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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.

Creative Commons License

Creative Commons Attribution 4.0 International 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

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