In this segment of the 2013 Neuro-Ophthalmology Subspecialty Day series on recognizing distinctive neuro-ophthalmic symptoms, signs, and tests, Leah Levi presents to panelists Anthony Arnold, Lanning Kline, Mark Kupersmith, and Valerie Purvin the case of a 58-year-old woman with hypertension and diabetes who developed bilateral ptosis and binocular vertical diplopia over several weeks. She had breast cancer 17 years ago, with no known recurrences, and there is no family history of ptosis or dysphagia.