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Medical Subject Headings

Humans; Male; Female; Pregnancy; Infant; Acetylcholine; Tamsulosin; Metoprolol; Pantoprazole; Alprazolam; Atovastatin; Bupropion; Glipizide; Paroxetine; Trazodone; Oculomotor Muscles; Diplopia; Exotropia; Blood Pressure; Deglutition Disorders; Prostatic Hyperplasia; Lisinopril; Aspirin; Cholecalciferol; Penicillins; Spouses; Depression; Eyeglasses; Facial Nerve; Hyperlipidemias; Mastication; Ultraviolet Rays; Visual Fields; Eyelids; Hydrochlorothiazide; Cataract; Mascular Degeneration; Myasthenia Gravis; Glaucoma; Visual Acuity; Refractive Errors; Headache; Hypersensitivity; Risk Factors; Hypertension; Diabetes Mellitus; Muscle Weakness; Gastroesophageal Reflux; Neuromuscular Junction; Diagnostic Errors; Amlodipine; Pulmonary Disease, Chronic Obstructive; Confusion; Patient Reported Outcomes, Reflex

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disease caused by faulty transmission at the neuromuscular junction leading to fatigable muscular weakness. Ocular MG is distressing in that it can cause visual difficulties, but generalized MG can be life-threatening. MG is an acquired disorder that can easily be overlooked in clinic and is commonly misdiagnosed. Providers should be aware of the clinical features of this condition, as well as the critical testing needed to confirm the diagnosis so the appropriate management course can be implemented.

Case Report: This case features a 67-year-old Caucasian male diagnosed with ocular myasthenia gravis with in-office positive rest/ice testing and positive Cogan’s lid twitch sign, followed by confirmatory serum laboratory anti-acetylcholine binding, blocking and modulating antibody testing results. The patient was referred to neuro-ophthalmology where treatment with pyridostigmine bromide was initiated. In addition to the details of this case, this report highlights the other key diagnostics, laboratory testing and imaging, detailed pathogenesis, as well as systemic treatment options and ophthalmic interventions for the condition.

Conclusion: Ocular myasthenia gravis is a neuromuscular disease that is commonly misdiagnosed or overlooked, as it can mimic any pupil-sparing ocular motility disorder. Detailed patient history, clinical awareness, and special testing are all important in the diagnosis of ocular myasthenia gravis. In many cases the diagnosis can be tentatively made via in office non-invasive tests; however, laboratory investigation and imaging is necessary to rule out systemic myasthenia gravis. Interdisciplinary referrals and education can potentially avoid life threatening consequences.

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)

10.37685/uiwlibraries.2575-7717.7.2.1043

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