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The ice test versus the rest test in myasthenia gravis
K C Kubis1, H V Danesh-Meyer, P J Savino
1Neuro-ophthalmology Service, Wills Eye Hospital, Thomas Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
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.