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Endgames Case Review

Ptosis that resolves with application of an ice pack

BMJ 2020; 369 doi: (Published 16 April 2020) Cite this as: BMJ 2020;369:m1147
  1. Arup Chakraborty, consultant general medicine and intensive care1,
  2. John Jacob, consultant neurology1 2
  1. 1Milton Keynes University Hospital, Milton Keynes, UK
  2. 2Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  1. Correspondence to: A Chakraborty arup24{at}

A man in his 50s presented with a one week history of left sided ptosis and difficulty swallowing. The ptosis was absent on waking, worsened during the day, and improved after rest. His medical history included hypertension. Apart from bilateral ptosis that was worse on the left (fig 1), clinical examination was unremarkable. Application of an ice pack to the left eye for five minutes led to improvement of the ptosis on that side. The ptosis recurred 20-30 minutes after the ice pack was removed.

Fig 1

Patient on presentation and after application of ice pack

Within two weeks of the initial presentation, the patient …

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