Medical Subject Headings
Male, Aged, Diplopia, Pyridostigmine Bromide, Blepharoptosis, Myasthenia Gravis
Abstract
Abstract
Background: Myasthenia gravis (MG) is an autoimmune disease disorder that affects the skeletal muscles causing increased fatigability and weakness. When it affects the ocular muscles only, it is known as ocular myasthenia gravis (OMG). Patients with OMG will often have symptoms of diplopia and ptosis, which will be worse towards the end of the day. This case report will discuss the common symptoms of OMG as well as the appropriate treatment and management. It will also review the diagnostic tests used to aid in the diagnosis of OMG and discuss the prognosis of OMG. Case Report: A 67-year-old male presented with a chief complaint of diplopia that was variable throughout the day. Additionally, he complained that his left eyelid was drooping. Clinical examination revealed a mild ptosis of the left eye and right adduction deficit. An MRI/MRA of the head and orbits was ordered, along with a myasthenia panel. His MRI and MRA were unremarkable, and he tested negative for acetylcholine receptor antibodies. A neurologic exam was completed, and the patient was diagnosed with late-onset, triple antibody negative, ocular myasthenia gravis. His symptoms improved once he was placed on prednisone. Conclusion: When a patient presents with pupil-sparing, painless, diplopia, ptosis or ophthalmoloplegia, OMG should always be considered. While the diagnosis relies heavily on history and physical examination, serologic, radiographic, and electrophysiologic testing are used to support the diagnosis. First line treatment for patients with OMG is pyridostigmine; however, patients will often require corticosteroids. Some may continue to have diplopia or ptosis even with maximal medical therapy. When this occurs, prism or surgery is an option. The prognosis for OMG is good with most patients reaching remission.
Recommended Citation
Garbo Maxey A, Wilson K. Ocular Myasthenia Gravis; a Case Report. Optometric Clinical Practice. 2024; 6(2):5. https://doi.org/https://doi.org/10.37685.uiwlibraries.2575-7717.5.2.1026
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Digital Object Identifier (DOI)
https://doi.org/10.37685.uiwlibraries.2575-7717.5.2.1026
Included in
Adult and Continuing Education and Teaching Commons, Health and Physical Education Commons, Neurology Commons, Neurosciences Commons, Ophthalmology Commons, Optometry Commons, Other Education Commons, Other Medicine and Health Sciences Commons, Other Teacher Education and Professional Development Commons