Ocular myasthenia

Ocular symptoms and signs are the most common clinical manifestation of myasthenia gravis (MG). Paradoxically, however, the ocular aspects of myasthenia are the least well studied and understood. We even lack good clinical outcome measures that might be used to quantify disease severity and impact on patient-reported outcome measures. In this chapter we discuss possible explanations for the predilection for ocular involvement in MG, the protean clinical manifestations of ocular disease, the challenges associated with reaching a confident diagnosis, and the risk of progression to generalized disease. With the exception of a small recent study of steroids in ocular myasthenia, clinical trials typically exclude ocular myasthenia patients. The result is uncertainty about important clinical questions such as the value of steroids and other immunosuppressive agents in mitigating the risk of progression to generalized disease and the uncertain role of thymectomy in the overall treatment of ocular myasthenia.