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Ocular myasthenia gravis

an update on diagnosis and treatment

Fortin, Elizabetha; Cestari, Dean M.a; Weinberg, David H.b

Current Opinion in Ophthalmology: November 2018 - Volume 29 - Issue 6 - p 477–484
doi: 10.1097/ICU.0000000000000526
NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari

Purpose of review Myasthenia gravis is an autoimmune disease that commonly affects the palpebral and extraocular muscles. Ocular myasthenia gravis (OMG) is a variant of the disease that is confined to the ocular muscles but frequently becomes generalized over time. The diagnosis of OMG is often challenging but both clinical and laboratory findings are helpful in confirming the clinical suspicion. This review provides an update on the diagnostic approach and therapeutic options for OMG.

Recent findings Antimuscle-specific tyrosine kinase and LDL-related receptor-related protein 4 are newly available serologic testing for myasthenia gravis that can help in increasing the diagnostic sensitivity of OMG. They should be included to the diagnostic algorithm of OMG in appropriate clinical situations.

Summary OMG remains a primarily clinical diagnosis, but recent advances in laboratory testing can improve the diagnostic accuracy and should be used in appropriate clinical settings. The mainstay of treatment for OMG has not significantly changed over the past years, but the increasing availability of steroid-sparing agents improved the disease control while minimizing steroid-induced complications.

aDepartment of Ophthalmology, Neuro-Ophthalmology Service, Massachusetts Eye and Ear

bDepartment of Neurology, St Elizabeth's Medical Center, Boston, Massachusetts, USA

Correspondence to Elizabeth Fortin, MD, Department of Ophthalmology, Neuro-Ophthalmology Service, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA. Tel: +1 617 319 7957; e-mail:

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