A Rare Case of Non-Neurological Ptosis

Ptosis in pediatrics is commonly attributed to neurological causes. Rarely, chronic inflammation of the upper eyelid and the formation of giant papillary conjunctivitis due to vernal keratoconjunctivitis (VKC) may lead to ptosis. In this case report, we present an eight-year-old girl with conjunctivitis who was referred to a pediatric neurology service for evaluation of ptosis. She presented with progressive left-eye ptosis while experiencing allergic conjunctivitis. Her neurological exam showed non-fatigable ptosis with a negative curtain sign. The rest of the neurology examination was normal. She tested negative for anti-MuSK and anti-Ach. The orbital MRI was unremarkable. Further detailed examination by an ophthalmologist showed severe VKC with a giant papillary formation that had led to mechanical ptosis.