|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 3 | Page : 291
Comments on: Off-center presentation of ocular myasthenia
Anooja R Babu
Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala, India
|Date of Submission||28-Nov-2022|
|Date of Decision||28-Nov-2022|
|Date of Acceptance||28-Nov-2022|
|Date of Web Publication||22-Dec-2022|
Dr. Anooja R Babu
Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Babu AR. Comments on: Off-center presentation of ocular myasthenia. Kerala J Ophthalmol 2022;34:291
The case report “Off-center Presentation of Ocular Myasthenia” by Dr. Mary A. Stephen has highlighted the case report of a 70-year-old diabetic male who presented with diplopia. The article brilliantly described a presentation of ocular myasthenia and highlighted the need for a high degree of suspicion for timely diagnosis of ocular Myasthenia Gravis. In this case, the initial diagnosis of diabetic mononeuropathy changed to ocular myasthenia when the initial presentation of unilateral ptosis gradually evolved to bilateral ptosis. Early detection of myasthenia is important as the management of diabetic mononeuropathy is entirely different from that of myasthenia, which the author achieved by meticulous examination of the patient and by timely clinical suspicion.
From an academic point of view, the few points that I would like to contribute include:
- Thoracic imaging like MRI or CT scan could have been done to detect thymoma, as it is present in 15% of cases.,
- Testing for striational antibodies can help determine the severity as it is a marker of severe Myasthenia Gravis (MG). Nearly all patients with MG and thymoma and half of the late-onset MG subgroup demonstrate the presence of striational antibody.
- In seropositive cases, the titers of AchR (Acetylcholine Receptor) antibody are found to be significantly higher in patients who progressed to generalized disease than those whom it remained as ocular.
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Conflicts of interest
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| References|| |
Stephen MA, Jayasri P, Harigaravelu P J. Off-center presentation of ocular myasthenia. Kerala J Ophthalmol 2022;34:164-6. [Full text]
O'Hare M, Doughty C. Update on ocular myasthenia gravis. Semin Neurol 2019;39:749-60.
Fortin E, Cestari DM, Weinberg DH. Ocular myasthenia gravis: An update on diagnosis and treatment. Curr Opin Ophthalmol 2018;29:477-84.
Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA. Ocular myasthenia gravis: A review. Indian J Ophthalmol 2014;62:985-91.
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Kusner LL, Puwanant A, Kaminski HJ. Ocular myasthenia: Diagnosis, treatment, and pathogenesis. Neurologist 2006;12:231-9.