Dysphagia in a Patient With Recurrent Bilateral Eyelid Ptosis

Abstract

Question: An 85-year-old man presented with worsening of dysphagia. The symptoms had started 4 years earlier affecting first solid foods and progressively liquid intake. The patient had lost 16 kg over the past year. He had a long-standing depressive disorder treated with a tetracyclic antidepressant and a selective serotonin reuptake enhancer drug. His past medical history also comprised a recurrent bilateral eyelid ptosis. Ptosis was not present at age 45 (Figure A) and appeared during the sixth decade. Although the patient had bilateral surgical repairs at ages 69 and 73, eyelid ptosis was still present at age 85 (Figure B). Physical examination and laboratory tests were otherwise not remarkable. Upper tract gastrointestinal endoscopy was normal. Barium pharyngoesophagography was performed (Figure C). Using the Internet, the patient’s first cousin, who had the same symptoms, found the diagnosis. What is your diagnosis? What treatment do you propose?