A 12-year old male presented with the right eye turned outward called exotropia and both upper eyelids drooping, which is called bilateral ptosis. This young male had been twice to the emergency room and had been examined by 2 pediatricians and one pediatric neurologist. No diagnosis had been made after a normal CT scan and a normal MRI of the brain. The patient was referred to Dr. Pollard who examined the patient and diagnosed Myasthenia Gravis and found high serum titers of antibodies to acetylcholine receptor sites. The patient was admitted to the hospital as he was having trouble with slurred speech and swallowing. Consultation with the neurology service at Scottish Rite Hospital confirmed our diagnosis and he was treated in the Intensive Care Unit with systemic steroids, Mestinon, a drug for Myasthenia Gravis and plasma phoresis. So far he has had complete remission of his symptoms. In Myasthenia Gravis there is not enough of the chemical acetylcholine to work at the neuro-muscular junction. Many muscles are affected with paralysis or paresis such as droopy eyelids (weakness of the muscle that opens the eyelids), weakness of the right medial rectus muscle and weakness of the muscles of speech and swallowing.
Success Stories
Exotropia and Bilateral Ptosis in Myasthenia Gravis Patient
Discuss On Facebook
Related Articles • More Articles
This is a 4-month-old female with both eyes turning outward which is very unusual as usually one eye is fixating, and one eye is turned out. This young baby has bilateral exotropia due to an unusual type of strabismus, which we call Duane's Type II.
This three-year-old girl was flown here to the James Hall Eye Center from Tajikistan in Central Asia. The first picture shows her with bilateral excessive tearing due to a tear duct obstruction on both sides. She also has esotropia -crossed eyes.
This several month old infant has eyes looking downward and bilateral upper eyelid retraction. We call this the "setting sun sign" as the eyes appear to be "setting". This child has nothing wrong with the eyes but this is a sign of increased pressure in the brain.