Ocular myasthenia gravis is an autoimmune condition affecting the muscles surrounding and involving the eyes. Symptoms can include double vision, droopy eyelids, and more.

Ocular myasthenia gravis occurs when the immune system attacks the neuromuscular junction.

The neuromuscular junction is a tiny space where neurotransmitter chemicals flow between a nerve and a muscle. These neurotransmitters allow a person to make voluntary movements since the nerves pass a signal to the muscles through neurotransmitters.

Keep reading for more information about ocular myasthenia gravis, including symptoms, causes, diagnosis, treatments, and more.

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Symptoms of ocular myasthenia gravis mostly affect the eyes and can include:

  • double vision
  • difficulty focusing the eyes
  • droopy eyelids
  • eye muscle fatigue
  • ophthalmoplegia (eye muscle paralysis)
  • Cogan lid twitch, a type of eyelid twitching

The condition can affect one or both eyes.

Between 20% and 60% of people with the condition may develop generalized myasthenia gravis symptoms, which means the condition can affect other body parts.

Ocular myasthenia gravis can mimic symptoms of other disorders, such as thyroid eye disease and cranial nerve palsy. If someone notices symptoms affecting their vision or eyes, it is crucial that they contact a doctor.

Ocular myasthenia gravis happens when the immune system creates autoantibodies that attack the neuromuscular junction’s specific receptors, including the:

  • nicotinic acetylcholine receptors
  • muscle-specific kinase
  • lipoprotein-related protein 4

Infection or immunization may lead to the start of symptoms.

Factors that may cause or worsen symptoms once ocular myasthenia gravis develops include:

  • certain medications or drugs
  • illness
  • fatigue
  • an anesthetic
  • surgery recovery

COVID-19 may cause ocular myasthenia gravis in some people. Less often, the COVID-19 immunization can also lead to the disorder.

Congenital myasthenia gravis is a rare form of the disorder that results from specific mutations. A person with this form is born with it, which may affect the eyes.

A doctor can often diagnose ocular myasthenia gravis based on the presence of classic signs and symptoms, though blood tests can confirm the diagnosis.

They usually perform a physical examination and review personal and family medical history. They may ask about recent medication use or infections.

A doctor typically performs clinical testing, which can include:

  • Ice test: The doctor fills a surgical glove with ice and places it on the drooping eyelid for about 2 minutes. After removing the glove, they might observe a noticeable improvement in the drooping.
  • Sleep or rest test: The person rests their eyes for 30 minutes. They may see improvements in drooping eyelids or double vision, with a return to symptoms in 5 to 30 minutes.
  • Cogan lid twitch sign: For this test, the person focuses their gaze downward for a period. The upper eyelid moves to an exaggerated position, twitches a bit, and returns to the usual position.
  • Forced eyelid closure test: In this test, a person squeezes their eyes shut for about 10 seconds. They then open their eyes and focus on an object. The test is positive if the upper eyelid opens too wide and then slowly drifts back into position.

The doctor may then order a blood test to check for the presence of one or more autoantibodies associated with myasthenia gravis. The results can confirm the diagnosis.

Treatments for ocular myasthenia gravis are similar to those for systemic myasthenia gravis, with extra attention to eye symptoms.

However, treatments a doctor may recommend include:

  • pyridostigmine, a cholinesterase inhibitor
  • oral steroids
  • intravenous immunoglobulins
  • second-line immunosuppressive agents, such as:
    • azathioprine
    • mycophenolate mofetil
    • cyclophosphamide
    • cyclosporine
    • tacrolimus
  • biologic monoclonal antibody therapy, including eculizumab and rituximab
  • plasma exchange

Treatments generally work, but some people may develop steroid-resistant muscle weakness.

In some cases, a doctor may also recommend surgery. Possible procedures include thymectomy to reduce the autoimmune process and ptosis repair or strabismus surgery to relieve the disorder’s effects.

A person’s doctor can advise on what treatments they recommend and answer questions.

Ocular myasthenia gravis mainly or solely affects the eyes.

Generalized myasthenia gravis causes muscle weakness throughout the body.

A person may initially experience eye symptoms and later develop symptoms affecting other body parts.

Is ocular myasthenia gravis curable?

There is currently no cure for ocular myasthenia gravis, but treatments can help improve symptoms and prevent the disorder’s progression.

Can a person with ocular myasthenia gravis go into remission?

Treatments can help improve a person’s symptoms. In some cases, a person may enter remission.

Is ocular myasthenia gravis progressive?

About 20% to 60% of all cases of ocular myasthenia gravis may progress to the general form of the disorder. The general form means muscle weakness is present throughout the body, not just affecting the eyes.

Can ocular myasthenia gravis cause blindness?

Ocular myasthenia gravis does not cause blindness. However, it can cause double vision, droopy eyelids, and other eye symptoms.

Ocular myasthenia gravis is an autoimmune disorder that causes muscle weakness around the eyes. Symptoms include double vision, fatigue, and droopy eyelids.

Some medications may help a person manage symptoms of ocular myasthenia gravis. In some cases, a doctor may also recommend surgery.

People with ocular forms of the disorder can sometimes develop a generalized form, which may cause additional symptoms in different body parts.