Ocular Aspects of Myasthenia Gravis

Jason J. S. Barton, MD, PhD, FRCPC, and Mohammad Fouladvand, MD, Human Vision and Eye movement Laboratory, Departments of Neurology and Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Biomedical Engineering, Boston University, Boston, Massachusetts.

Semin Neurol. 2000;20(1) 

In This Article


In a patient with signs limited to the ocular muscles, a key issue is the likelihood of developing generalized myasthenia. A study of nearly 1500 patients showed that about 50% presented with strictly ocular involvement. Of this group with ocular myasthenia, about 30% did not generalize over a mean of 17 years of follow-up; among the 70% who progressed, 94% did so within the first 3 years.[2] Similar findings were reported in another study,[4] with 50% of patients with ocular myasthenia developing generalized disease, and 80% of these doing so within 2 years of diagnosis. Ten percent actually achieved complete remission, although remission at a later date remained possible.[134] Of note, EMG findings of subclinical disease in limb muscles in this study[4] did not predict generalization. Development of generalized myasthenia after 3 years can occur, but it does so at a slower rate.[127]

Anticholinesterase medications do not improve the outlook for ocular myasthenia.[2] Whether predisone, thymectomy, or other immunosuppression alters the likelihood of generalization is not yet entirely clear. Two retrospective reviews have suggested that steroids and azathioprine may reduce the rate of generalization by as much as 75%.[127,128] Available data are too scant to show whether thymectomy adds any prognostic advantage.[127,133]


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