Ocular Myasthenia Gravis on Physical Exam A 41yo female was referred by her neurologist for double vision. Her clinical exam was consistent with non-localized EOM weakness and bilateral ptosis. Her ocular exam was otherwise unremarkable. Myasthenia gravis was strongly suspected and anti-ACh antibodies (both blocking and binding) were ordered. In-office testing such as cogan sign and the ice pack test were negative and to our dismay the blood work was unremarkable. Seronegative ocular myasthenia gravis has been found in approximately 20% of patients. Further investigation may include a Tensilon test however the co-managing neurologist was quick to point out this is outdated and often replaced with Electromyography. Pyridostigmine (Mestinon) therapy was initiated and subsequently improved the diplopia and ptosis tremendously. MG patients need chest imaging as 10-15% with MG will have a thymic tumor, and always ask your MG patients about difficulty swallowing or breathing as this may constitute a medical emergency. Bennett & Bloom Eye Center @anterior_seg_rocks #eyelid #Ocular #Myasthenia #Gravis #PhysicalExam #clinical #video #ophthalmology #neurology
