Dr. Huntley's
Diagnosis
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❑ Horner syndrome
❑ Diabetic mononeuritis
❑ Eyelid edema
❑ Myasthenia gravis
❑ Posterior communicating artery aneurysm
Observation of pupillary involvement is the key to differentiating oculomotor (CN III) lesions (mydriasis) from Horner syndrome (miosis).
Horner syndrome Findings include a small pupil, enophthalmos (illusory, caused by retraction of the globe), and anhidrosis with mild vasodilation on the affected side. The ptotic eyelid can still be voluntarily raised.
Diabetic mononeuritis There may be severe pain and ophthalmoplegia but there is usually pupillary sparing.
Eyelid edema Usually conjunctival erythema exists, although angioedema may occur without apparent inflammation.
Myasthenia gravis Ptosis is bilateral and fluctuates, being worse later in the day. Sustained upward gaze produces gradual ptosis of the eyelids. Associated findings include dysconjugate eye movements with sustained horizontal gaze; hoarse, nasal, or slurred voice on prolonged phonation; and inability to sustain motor activity of the limbs.
Posterior communicating artery aneurysm Ptosis is associated with pupillary dilation and abduction of the eye, with inability to turn the eye medially.
Review other book chapters online related to Blepharoptosis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5 
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