Ptosis slk – This 42yo lady presented complaining of a droopy left upper eyelid, and stated she wanted surgery to lift the lid. This is what she looks like with eyes in primary position.
Turns out, she has a completely separate problem causing bilateral variable ptosis. In downgaze, the superior limbic keratitis (slk) is clearly evident, worse on the left side.
There are many lessons here, but the most important one is to never let the patient bias your clinical decision-making process. I call this the stolen diagnosis: the patient steals the diagnosis from the internet and offloads it to you. Beware!
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