To the Editor.
—The recent reviews of the office Tensilon test for ocular myasthenia gravis by Drs Seybold1 and Daroff2 were instructive and informative. Dr Daroff's point that a positive and "perverse" reaction can exist in a patient with ocular myasthenia gravis after administration of Tensilon is central to our understanding and interpretation of this test. Previously, we called attention to a "perverse" reaction of sorts, "enhanced" ptosis, that may be useful in the diagnosis of ocular myasthenia gravis.3,4"Enhanced" ptosis may be demonstrated in myasthenics with bilateral ptosis during ocular upgaze by elevating and maintaining the more ptotic eyelid in a fixed position with the thumb or index finger. The fellow (opposite) eyelid then slowly falls and closes completely or incompletely, or descends in an oscillatory manner to a point of complete or incomplete closure. During the maneuver, the patient must be instructed to refrain from
Gorelick PB. Office Tensilon Test. Arch Neurol. 1987;44(7):689–690. doi:10.1001/archneur.1987.00520190005002
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