Ipsilateral Hypotropia

During a routine eye examination, a 74-year-old woman stated that her left upper eyelid drooped more than the right upper eyelid. The eye muscle imbalance had been long-standing; the patient denied diplopia.

On straight gaze, when the patient's dominant right eye was fixating, an inferior displacement of both the left globe and left upper eyelid was evident (A). When the patient assumed fixation with her left eye, the pseudoptosis diminished on the left and the right globe and the right upper eyelid were elevated (B).

Ipsilateral hypotropia, a form of strabismus, may give rise to a pseudoptosis because the upper lid follows the globe inferiorly. This usually occurs when one eye is 10 to 20 degrees lower than the fixating eye.¹ The diagnosis is made by covering the fixating eye; as the hypotropic eye begins to fixate, the lid moves upward to an almost normal position.

Extraocular muscle surgery for the vertical deviation can correct the hypotropia and pseudoptosis. Because this patient's condition was long-standing, she refused repair.

REFERENCE:1. Schaefer AJ. Surgical techniques for congenital and acquired ptosis. In: Stewart WB, ed. Ophthalmic Plastic and Reconstructive Surgery. San Francisco: American Academy of Ophthalmology; 1984:171.