Introduction: Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction (NMJ) at the postsynaptic level. Ocular MG (OMG) is a subtype of MG where the weakness is clinically isolated to the EOMs, levator palpebrae and orbicularis oculi. There is not enough data on the clinico epidemiologic profile of OMG in the Indian population.

Methods: During a period of one year(September 2007 to August 2008),out of 40 consecutive patients of MG 16 patients with a diagnosis of ocular MG presenting to the Neuromuscular clinic, Department of Neurology, at tertiary care referral were recruited for the study. All patients were followed up regularly for a minimum period of 3 years.

Objectives: To describe the clinicoepidemiologic profile and outcome of OMG.

Conclusion: Asymmetric ptosis and diplopia are the commonest manifestations in ocular myasthenia. Steroid is mostly needed in OMG.

Keywords: OMG, Antibodies, diagnosis, Thymoma, immunomodulation.

1. Singhal BS, Bhatia NS, Umesh T, Menon S. Myasthenia gravis: a study from India. Neurol India. 2008;56(3):352-5.
2. Grob D, Arsura EL, Brunner NG, Namba T. The course of myasthenia gravis and therapies affecting outcomea. Annals of the New York Academy of Sciences. 1987;505(1):472-99.
3. Antonio-Santos AA, Eggenberger ER. Medical treatment options for ocular myasthenia gravis. Current opinion in ophthalmology. 2008;19(6):468-78.
4. Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect of thymectomy. Annals of the New York Academy of Sciences. 1981;377(1):678-90.
5. Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD. Antibody to acetylcholine receptor in myasthenia gravis Prevalence, clinical correlates, and diagnostic value. Neurology. 1998;51(4):933--a.
6. Grigg J. Extraocular muscles: relationship of structure and function to disease. Australian and New Zealand journal of ophthalmology. 1999;27(6):369-70.
7. Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA. Ocular myasthenia gravis: A review. Indian journal of ophthalmology. 2014;62(10):985.
8. Sethi KD, Rivner MH, Swift TR. Ice pack test for myasthenia gravis. Neurology. 1987;37(8):1383-.
9. Osserman KE, Genkins G. Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. The Mount Sinai journal of medicine, New York. 1971;38(6):497.
10. Kerty E, Elsais A, Argov Z, Evoli A, Gilhus N. EFNS/ENS Guidelines for the treatment of ocular myasthenia. European journal of neurology. 2014;21(5):687-93.
11. Kupersmith MJ, Latkany R, Homel P. Development of generalized disease at 2 years in patients with ocular myasthenia gravis. Arch Neurol. 2003;60(2):243-8.
12. Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD. Antibody to acetylcholine receptor in myasthenia gravis. Prevalence, clinical correlates, and diagnostic value. Neurology. 1976;26(11):1054-9.
13. Sanders DB, Andrews PI, Howard JF, Massey JM. Seronegative myasthenia gravis. Neurology. 1997;48(Suppl 5):40S-5S.
14. Taiwan J Ophthalmol. 2018 Apr-Jun; 8(2): 67–73. doi:  10.4103/tjo.tjo_39_17 Update on ocular myasthenia gravis in Taiwan Cha-oWen Lin, Ta-Ching Chen,¹Jieh-Ren Jou,^1,2 and Lin-Chung Woung^1,3)
15. Finelli PF, Hoyt WF. Myasthenic abduction mystagmus in a patient with hyperthyroidism. Neurology 1976;26 (6 PT 1):589‑90
16. Costa J, Evangelista T, Conceição I, de Carvalho M. Repetitive nerve stimulation in myasthenia gravis – relative sensitivity of different muscles. Clin Neurophysiol 2004;115:2776‑ 32
17. Oosterhuis HJ.Observations of natural history of myasthenia gravis and the effect of thymectomy. Ann N Y Acad Sci 1981;377:67?90

Dr Thomas Iype

Professor, Professor, Dept. of Neurology, Govt. Medical College, Thiruvananthapuram, India