 Now, here's another lid disorder, levator disinsertion. Watch the left lid. This is in a pregnant patient with poorly fitting contacts. She has tulsis of the left lid. Now, watch where the creases where the lid starts to be tugged at. I think you can see that it's much higher than that right lid. And that's presumably because the insertion sites have slipped and the lids are being pulled upwards from a more proximal portion of their tissue. The other characteristic of levator disinsertion is the demonstration of full levator function. Measure the full excursion of the lids and convince yourself that they're the same on both sides. If you don't see that aspect, then another cause for tulsis should be suspect. Watch that crease on the left. See how high it is compared to the right? I think there's no question that this patient has some disinsertion of the levator.