Abstract

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating weakness and fatigability of skeletal muscles. Ocular myasthenia gravis (OMG) presents with symptoms confined to the ocular muscles. A 21-year-old male presented with a two-month history of bilateral ptosis, which improved in the morning or after a nap but worsened throughout the day. Ocular examination revealed bilateral ptosis with gaze restriction. Visual acuity, anterior segment, visual fields, slit-lamp, and fundus examinations were unremarkable. The ice pack and rest tests showed marked improvement, raising suspicion for MG. The acetylcholine receptor (AChR) antibody test was positive for AChR binding antibodies. The patient was initiated on pyridostigmine, an acetylcholinesterase inhibitor, and corticosteroids. Ptosis and ophthalmoplegia improved at the one-week follow-up and completely resolved after eight weeks. The hallmark features of MG are fluctuating, fatigable muscle weakness that worsens with activity and improves with rest. A thorough clinical examination, along with diagnostic tests such as electrophysiological studies and antibody tests, is essential for confirming the diagnosis. Ocular myasthenia gravis has a high likelihood of progressing to generalized myasthenia gravis (GMG) within two years. Early diagnosis and prompt treatment are critical to prevent or mitigate the risk of myasthenic crisis and long-term complications.

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