DR. SAUVIK BARUA

DR.GOGOI RAJENDRA NATH

Abstract

Myasthenia Gravis is an autoimmune disease in which there is antibody mediated damage of postsynaptic ACh receptors in neuromuscular junction. A 62y/F presented with drooping of left upper eye lid(LUL) since 20 days, associated with generalised weakness and that improved with rest. BCVA 6/6,N6(OU); Left Eyebrows raised, LUL drooping thereby reducing the palpebral apertures to 6mm×30mm; L/E MRD 1: 2mm, MRD 2: 4mm, MCD: 8mm; L/E LPS Function: Berke’s: 14mm and Putterman’s MLD: 8mm. Clinical tests done: Fatiguability test: +, Sleep Test:+, Cogan Twitch Sign:+, Ice Pack Test:+, Neostigmine Test:+. Serum ACh Receptor Antibody Titre: 6.67nmol/L (HIGH), other investigations were WNL. The patient was diagnosed as a case of Ocular Myasthenia L/E and managed with Oral Pyridostigmine 60mg (TDS, PC) leading to clinical improvement. Uniocular Ptosis as the only presenting feature in Ocular Myasthenia is a very rare finding: seen in only 11% patients and does not commonly involve elderly females.