A Rare Case of Ocular Myasthenia Presenting with Uniocular Ptosis in a Patient Attending OPD of a Tertiary Care Centre in North Eastern India

A 62y/F presented with drooping of left upper eye lid since 20 days which improved with rest and associated with generalised weakness. BCVA 6/6, N6 (OU); Left Eyebrows raised, Left Upper Eye Lid drooping reducing the palpebral apertures to approximately 6mm?30mm; L/E MRD 1: 2mm, MRD 2: 4mm, MCD: 8mm; L/E LPS Function: Berke?s: 14mm and Putterman?s MLD: 8mm. Clinical tests done: Fatiguability test: +, Sleep Test: +, Cogan Twitch Sign: +, Ice Pack Test: +, Neostigmine Test: +. Serum Serum Acetylcholine Receptor Antibody Titre: 6.67nmol/L (HIGH), while other investigations were within normal limits. The patient diagnosed as a case of Ocular Myasthenia involving left eye. The patient was managed conservatively with Oral Pyridostigmine 60mg (TDS, PC) leading to improvement of the condition. Myasthenia Gravis is an autoimmune disease in which there is antibody mediated damage of postsynaptic acetylcholine receptors in neuromuscular junction. Uniocular Ptosis as the only presenting feature in Ocular Myasthenia is a very rare finding: seen in only 11% patients as mentioned in Karri B et al study in 2015.