Myasthenia gravis, a disease characterized by paralysis of skeletal muscles, is of considerable ophthalmologic interest because the initial symptoms usually are found in the extraocular muscles and, in the late stages of the disease, practically all patients show involvement of the extraocular muscles. The ophthalmologist is one of the first to encounter the evidences of this disease and must therefore be familiar with the means of differential diagnosis and therapy.
Diagnosis is usually established in a suspected case by finding dramatic improvement following the subcutaneous injection of neostigmine or the intravenous injection of edrophonium (Tensilon). Aggravation of symptoms may occur with the administration of quinine or curare. Quinine and curare are usually utilized only if the results of tests with neostigmine or edrophonium are inconclusive.
Therapy of this condition, once the diagnosis has been established, is largely dependent upon the use of neostigmine (Prostigmin). The dosage which is required usually
LEOPOLD IH, HEDGES TR, MONTANA J, KRISHNA N, BECKETT S. Local Administration of Anticholinesterase Agents in Ocular Myasthenia Gravis. AMA Arch Ophthalmol. 1960;63(3):544-547. doi:10.1001/archopht.1960.00950020546012