat down"
Digital Journal of Ophthalmology 1997
Volume 3, Number 12
February 4, 1997
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Melanie Ryan-Graham, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA



Examination
Vision: 16/15 OD, 16/15 OS
Color: Normal OU
Pupils: Light-near dissociation of the right pupil, no pupillary ruff OD, consistent with Adie's pupil. Left pupil normal.
Exophthalmometry: 12mm OU, base 98
Orbits: No resistance to retropulsion
Lids:
- Palpebral fissure: 5mm OU
- Marginal reflex distance: -1mm OU
- Levator function: 11mm OU
- Upper lid crease: 10.5 OU (normal)
- Orbicularis oculi: slight weakness OU
Motility: full, no diplopia. Good Bell's phenomenon
Neurologic: Corneal sensation intact, palatal speech, weak lower facial and neck muscles, transverse smile. No myotonia with handshake
Fundus: No pigmentary retinopathy
Visual Fields: See Figures 2a-2b
top
Figure 1
 The clinical photo demonstrates the patient's ptosis

Figure 2a
 Figures 2a-2b. The Goldmann visual field demonstrated a superior field defect OU which dissappeared with elevation of the upper lids.

Figure 2b


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