Department of Optometry, VA Boston Healthcare System, Boston, Massachusetts.
Optom Vis Sci. 2020 May;97(5):377-382. doi: 10.1097/OPX.0000000000001512.
This case emphasizes the high degree of suspicion necessary for a timely diagnosis of myasthenia gravis.
This report discusses a case of ocular myasthenia gravis presenting as a pseudo-third nerve palsy with ptosis. The pathogenesis, treatment, and management of ocular myasthenia gravis are discussed.
A 68-year-old white man presented to our clinic after noticing a new right eyelid droop for several days and experiencing horizontal double vision for the past 3 weeks. A pupil-sparing partial third nerve palsy was diagnosed, and MRI and laboratory work were ordered to assist with diagnosis. Laboratory results demonstrated highly positive acetylcholinesterase antibodies, confirming a diagnosis of ocular myasthenia gravis.
Myasthenia gravis commonly presents with ocular signs and symptoms. Because ocular myasthenia gravis can mimic other causes of diplopia, heightened awareness and suspicion are necessary to make a timely diagnosis.
本病例强调了及时诊断重症肌无力所需的高度怀疑。
本报告讨论了一例以假性第三颅神经麻痹伴上睑下垂为表现的眼肌型重症肌无力。讨论了眼肌型重症肌无力的发病机制、治疗和管理。
一位 68 岁白人男性，因注意到数天来右眼上睑下垂，并在过去 3 周内出现水平复视，到我院就诊。诊断为瞳孔保留性部分第三颅神经麻痹，并开具了 MRI 和实验室检查以协助诊断。实验室结果显示乙酰胆碱酯酶抗体高度阳性，确诊为眼肌型重症肌无力。
重症肌无力常表现为眼部体征和症状。由于眼肌型重症肌无力可模拟其他复视原因，因此需要提高警惕和怀疑，以做出及时诊断。
