Arnon Roee, Yahalomi Tal, Rozen-Knisbacher Irit, Pikkel Joseph, Mostovoy Dina
Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel.
Ben Gurion University School of Medicine, Beer-Sheva, Israel.
Case Rep Ophthalmol. 2020 Jul 13;11(2):322-329. doi: 10.1159/000508815. eCollection 2020 May-Aug.
Ocular myasthenia gravis (OMG) is an autoimmune disease of the neuromuscular junction and commonly associated with other immune diseases. We describe a 16-year-old female who presented to our clinic with 1-month complaints of diplopia and strabismus, visual acuity deterioration, and ocular irritation. Her examination showed crossed diplopia and alternating exotropia of 25 prism diopters, severe blepharitis, conjunctival hyperemia, corneal pannus, epithelial irregularities, and subepithelial opacities. Workup included pediatric neurologic examination, laboratory tests, imaging, and electrophysiological tests. Diagnoses of OMG and blepharitis with ocular surface disease were made. Topical treatment included eyelid hygiene, tea tree oil scrubbing, topical steroids, and tacrolimus ointment. Systemic treatment included corticosteroids, pyridostigmine, azathioprine, intravenous immunoglobulins, amitriptyline, and doxycycline. Both diseases were refractory to intensive immunosuppressive treatment and had simultaneous relapses and an intertwined course. Our hypothesis is that a shared immune mechanism may be the cause of both OMG and ocular surface disease in our patient.
眼肌型重症肌无力（OMG）是一种神经肌肉接头处的自身免疫性疾病，通常与其他免疫性疾病相关。我们描述了一名16岁女性，她因1个月来的复视、斜视、视力下降和眼部刺激症状前来我们诊所就诊。她的检查显示交叉复视和25棱镜度的交替外斜视、严重睑缘炎、结膜充血、角膜血管翳、上皮不规则和上皮下混浊。检查包括儿科神经系统检查、实验室检查、影像学检查和电生理检查。诊断为OMG合并睑缘炎伴眼表疾病。局部治疗包括眼睑清洁、茶树油擦洗、局部类固醇和他克莫司软膏。全身治疗包括皮质类固醇、吡啶斯的明、硫唑嘌呤、静脉注射免疫球蛋白、阿米替林和多西环素。这两种疾病对强化免疫抑制治疗均耐药，同时复发且病程相互交织。我们的假设是，共同的免疫机制可能是我们患者OMG和眼表疾病的病因。
