Some Cases of Ptosis

At a recent meeting of the Bath and Bristol Branch of the British Medical Association1 I showed some lantern slides illustrating ptosis, and it has been suggested to me that a short resume of the cases might be of interest to the readers of the Bristol Medico-Chirurgical Journal. The ptosis was symptomatic of ophthalmoplegia externa, and the unusual point was that it came on in middle life in twelve members of one family. Ophthalmoplegia externa is not a disease of everyday occurrence, and it may be useful to outline briefly some of its features. In the first place, in a well marked case, the external ocular muscles are completely paralysed, and the eyes are as immovably fixed in the orbits as they would be if embedded in cement. Patients with complete ophthalmoplegia externa can neither move their eyes upwards, downwards, inwards nor outwards; but there is no paralysis of the internal muscles. The iris is untouched, and accommodation, irritation, and light reflexes are alike active. The muscles affected are the recti and the obliqui, the levator palpebrae and the orbicularis. The paralysis of the orbicularis is of interest from the fact that formerly this muscle was supposed to get its nerve supply from the facial. Mendel has shown the probability that it comes, via the facial, from the third nerve nucleus. Ophthalmoplegia externa may be congenital, or it may come on late in life. It is sometimes associated with syphilis, with locomotor ataxy, or with general paralysis; but sometimes it