Right levator disinsertion

This 78 year-old woman complained of problem with reading and bilateral drooping eyelids. Her vision was 6/6 in both eyes for distance and N5 with reading glasses. There were no significant cataracts in either eyes. Examination revealed bilateral ptosis worse in the right eye. The visual problem was thought to be caused by the the eyelid covering the pupillary axis during reading when the eyes are looking down. A levator advancement was carried out and the patient found her reading improved.  Bilateral ptosis more prominent in the right. Marginal reflexes showed absence right reflex as the pupil was covered by the lid. Normal eyelid position on downgaze. In the presence of a dystrophic  levator, the upper lid may fail to descend. Good levator function in both eye on upgaze. Appearance of the right eye two hours after levator advancement with  normal right pupil reflex. The left ptosis is now more prominent. A left  levator advancement may be required if the patient is not happy with  her appearance during the post-operative visit.

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