Unilateral blepharoptosis with synkinetic movements of the eyelids on horizontal gaze

A 17-year-old woman with a left congenital ptosis and an alternating esotropia is presented. During horizontal gaze to the right and left, the eyelid of the abducting eye elevated and the eyelid of the adducting eye lowered. There were no synkinetic eyelid movements with contraction of the pterygoid, sternocleidomastoid, or facial muscles. Synkinetic eyelid movements due to aberrant regeneration were unlikely due to absence of previous third nerve palsy. A supranuclear innervational abnormality is proposed to explain the clinical findings.