eMedicine Specialties > Ophthalmology > Ophthalmology for the General Practitioner

Myasthenia Gravis: Follow-up

Author: Shady Awwad, MD, Staff Physician, Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas
Coauthor(s): Riad Ma'luf, MD, Head, Division of Oculoplastics, Department of Ophthalmology, Clinical Assistant Professor, American University of Beirut Medical Center; Nicolas Hamush, MD, Consulting Staff, Department of Ophthalmology, Eye & Ear Hospital International, Naccache, Lebanon
Contributor Information and Disclosures

Updated: Jul 13, 2007

Follow-up

Further Inpatient Care

  • Intubation and intensive care unit transfer usually are reserved for patients in myasthenic crisis with respiratory failure. Plasmapheresis or IV Ig also will be needed.

Further Outpatient Care

  • Follow-up care is conducted mainly by the neurologist, who would orchestrate the treatment. The ophthalmologist is consulted accordingly.

Inpatient & Outpatient Medications

Complications

  • Systemically, myasthenic crisis is the most dreadful complication. Aspiration pneumonia also may occur due to the poor oropharyngeal muscle function. Cholinergic crisis may follow excessive treatment with cholinesterase inhibitors.
  • Ophthalmologically, a common complication is cataract formation due to chronic steroid intake.

Prognosis

  • Approximately 15-17% of patients will remain having strictly ocular symptoms over a mean follow-up period of 17 years, as determined in one study. Those patients are referred to as having ocular MG. The rest develop a generalized weakness and are referred to as having generalized MG.
  • Some evidence shows that steroids or azathioprine might prevent the conversion to generalized MG in 75% of patients with ocular MG.
  • Bever and coworkers reported that 82% of patients who later developed generalized weakness did so in the first 2 years after diagnosis.16 Hence, patients who keep having strictly ocular symptoms for 3 or more years are unlikely to revert to the generalized aspect of the disease.
  • The juvenile form of the disease usually has a much more favorable prognosis than the adult one, with a better chance of spontaneous remission.

Patient Education

  • Patients should be instructed to immediately report any noticeable decrease in their respiratory function.
  • It should be made clear to patients that some common medications, such as aminoglycosides, penicillin, and ciprofloxacin, can exacerbate the symptoms. They should always consult their neurologist prior to starting any of the medications listed above.

Miscellaneous

Medicolegal Pitfalls

  • It is essential to rule out mass lesions compressing the cranial nerves in strictly ocular MG. A CT scan or MRI of the brain and orbit is indicated.
 


More on Myasthenia Gravis

Overview: Myasthenia Gravis
Differential Diagnoses & Workup: Myasthenia Gravis
Treatment & Medication: Myasthenia Gravis
Follow-up: Myasthenia Gravis
Multimedia: Myasthenia Gravis
References
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References

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  2. Cogan DG. Myasthenia gravis: A review of the disease and a description of lid twitch as a characteristic sign. Arch Ophthalmol. Aug 1965;74:217-21. [Medline].

  3. Van Stavern GP, Bhatt A, Haviland J, Black EH. A prospective study assessing the utility of Cogan's lid twitch sign in patients with isolated unilateral or bilateral ptosis. J Neurol Sci. May 15 2007;256(1-2):84-5. [Medline].

  4. Cooper J, Pollak GJ, Ciuffreda KJ, Kruger P, Feldman J. Accommodative and vergence findings in ocular myasthenia: a case analysis. J Neuroophthalmol. Mar 2000;20(1):5-11. [Medline].

  5. Padua L, Stalberg E, LoMonaco M, Evoli A, Batocchi A, Tonali P. SFEMG in ocular myasthenia gravis diagnosis. Clin Neurophysiol. Jul 2000;111(7):1203-7. [Medline].

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Further Reading

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Keywords

MG, ocular myasthenia gravis, generalized myasthenia gravis, ocular MG, generalized MG, neuromuscular disorder

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Contributor Information and Disclosures

Author

Shady Awwad, MD, Staff Physician, Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas
Shady Awwad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Riad Ma'luf, MD, Head, Division of Oculoplastics, Department of Ophthalmology, Clinical Assistant Professor, American University of Beirut Medical Center
Disclosure: Nothing to disclose.

Nicolas Hamush, MD, Consulting Staff, Department of Ophthalmology, Eye & Ear Hospital International, Naccache, Lebanon
Nicolas Hamush, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician, Primary Medical, Huntington Walk-In and Greenwich Convenient Medical Center
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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