Myasthenia Gravis (Ocular) — What You Should Know (2023)

Myasthenia gravis is a neurological disorder that often affects the eyes. Eye conditions associated with ocular myasthenia gravis include diplopia (double vision) and ptosis (eyelid droop).

While medical therapy is often used to treat generalized myasthenia gravis, it is not clear whether medications are effective in treating ocular symptoms.

Other measures, such as eyeglasses with prisms, are frequently used. Surgery may be considered for those with severe symptoms that affect vision or are cosmetically undesirable.

Myasthenia Gravis (Ocular) — What You Should Know (1)

How DoesMyasthenia Gravis Affect Me?

Myasthenia gravis is an autoimmune disease that affects the muscles, causing muscle weakness. The disease can affect various muscle groups in the body, and muscles in the face, the neck, and the limbs can exhibit symptoms of weakness and immobility.

Myasthenia gravis is one of the better understood neurological disorders, but it can be a debilitating disease, and those with generalized myasthenia gravis can experience difficulty moving, or even breathing on their own. There is no cure, but there are several treatments available.

(Video) Lecture: Ocular Myasthenia Gravis

Symptoms of myasthenia gravis can include:

  • Muscle fatigue, to the point of immobility
  • Double vision
  • Ptosis (a drooping eyelid)
  • Difficulty holding up the head
  • Fatigue
  • Vocal changes
  • Weakness of the facial muscles, affecting speech and chewing or swallowing
  • Ophthalmoparesis and Ophthalmoplegia—respectively, weakening and paralysis or the muscles responsible for eye movement
  • Difficulty breathing

Ocular Myasthenia Gravis

In approximately 15 percent of people with myasthenia gravis, the only muscles affected are those in the eyes, in which case the condition is called ocular myasthenia gravis. Some of the first signs of ocular myasthenia gravis include a dropping eyelid and double vision.

Symptoms affecting the eyes are extremely common in myasthenia gravis, and approximately 90 percent of patients suffer in this way. In about 75 percent of patients, the first symptoms of myasthenia gravis manifest in the eyes.

About half of all ocular myasthenia gravis sufferers will eventually experience symptoms in other muscle groups beyond the eyes.

Studies have shown that myasthenia gravis patients whose symptoms affect only their eyes for about three years are not likely to develop more generalized symptoms. Their myasthenia gravis, in most cases, will not extend to the other muscle groups in the body.

Ocular symptoms may come and go, sometimes appearing when the patient is exposed to bright sunlight, under stress, recovering from surgery, or experiencing another illness. Symptoms may also disappear on their own, and the patient will experience a spontaneous remission of the myasthenia gravis.

(Video) What you should know about myasthenia gravis - Online interview

Symptoms Of Ocular Myasthenia Gravis

With ocular myasthenia gravis, the symptoms typically include ptosis and diplopia.

Ptosis:A drooping eyelid can be seen in either eye or in both eyes. The drooping may not be always visible, but will often follow a pattern that can be seen on physical examination by an ophthalmologist or other eye care professional.

If the patient looks upward for several seconds or up to a minute, they may be unable to keep one or both eyelids open enough to see. Sometimes the eyelids may also flutter.

Diplopia:Patients with ocular myasthenia gravis may experience double vision. This is due to a weakening of the eye muscles. In some cases, one of the ocular muscles will be unable to move properly, and this will cause the patient to see double.

The failure of an ocular muscle in the absence of trauma (such as an injury or an accident) is not common. When an ophthalmologist sees this sign, it may prompt them a diagnosis of myasthenia gravis.

Other ocular symptoms:Some research has described other possible symptoms of ocular myasthenia gravis, including weakness of the upper eyelid, difficulty focusing, and difficulty turning both eyes inward when looking at an object at close range.

(Video) Ocular Myasthenia Gravis

Who Is At Risk For Myasthenia Gravis?

Myasthenia gravis tends to appear mainly in young women and men over the age of 50. Young people diagnosed with myasthenia gravis have a better chance at achieving remission than older patients.

Treatments Options For Ocular Myasthenia Gravis

Because ocular myasthenia gravis is a well-described condition, there are several treatment avenues open to patients. Depending on the type and severity of the symptoms, treatment can include eyeglasses (with or without eyelid crutches) and surgery.

Myasthenia gravis is usually treated by team of physicians, and ocular symptoms in particular are generally treated by a neurologist working with an ophthalmologist.

Medications:Several different medications may be used to treat generalized myasthenia gravis, but there is no good evidence that any of these are effective at treating ocular symptoms. There is some evidence that treatment with medication may prevent ocular myasthenia gravis from progressing to generalized myasthenia gravis.

Many medications used to treat myasthenia gravis have the potential for significant side effects, and patients who are only experiencing ocular symptoms may not be good candidates for these drugs. This is especially true if symptoms can be managed with other, less risky methods.

Patching:Double vision can sometimes be treated by patching one eye. An opaque patch is fitted over the eye that is experiencing the symptoms of myasthenia gravis.

(Video) Ocular Myasthenia Gravis

Eyeglasses:In cases in which double vision is the problem, special eyeglassesfitted with a Fresnel prism may be employed. These glasses bend the light in such a way as to eliminate double vision.

Eyelid crutches:When ptosis becomes a problem and prevents a patient from being able to see, a device called an eyelid crutch (or a ptosis crutch) can be added to standard eyeglasses. The crutch is a piece of metal or plastic that attaches to the inside of the glasses and effectively holds the eyelids up. This is a low-cost, no-risk alternative to surgery in cases in which surgery to correct the ptosis is not possible.

Surgery For Ocular Myasthenia Gravis

Most often, two different forms of surgery are used to treat ocular myasthenia gravis:

Strabismus surgery:This surgery is done on the muscles of the eyes in order to improve double vision and correct any underlying deviation of the eye (such as the eye turning inward or outward). It might be done on patients whose myasthenia gravis does not appear to be progressing or in those whose eyes have a significant deviation.

During this surgery, a muscle that controls the eye is detached and then reattached so that it can better control the eye’s movements. In some cases, the surgery may need to be repeated in order to fine-tune the eye alignment.

Blepharoptosis surgery:In some cases, medication or other therapies may not be effective for treating ptosis. In cases of persistent ptosis, blepharoptosis surgery may be considered to improve both the functioning of the eyelid and its cosmetic appearance. Some patients with ptosis may find their vision obstructed by the drooping eyelid, and are unable to read or drive.

(Video) Ocular Myasthenia Gravis

During levator advancement or resection surgery, the eyelid droop is corrected by shortening the muscle that raises the eyelid. This is typically an outpatient surgery. The patient recovers at home, using ice packs on the eyes for a few days, followed by antibiotic eye and lubricating drops or ointment for one to three weeks.

Ptosis can also be corrected with surgical installation of a frontalis sling. This surgery is more often performed when the eyelid muscle is unable to raise the eyelid. A loop of thread (either sutures or a tendon from the patient or a donor) is inserted into the eyelid and attached to the brow.

By lifting the brow, the eyelid can be lifted higher to facilitate sight. Lubricating eye drops may be required to keep the eye moist because during the initial recovery period, the eyelid may not close fully.


How serious is ocular myasthenia gravis? ›

Myasthenia gravis (MG) is a potentially serious, but treatable autoimmune disease affecting the neuro-muscular junction (NMJ) of the skeletal muscle. Ocular myasthenia gravis (OMG) can mimic isolated cranial nerve palsies, gaze palsies, internuclear ophthalmoplegia, blepharospasm, and even a stroke.

What is the most common ocular finding in myasthenia gravis? ›

Double vision is a common symptom of myasthenia gravis because this condition very frequently affects the strength of the eye muscles.

How do you manage ocular myasthenia? ›

Treatments proposed for ocular myasthenia include drugs that suppress the immune system including corticosteroids and azathioprine, thymectomy (surgical removal of the thymus gland), and acetylcholinesterase inhibitors (which increases acetylcholine to compensate for the lack of acetylcholine receptors).

Does ocular myasthenia progress? ›

Fifty percent of ocular myasthenia gravis (OMG) patients will progress to generalized myasthenia, 90% within 3 years from the onset of ocular symptoms.

Can I drive with ocular myasthenia? ›

A common fear when first diagnosed with myasthenia is that you will never be able to drive again. This is not necessarily true, however anyone with myasthenia, who wishes to drive or holds a driving licence, is legally required to inform the Driver and Vehicle Licensing Agency (DVLA), even if their symptoms are mild.

Is ocular myasthenia gravis considered a disability? ›

If you struggle with myasthenia gravis (MG), chances are you can get disability benefits if you apply for them with the Social Security Administration (SSA). There is a listing with the SSA specifically for MG, which means that if your condition meets the listing you are approved for benefits automatically.

How long does ocular myasthenia gravis last? ›

Symptoms usually start to improve 2-4 weeks after treatment is started. Maximum benefit is usually seen after 6-12 months of treatment. More information can be found on its designated information sheet. Azathioprine helps to reduce or suppress your body's own immune defense system.

What is the most important investigation in suspected myasthenia gravis? ›

The main test for myasthenia gravis is a blood test to look for a type of antibody (produced by the immune system) that stops signals being sent between the nerves and muscles. A high level of these antibodies usually means you have myasthenia gravis.

Does ocular myasthenia gravis cause fatigue? ›

Most people have experienced muscle weakness after exercise, heavy exertion, or illness, but extreme fatigue and loss of motor control can be signs of a neurological disorder called myasthenia gravis (MG).

How fast does myasthenia gravis progress? ›

THE INITIAL SYMPTOMS or signs of myasthenia gravis are ptosis, extraocular muscle weakness, or ocular misalignment in up to 65% of patients. Clinically apparent generalized disease is reported to develop in approximately 53% of patients with ocular myasthenia gravis and in 44% within 2 years.

What causes myasthenia gravis to get worse? ›

It may be triggered by infection, stress, surgery, or an adverse reaction to medication. Approximately 15 to 20 percent of people with myasthenia gravis experience at least one myasthenic crisis. However, up to one-half of people may have no obvious cause for their myasthenic crisis.

Is ocular myasthenia the same as myasthenia gravis? ›

Ocular myasthenia gravis is a form of myasthenia gravis (MG) in which the muscles that move the eyes and control the eyelids are easily fatigued and weakened. What are the common symptoms of ocular myasthenia gravis? People with ocular MG have trouble with sight due to double vision and/or drooping eyelids.

How long does it take prednisone to work for ocular myasthenia gravis? ›

Conclusions: Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, can control the diplopia in patients with ocular myasthenia gravis.

Does myasthenia affect your brain? ›

MG interferes with the brain's ability to communicate effectively with muscles, but the interference happens at the junction between nerve endings and muscle cells, not in the brain itself. MG patients do often suffer from brain-related problems such as depression and sleep disorders.

Does myasthenia gravis get worse with age? ›

Does It Get Worse With Age? Myasthenia Gravis is usually found in women over the age of 40 and men over 60. Myasthenia Gravis has been shown to worsen as time progresses gradually, and while there is no cure, it has been shown that treatments may improve the condition.

Does myasthenia gravis affect memory? ›

Traditionally, it is defined as a disease with purely motor manifestations, but a recent study found that the patients with MG have non-motor symptoms, such as headache, sleep disorder, and cognitive and psychosocial issues (2). Nearly 60% of the individuals with MG complain of memory difficulties (3).

Does heat affect ocular myasthenia gravis? ›

The deleterious effect of heat on the clinical symptoms and the electro-physiological abnormalities of myasthenia gravis is well established. In most patients, an elevation in total body or regional temperature from exposure to heat in the environment produces an increase in weakness that is usually benign in nature.

Is walking good for myasthenia gravis? ›

Physical training and exercise are safe in myasthenia gravis. This can improve both muscle strength and daily function. Type and intensity of systematic training should be adapted in the individual patient.

Can I drink alcohol with myasthenia gravis? ›

The myaware Medical Committee say that moderate alcohol intake will not worsen your myasthenia. You may experience some side effects like flushing might occur and people should judge for themselves if they have any unpleasant reactions. However, serious problems are very unlikely.

How does myasthenia gravis affect sleep? ›

Myasthenia gravis (MG) causes fatigue or extreme tiredness. At the same time, many people with this autoimmune disease have trouble sleeping. Common sleep disorders for people with MG include excessive daytime sleepiness (EDS), insomnia, restless leg syndrome (RLS), and sleep apnea.

Is ocular myasthenia an autoimmune disease? ›

Ocular myasthenia gravis (OMG) is an autoimmune disease of the neuromuscular junction and commonly associated with other immune diseases.

What are 3 factors that can make myasthenia gravis worse? ›

Factors that can worsen myasthenia gravis
  • Fatigue.
  • Illness or infection.
  • Surgery.
  • Stress.
  • Some medications — such as beta blockers, quinidine gluconate, quinidine sulfate, quinine (Qualaquin), phenytoin, certain anesthetics and some antibiotics.
  • Pregnancy.
  • Menstrual periods.
22 Jun 2021

How do you improve eye muscle strength? ›

Eye Circles: While sitting or standing, move your eyes in a clockwise direction 20 times, making the circle as wide as you can. Relax for 10 seconds, then repeat in the opposite direction. Doing this three times daily will help to stretch your eye muscles.

Why are the eyes often affected first in myasthenia gravis? ›

It's very common for myasthenia gravis to affect the muscles that control eye movement. In fact, for a large percentage of people, eye-related changes are one of the first symptoms of myasthenia gravis. Because of the lack of signals to the nerves, changes to the eyes may include: Drooping eyelids.

What is the most common complication of myasthenia gravis? ›

The most serious complications of myasthenia gravis is a myasthenia crisis. This is a condition of extreme muscle weakness, particularly of the diaphragm and chest muscles that support breathing. Breathing may become shallow or ineffective.

What body part is most commonly affected by myasthenia gravis? ›

Myasthenia gravis is a rare long-term condition that causes muscle weakness. It most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking.

What is the main target of myasthenia gravis? ›

Although the chief target of the autoimmune attack in most cases is the skeletal muscle nicotinic acetylcholine receptor (nAChR), other antigenic targets that are components of the neuromuscular junction (NMJ) have also been implicated.

Does ocular myasthenia gravis cause headaches? ›

Twenty-five (13.6%) complained that headache appeared or was exacerbated after the MG onset. The investigation into differences in the clinical characteristics of the MG patients showed that women tended to suffer from MG-associated headache more often than men.

What percentage of patients with myasthenia gravis initially present with ocular signs? ›

Eventually, 90% of patients with MG develop ocular symptoms. About 50% of patients present solely with ocular symptoms, and about 50%-60% of these patients will progress to develop generalized disease. Ptosis may be unilateral or bilateral or may alternate sides.

Can ocular myasthenia gravis cause dizziness? ›

The disease is different in every patient. Even a milder form of the disease, so called eye m yasthenia, is very unpleasant, double vision makes orientation worse, causes dizziness, the eyelid drop results in a functional blindness.

Can you live a normal life with MG? ›

Many people with MG can live fairly normal lives. The first one to three years – when various symptoms appear – often are the most difficult. It can take time to work through various treatments to find what works best for you. MG is called the “snowflake disease” because its symptoms differ for every patient.

How is a person's daily life affected by myasthenia gravis? ›

Myasthenia gravis can be especially damaging to a person's finances if it becomes hard to work. The main symptoms of MG such as fatigue, muscle weakness, and time lost to doctor's visits can make work-life balance difficult for many people and impossible for some.

Are there different stages of myasthenia gravis? ›

Myasthenia gravis (MG), a neuromuscular disease characterized by weakness and fatigue, is typically divided into five types: generalized, congenital, ocular, juvenile, and transient neonatal myasthenia gravis, depending on time of disease onset, the cause of the neuromuscular dysfunction, and the muscle groups affected ...

Does Vitamin D Help myasthenia gravis? ›

Supplementation with vitamin D has been shown to promote a healthy immune response and reduce fatigue in people with myasthenia gravis.

Does cold weather affect myasthenia gravis? ›

Extreme heat is the biggest concern for persons living with Myasthenia Gravis but extreme cold can be just as much of an issue. Remember - - how each person reacts to temperatures varies drastically. Your body's natural reaction to shiver when cold is the main concern. The action of shivering fatigues your muscles.

Does stress affect myasthenia gravis? ›

Most myasthenia gravis patients learn very quickly that emotional stress and excitement affects their MG. Stress causes many physical changes in one's body and uses up energy.

What drug worsens myasthenia gravis? ›

Drugs to avoid

Commonly-used medications like ciprofloxacin or certain other antibiotics, beta-blockers like propranolol, calcium channel blockers, Botox, muscle relaxants, lithium, magnesium, verapamil and more, can worsen the symptoms of myasthenia gravis.

What is the best exercise for myasthenia gravis? ›

Low impact exercises such as walking, swimming, and light jogging may actually reduce fatigue in patients with MG. In general, the reason why exercise exasperates symptoms in individuals with MG is due to pre-existing inactivity.

What happens if you take mestinon and you don't need it? ›

Taking too much or too little of pyridostigmine (Mestinon) often results in similar symptoms of worsening muscle weakness. Talk to your provider about how to recognize an overdose versus myasthenia gravis crisis.

What organs are affected by myasthenia gravis? ›

In some affected individuals, the disease process may be limited to certain eye muscles, which is often described as “ocular myasthenia.” In those with more generalized disease or “generalized myasthenia gravis,” affected muscles may include those of the eyes, face, jaw, and throat region; arm and leg (limb) muscles; ...

Does myasthenia cause anxiety? ›

Myasthenia gravis is a neuroimmunological disorder leading to skeletal muscle weakness. Common symptoms of the disease, such as anxiety, depression, and insomnia, can cause significant distress in patients.

Does myasthenia gravis affect mental health? ›

Mood changes, fatigue, shortness of breath, social withdrawal, anxiety, and depression occur in both MG and primary psychiatric conditions, which may lead to misdiagnosis and improper or delayed treatments [2,3].

Can you drive with myasthenia gravis? ›

Do not drive when you have double vision or weak neck muscles. Do not drive if your arms or legs are too weak to handle the car safely. If double vision or droopy eyelids start while you are driving, pull over and call for help. Use tape to keep droopy eyelids open while driving.

What is the hallmark of myasthenia gravis? ›

The clinical hallmark of myasthenia gravis is fatigable muscle weakness. The history should elicit the pattern and severity of the weakness and any fluctuation of symptoms. Symptoms are typically worse at the end of the day.

Why is myasthenia gravis worse at night? ›

In patients with myasthenia gravis, the body's immune system mistakenly interferes with the muscles' receptors for acetylcholine. When these receptors cannot work properly, the affected muscles tire easily. The amount of weakness typically fluctuates and may be worse at the end of the day.

What is the life expectancy for myasthenia gravis patients? ›

There is no cure for MG, but most people with the condition have a normal life span. Only 3 to 4 out of every 100 people with MG die because of MG. Years ago, early death occurred in over a third of people with MG.

What is end stage myasthenia gravis? ›

The most serious complications of myasthenia gravis is a myasthenia crisis. This is a condition of extreme muscle weakness, particularly of the diaphragm and chest muscles that support breathing. Breathing may become shallow or ineffective.

Is myasthenia gravis a terminal illness? ›

Currently, there's no cure for myasthenia gravis. However, available treatments usually can control symptoms, allowing those diagnosed with the condition to lead relatively normal lives. In addition, most people with myasthenia gravis have a normal life expectancy.

What are 3 symptoms of myasthenia gravis? ›

Symptoms of myasthenia gravis

difficulty making facial expressions. problems chewing and difficulty swallowing. slurred speech. weak arms, legs or neck.

What is the average age of onset for myasthenia gravis? ›

The disease occurs, for the most part, in the third decade, and is rare before the age of 15, or after 70. In approximately 60 per cent of the patients the disease develops between the ages of 20 and 40.

What is the most common cause of death from myasthenia gravis? ›

As MG progresses, it can affect the muscles involved in breathing. When these muscles are affected, it can become harder to breathe. This can become so severe that a person cannot breathe on their own. This is considered a crisis and can lead to death.

Does myasthenia gravis affect sleep? ›

MG patients often have sleep problems, either with the quantity or quality of sleep. You might experience insomnia, or symptoms of sleep apnea such as loud snoring, daytime sleepiness, and repeated stops in breathing as you sleep.

What are the worst symptoms of myasthenia gravis? ›

People with myasthenia gravis may experience the following symptoms:
  • weakness of the eye muscles (called ocular myasthenia)
  • drooping of one or both eyelids (ptosis)
  • blurred or double vision (diplopia)
  • a change in facial expression.
  • difficulty swallowing.
  • shortness of breath.
  • impaired speech (dysarthria)

Can ocular myasthenia gravis be cured? ›

There's no cure for myasthenia gravis, but treatment can help relieve signs and symptoms, such as weakness of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and breathing.


1. Myasthenia Gravis | Pathophysiology, Signs & Symptoms, Diagnosis, Treatment
(JJ Medicine)
2. The Reality Of Myasthenia Gravis: What You Should Know
(Lucid Med)
3. Ocular Myasthenia Gravis || Dr. Niha Aggarwal
(Ophthalmology NEXT By Dr Niha Aggarwal)
4. MGFA Webinar Series: Ocular MG
(Myasthenia Gravis Foundation of America Inc.)
5. Steroids in myasthenia gravis
(Neuro-Ophthalmology with Dr. Andrew G. Lee)
6. Myasthenia Gravis, What you should know !?
(الجمعية الصيدلانية العُمانية)
Top Articles
Latest Posts
Article information

Author: Gregorio Kreiger

Last Updated: 16/09/2023

Views: 5884

Rating: 4.7 / 5 (57 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Gregorio Kreiger

Birthday: 1994-12-18

Address: 89212 Tracey Ramp, Sunside, MT 08453-0951

Phone: +9014805370218

Job: Customer Designer

Hobby: Mountain biking, Orienteering, Hiking, Sewing, Backpacking, Mushroom hunting, Backpacking

Introduction: My name is Gregorio Kreiger, I am a tender, brainy, enthusiastic, combative, agreeable, gentle, gentle person who loves writing and wants to share my knowledge and understanding with you.