Ocular myasthenia: Missed Diagnosis in Neuro-Ophthalmology
Ocular Myasthenia; Eye Movement Recordings
Clinical Signs: exodeviation of the right eye, approximately 35 degrees; fixation is steady; visual acuity is 20/15 in both eyes; no fields effects; suppression of vision in right eye; horizontal gaze shows initial high velocity burst with dysmetria and low velocity drift; limited eye movement to approximately 5-10 degrees around primary; intersaccadic fatigue and ocular dysmetria. Presenting Symptom: upward flick of both lids with change of fixation (especially on upgaze); adaptation to ptosis by inclining head approximately 30 degrees backwards and slight furrowing of brow; twitch in both lids, though more prominent in right eye; musculature of lids not too abnormal, with mild weakness in resistance to opening. 28 year old male; history going back to 16 years of age with development of strabismus and ptosis; tensilon responsive and diagnosed as myasthenia; no results with mesterlone. Treatment: Edrophonium; Mesterolone. Disease/ Diagnosis: Myasthenia Gravis.
David G. Cogan, MD (1908-1993), Former Director of Ophthalmology, National Eye Institute
Fred C. Chu
U.S. Department of Health and Human Services. National Institutes of Health. National Eye Institute
Spencer S. Eccles Health Sciences Library, University of Utah