A patient with diagnoses of hyperthyroidism at 14 years old and myasthenia gravis at 20 years old, presented at age 21 with bilateral exophthalmos, decreased function of extraocular muscles, and bilateral optic neuropathy. Oral administration of prednisone was begun immediately. Vision improved after four days of therapy, worsened when prednisone was tapered, and again improved when the high dose was reinstituted. Administration of edrophonium chloride (Tensiton) improved extraocular muscle function and ptosis.
Cohen JS. Optic Neuropathy of Graves Disease, Hyperthyroidism, and Ocular Myasthenia Gravis. Arch Ophthalmol. 1973;90(2):131-132. doi:10.1001/archopht.1973.01000050133013