An uncommon case of ptosis from invasive bacterial sinusitis

Acquired palpebral ptosis (also called blepharoptosis, or ptosis) is an abnormally low-positioned upper eyelid and occasionally presents as a chief complaint to the emergency department. Due to the wide range of causes and spectrum of severity, emergency physicians must recognize and initiate appropriate diagnostic and treatment pathways to limit the risk of long-term complications in those affected. We report a case of a 19 year old healthy man who presented with a chief complaint of unilateral eyelid droop in the setting of three days of sinusitis symptoms. Neuroimaging revealed invasive sinusitis with leptomeningeal enhancement and extraconal subperiosteal abscess. He was treated with intravenous antibiotics, admitted to the hospital, and discharged home after 7 days. This uncommon cause of ptosis highlights the need for a broad differential diagnosis for this condition and recognition of uncommon complications of invasive sinusitis.