title: Ptosis from localized A-lambda-amyloid deposits in the levator palpebrae muscle.
abstract: OBJECTIVE
  To describe a patient with unilateral ptosis caused by localized amyloid deposits of immunoglobulin lambda-light chains (A-lambda-amyloid) in the levator palpebrae muscle.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  A 32-year-old otherwise healthy female with right-sided unilateral ptosis.
  
  
  METHODS
  The patient presented with right-sided unilateral ptosis without other ocular abnormalities. Palpebral fissures measured 5 mm on the right side and 8 mm on the left. Systemic evaluation, including neurologic and neuroradiologic examinations, was normal.
  
  
  RESULTS
  Several years after initial presentation, conjunctival amyloid deposits appeared. Ptosis surgery with resection of the levator muscle was performed, revealing massive deposits of A-lambda-amyloid in the excised tissue.
  
  
  CONCLUSIONS
  Our patient had unilateral ptosis due to localized A-lambda-amyloid deposits in the levator muscle. No other amyloid deposits were initially found. Visible conjunctival deposits developed only years later. Ocular amyloidosis with isolated initial involvement of the levator muscle is a rare condition. Localized monoclonal gammopathy may have been the cause of this unique presentation.
authors.affiliation: Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. stefan_dithmar@med.uni-heidelberg.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Dithmar
authors.forename: Reinhold P
authors.initials: RP
authors.lastname: Linke
authors.forename: Gerold
authors.initials: G
authors.lastname: Kolling
authors.forename: Hans E
authors.initials: HE
authors.lastname: Völcker
authors.forename: Burkhard
authors.initials: B
authors.lastname: Helmke
mesh_terms: D000328:Adult; D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D001763:Blepharoptosis / Q000209:etiology* / Q000378:metabolism / Q000601:surgery; D003229:Conjunctival Diseases / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D005260:Female; D006801:Humans; D009801:Oculomotor Muscles / Q000378:metabolism* / Q000473:pathology
chemical_list: D000682:Amyloid; C033048:amyloid protein AR, human