Psychogenic unilateral pseudoptosis

A 13- year-old girl presented with unilateral psychogenic pseudoptosis. She had sudden-onset ptosis on the left side 3 weeks before presentation. Careful review of her medical history revealed multiple assessments for chronic pain symptoms over the previous 2 years. Physical examination revealed isolated ptosis on the left side, with no other abnormal neurologic findings. On sustained upward gaze, mild elevation of the upper eyelid accompanied by slight elevation of the lower eye lid was seen. Imaging of the brain, laboratory investigations and Electrophysiologic studies for neurogenic and myogenic pathologies were normal. Dramatic and sustained response with complete resolution of ptosis was observed after administration of placebo during the edrophonium test, thus confirming the diagnosis of psychogenic pseudoptosis. The patient was offered psychologic assessment and support. There was no recurrence of symptoms at follow-up after 2 months. Psychogenic pseudoptosis is an uncommon manifestation of conversion disorder in children. Early recognition of the condition and institution of appropriate psychologic therapeutic interventions are essential for good recovery.