History:  This 3-year-old girl has an inability to elevate the left eye, but the Bell phenomenon is intact.  Refraction is OD +0.50 - 0.50 x 180 and OS +0.50.  Other than the motility, the eye examination is normal.  There appears to be a pseudoptosis of the left upper lid.  Earlier pictures demonstrate a less severe involvement.  Is this a double elevator palsy or is further investigation needed?  A neurologic examination was said to be normal and CT scan was unremarkable. 

Diagnosis:  double elevator palsy 

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