Diagnosis of Tensilon-Negative Ocular Myasthenia Gravis By Daily Selfie

Abstract

The initial symptoms of myasthenia gravis are usually ptosis and diplopia. The diagnosis is often confirmed by testing for anti-acetylcholine receptor antibodies or by observing the effects of intravenous edrophonium (Tensilon) injection. However, these standard tests may be negative in patients with isolated ocular findings. We present the case of an 83-year-old woman with negative serologic and Tensilon testing. She was asked to photograph herself daily. The resulting sequence of daily selfies captured striking fluctuations in her ocular alignment and ptosis. Daily selfies may be a useful strategy for confirming the clinical diagnosis of ocular myasthenia gravis.

FIG. 1

Selfies to capture serial changes in ptosis and eye misalignment. The patient remembered to take a selfie on 24 of 49 mornings (numbers indicate the day since last clinic exam). Although her ocular deviation was unclear on some days, owing to uncertainty regarding her gaze angle and the camera position, the images provide objective documentation of fluctuating ptosis and eye misalignment. Her initial exotropia was replaced by esotropia, that became marked on days 23–29, followed by subsequent return of exotropia on day 41. There was also a right ptosis that became complete on days 30–35.