The ice test versus the rest test in myasthenia gravis

Abstract

Objective: To compare the ice test with the rest test in subjects with myasthenic and nonmyasthenic ptosis.

Design: Randomized, noninterventional trial.

Participants: (1) Ten subjects with ptosis from previously undiagnosed myasthenia gravis. (2) Fifteen subjects with nonmyasthenic ptosis.

Methods: Application of ice compared with rest.

Main outcome measures: Improvement in eyelid elevation in millimeters after the application of a surgical glove filled with ice or cotton.

Results: In myasthenic subjects, the median improvement of ptosis with the rest test was 2 mm and with the ice test was 4.5 mm. The difference between the rest and ice tests is significant (P: < 0.001). There was no improvement in ptosis in nonmyasthenic subjects with either test.

Conclusion: In myasthenic ptosis, improvement in eyelid elevation after the ice test is in part caused by rest. The ice test significantly improves ptosis more than rest alone does.