Myasthenia Gravis

Overview

Myasthenia gravis is an autoimmune inflammatory condition in which acetylcholine receptors at neuro-muscular junctions in the body are attacked. These receptors are located in the space between a neuron and a muscle and are necessary for transmission of neural signals and subsequent movement of muscles. As a result of damage to these receptors, individuals with myasthenia gravis experience symptoms of muscle weakness and fatigue.

Signs & Symptoms of Myasthenia Gravis

All over the body, muscles become weakened and fatigued. Individuals with myasthenia gravis may also have difficulty swallowing, speaking, and breathing. In the eye, symptoms of myasthenia gravis include the following:

ptosis (drooping of an eyelid)
inability to maintain an up-gaze
intermittent double vision (diplopia)

These symptoms will tend to worsen throughout the day.

Detection & Diagnosis of Myasthenia Gravis

If your first visit is to an eye doctor, there are numerous tests that can be performed to determine whether your drooping eyelids and/or double vision a caused by Myasthenia gravis. These tests are very simple in nature, but extremely effective.

Cogan's Lid Twitch Sign
You will be asked to look down at the ground for approximately 10-15 seconds, after which you will be asked to immediately look straight ahead. In patients with myasthenia gravis, the upper eyelid will tend to overshoot and twitch somewhat, after which it will return to its drooping state.

Ice Pack Test
You will be asked to apply an ice pack to the droopy eyelid for about 2 minutes, after which the eye doctor will evaluate any improvement: if the drooping improves, this is a positive sign for myasthenia gravis.

Peek Sign
You will be asked to close your eyes for a period of time, after which you will be evaluated again for any eyelid drooping. If the drooping improves from before, this is a positive sign for myasthenia gravis.

While none of the above tests are definitively diagnostic tests for Myasthenia gravis, they are useful tools for determining whether further testing is needed and what type of testing is needed.

The gold standard for testing of myasthenia gravis is the Tensilon test, which makes use of a pharmaceutical agent to improve the drooping in the eyelid. A positive Tensilon test indicates myasthenia gravis.

Myasthenia Gravis Treatment

Treatment for Myasthenia gravis depends on the severity of the condition. Patients who are suspected of having myasthenia gravis will be referred to a neurologist who will take over their care and management.

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