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Authors
Jennifer Colavito, Jeffrey Cooper, Kenneth J Ciuffreda

Non-ptotic ocular myasthenia gravis: a common presentation of an uncommon disease

publication date
2005 Jul
Category
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Abstract/Introduction

Background: Myasthenia gravis (MG) is an acquired autoimmune disease of the neuromuscular junction which causes rapid muscle fatigue and weakness. Two thirds of all cases of myasthenia gravis (MG) initially manifest ptosis. In the absence of the characteristic variable ptosis, MG can present a challenge to the clinician. This article will review the current diagnostic and management strategies for MG.

Case reports: Five cases will be presented that did not initially present with ptosis. Each of these cases was previously misdiagnosed as a result of presentation of atypical myasthenia gravis signs and symptoms. The first two cases had signs and symptoms of a typical accommodative/vergence anomaly. The others manifested diplopia not normally associated with MG: one had a noncomitant vertical deviation; another had a stable 6(th) nerve palsy; and the third had a basic esotropia.


Conclusion/Results

Although the hallmark findings of MG are ptosis and eye muscle palsy with variability, MG may present without ptosis, affect nonstriated muscles, and/or manifest either as a nonstrabismic vergence anomaly or as comitant nonvariable strabismic deviation.


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Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.

Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.


Amanda T.

Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.

Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.


Alexa H.

Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.

He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.

It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.

Dr. McBryar , Kristen and John  are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!


Charlotte M.

Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.

Thank you!


Olivia C.

Seems much less frustrated with life

Reads non-stop and fast

Spelling abilities have been hugely improved

Seems much more confident

Thank You!!!


Kelly O.

When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!


Alice M.
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