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  • Title: Pseudopartial Third Nerve Palsy as the Presenting Sign of Ocular Myasthenia Gravis.
    Author: Bertolet AN, Druckenbrod RC.
    Journal: Optom Vis Sci; 2020 May; 97(5):377-382. PubMed ID: 32413010.
    Abstract:
    SIGNIFICANCE: This case emphasizes the high degree of suspicion necessary for a timely diagnosis of myasthenia gravis. PURPOSE: This report discusses a case of ocular myasthenia gravis presenting as a pseudo-third nerve palsy with ptosis. The pathogenesis, treatment, and management of ocular myasthenia gravis are discussed. CASE REPORT: A 68-year-old white man presented to our clinic after noticing a new right eyelid droop for several days and experiencing horizontal double vision for the past 3 weeks. A pupil-sparing partial third nerve palsy was diagnosed, and MRI and laboratory work were ordered to assist with diagnosis. Laboratory results demonstrated highly positive acetylcholinesterase antibodies, confirming a diagnosis of ocular myasthenia gravis. CONCLUSIONS: Myasthenia gravis commonly presents with ocular signs and symptoms. Because ocular myasthenia gravis can mimic other causes of diplopia, heightened awareness and suspicion are necessary to make a timely diagnosis.
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