Bilateral ptosis and upgaze palsy with right hemispheric lesions

Bilateral ptosis is reported with unilateral hemispheric lesions, suggesting partial lateralization of the control of the levator palpebrae superioris. There is a tight synkinesis between vertical eye and eyelid movements, but a similar, lateralized control of vertical gaze has not been previously described. We report 3 patients with right hemispheric infarctions, in whom bilateral ptosis was accompanied by impaired upward gaze. We postulate that this lateralization of ocular motor function reflects the special contribution that the nondominant hemisphere makes to attention.