My son has a puffy lid like that...he was born with it.

In fact he also has some conjuntival swelling in the same eye.

As he grew up it became worse and we ended up at a specialist who did a CAT scan of his face and head. (looking for a sphenoid bone defect).

The diagnosis was congenital damage from an amniocentesis procedure I had...that the needle poked his cheek near the eye and upset the lymphatic drainage and caused the puffy eye.

He is also congenitally nearsighted (legally blind).

Here are two photos...
2) is at 3 mos before we had his specialist vision intervention at
8 months. His left eye always looks this way, sometimes a little less, others more.

1) This is a photo at 5 or 6 yrs...showing the eye, left again, but I had to enlarge it so it is blurry.
I can't tell you how many doctors we've seen over the years.
Recently he started getting blurry...and ended up at the Univ. of Michigan and saw 3 specialists who cannot fix it or help it any at all.

3) shows him as an adult...the angle looking up does not show the puffy lid as much but it is still there. It can be worse at allergy season, and this picture was taken in winter.

One puffy lid may be due to something else besides MG.

I would suggest a heavy metals test, as ptosis can occur with some mercury overloads, or other heavy metals, lead, arsenic etc.

This link has a photo of Freda Koss who had mercury toxicity. Her eye
shows the ptosis clearly. She has a separate website also discussing this environmental issue.
Scroll down this link to find her:
http://www.mercurypoisoned.com/FDA_h...am_safety.html

Believe me we have covered many many bases over the years, with my son's eyes and esp the left one. He does not have MG at all.

Just adding this to the thread because of our experiences.