Dr. Mekhla Naik, N18166, Dr. Marian Anne Jacob, Dr. Saikumar S J, Dr. Giridhar Anantharaman
Blepharoptosisisa known but neglectedcomplication(Incidence:0-44%) of cataract surgery &can be multifactorial. We reporta case of 72/M, known case of DM & IHD, presenting with OD upper lid total ptosis without double vision/diurnal variation, 2 months after uneventful cataract surgery under peribulbar block. LPS function & Bell’s phenomenon were good with negative Ice test, normal EOM & pupils. Based on neurologist opinion & MRI he was diagnosed as ischemic 3rd nervepalsy. With no improvement after observing for 3 months, he underwent LPS reattachment. Postoperatively, due to under-correction he was re-evaluated & ice test turned out positive. Ocular Myaesthenia Gravis(OMG) was confirmed after second neurologist opinion& ptosis was fully corrected with oral steroids &immunosuppressants. Current case indicates that OMG,mimicking levator aponeurosis avulsion/3rdN palsy,may present as severe ptosisprecipitated by surgery, while a negative ice testnot ruling out the diagnosis.