This guideline last updated 06/05/2022 17:43:18

Differential diagnosis

• Ptosis
• Involutional ptosis
• Strabismus
• Myasthenia gravis
• Thyroid eye disease
• Myositis
• Chronic progressive external ophthalmoparesis

Possible management by Optometrist

Treatment

• None

Advice

• Refer urgently to ophthalmology

Management Category

• Urgent referral to ophthalmology

Possible management by Ophthalmologist

• Urgent CT angiography to rule out posterior communicating artery aneurysm
• Address vascular risk factors for arteriosclerotic infarction of the vasa vasorum (microvascular blood supply) of the third nerve
  • Smoking status
  • Alcohol
  • Diet
  • Excercise
  • Blood pressure
  • Diabetes