Unilateral ptosis: a rare presentation

We report a case of unilateral gradual drooping of right upper eyelid. It was mild to moderate in intensity and variable during the day. Examination was suggestive of myogenic ptosis (with slightly reduced levator palpebrae superioris function). She was screened for myasthenia gravis with negative tensilon test and oral trial of pyridostigmine for few weeks without any improvement, and was advised surgery at an overseas center. A second opinion was taken before surgery. A detailed history revealed that local administration of Botulinum toxin was done four months ago by a plastic surgeon. This along with mildly compromised levator function without any systemic features and negative tensilon test, led us to believe that ptosis was secondary to injection Botulinum toxin. Patient was reassured and advised to use crutch glasses for a month and then report any spontaneous improvement. She reported improvement in the right eye after six weeks, with reappearance of forehead lines.