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August 1981

Enhanced Ptosis in Myasthenia Gravis

Author Affiliations

From the Department of Neurology (Drs Gorelick and Pagano), Loyola University Medical Center, Maywood, Ill; and the Department of Ophthalmology (Dr Rosenberg), Rush-Presbyterian-St Luke's Medical Center, Chicago.

Arch Neurol. 1981;38(8):531. doi:10.1001/archneur.1981.00510080093017

The ocular manifestations of myasthenia gravis result from a dysfunction at the myoneural junction. Histories of diurnal variation, exacerbation during fatigue, periodic remission, and responsiveness to edrophonium chloride (Tensilon) are characteristic.1 Common signs are asymmetrical ptosis and ophthalmoplegia. Less common findings are lid retraction and lid oscillations.2 Abnormal saccadic movements,3-6 gaze palsies, vertical nystagmus,7 lid twitch, and pseudointernuclear ophthalmoplegia8 have also been reported. The question of pupillary dysfunction has not been fully resolved." This article describes "enhanced" ptosis as an unusual manifestation of ocular myasthenia gravis and discusses possible mechanisms.

TECHNIQUE  "Enhanced" ptosis is demonstrated during ocular upgaze in patients with bilateral ptosis by elevating and maintaining the more ptotic eyelid in a fixed position (Figure). The opposite eyelid slowly falls and may close completely. In this latter state, eyelid tone is greatly reduced. A variation of this response has also been observed; in

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