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This 69-year-old man has had ptosis of the left upper lid since childhood. Recently he has experienced drooping of the right upper lid. He uses frontalis contraction to help raise the lids. This is obvious in the picture. Levator function was measured at 10 mm in the right and 2 mm in the left. Vision is 4/60 (20/300) in the right eye (with cataract) and is 6/36 (20/60) in the left after cataract surgery done two years earlier. He is in good health otherwise and the remainder of the eye examination is unremarkable. Ocular motility is normal.

1.	In addition to levator function noted above, additional information that would be useful is:
	d -- (a) and (b) In cases of ptosis, before considering surgery it is necessary to determine if corneal sensation is normal and if Bell response is intact.  These are two potential protective mechanisms for the cornea.  Both help protect the cornea in case of exposure from overcorrection.
2.	The diagnosis in this case is:
	a -- congenital ptosis, left eye, with levator dehiscence, both eyes This man appears to have congenital ptosis in the left eye compounded by levator dehiscence in both eyes. This is supported by history, the disparity in levator function, and the extensive frontalis contraction.
3.	Treatment would include:
	e -- (c) and (d) This man is likely to benefit from levator resection or advancement in the right eye and frontalis suspension in the left.