Editor,—A 46 year old woman presented with a 3 week history of discomfort, swelling, and drooping of her right upper lid. Recently she had developed rheumatoid arthritis but was otherwise fit and well. On examination her right visual acuity was 6/4 unaided, there was a complete right ptosis with very poor levator function, and mild periorbital swelling (Fig 1). Eye movements were full and the remainder of the ocular examination was normal. A computed tomograph (CT) scan showed isolated enlargement of the right superior rectus/levator muscle complex (Fig2).