Ptosis and addiction deficit



Saw a patient in oculoplastic clinic. Patient Is a 15-year-old boy with bilateral ptosis of 1 year duration good Bells levator function 2mm no diplopia no SOB or swallowing problem and otherwise healthy no family history two younger sisters normal ocular appearance. Ocular movement shows poor addiction to either side with restricted vertical gaze ptosis not responding to ice test. Fundoscopy normal. Thinking of listing him for frontalis suspension but not sure of the underlying condition so referred him to neurologist for investigation. What could be the cause?

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