Familial synkinesis in oculo-palpebral movements.

Case 1, a female aged 38 years, had a partial congenital ptosis on the right side and an unduly wide palpebral fissure, amounting to a lid retraction, on the left (Fig. 1). Elevation of the right eye was completely absent and that of the left was markedly restricted (Fig. 2). On looking down, only the left eye moved downwards in a normal manner, while the right eye diverged (Fig. 3). The left upper eyelid followed the ipsilateral ocular movement in a normal manner but the right upper eyelid did not move downwards and the palpebral aperture remained open, simulating a pseudo-Graefe phenomenon of lid retraction on downward movement ofthe eyes (Fig. 4). Lateral versions and convergence were normal (Figs 5 and 6) and a general neurological examination revealed no other abnormality.