A 62-year-old woman complains of drooping of both upper lids that is worse towards the end of the day. Examination shows MRD1 of 2 mm bilaterally, levator function of 13 mm, a high and deep upper lid crease, and normal extraocular movements. The MOST likely diagnosis is:
- A Congenital ptosis
- B Levator aponeurotic dehiscence ✓
- C Myasthenia gravis
- D Chronic progressive external ophthalmoplegia
Correct answer: B. Levator aponeurotic dehiscence
Explanation
Aponeurotic (involutional) ptosis results from disinsertion or dehiscence of the levator aponeurosis from the tarsal plate. It shows good levator function, a characteristically high or absent lid crease, and often worsening with fatigue through the day. Congenital ptosis has reduced levator function and lid lag on downgaze. Myasthenia would show variable fatigability with other bulbar signs, and CPEO restricts ocular motility, which is normal here.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.