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Comitant Ocular Deviation in Myasthenia Gravis.

Tiffany Pike-Lee1, Jeremy Hill, Jianbo Li

  • 1Neuromuscular Center (TP-L, JH, YL), Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Quantitative Health Sciences (JL), Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; and Cole Eye Institute (GSK), Cleveland Clinic Foundation, Cleveland, Ohio.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|September 2, 2020
PubMed
Summary
This summary is machine-generated.

Comitant ocular deviation occurs in 22.5% of myasthenia gravis (MG) patients. This finding in ocular motility does not rule out MG or indicate a central cause.

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Area of Science:

  • Neuro-ophthalmology
  • Neurology
  • Ophthalmology

Background:

  • The occurrence of comitant ocular deviation in myasthenia gravis (MG) is not well-documented.
  • Myasthenia gravis is a neuromuscular disorder affecting voluntary muscles, including those controlling eye movements.

Purpose of the Study:

  • To investigate the prevalence and characteristics of comitant ocular deviation in patients with myasthenia gravis.
  • To determine if comitant ocular deviation in MG suggests a central nervous system etiology.

Main Methods:

  • Retrospective analysis of 120 patients with ocular or generalized MG seen at a neuro-ophthalmology clinic over 6 years.
  • Comitant ocular deviation defined as <20% variation in deviation magnitude across planes from primary position.
  • Review of clinical data and brain MRI findings in select patients.

Main Results:

  • Comitant ocular deviation was present in 27.5% of patients at initial evaluation.
  • Of 16 patients with follow-up, 6 maintained comitant deviation, while 10 converted to incomitant or no deviation.
  • Brain MRIs in 18 patients with comitant deviation showed no brainstem or cerebellar abnormalities.

Conclusions:

  • Comitant ocular deviation can be a manifestation of myasthenia gravis.
  • The presence of comitant ocular deviation in MG does not necessarily imply a central nervous system cause.
  • Diagnosing MG should not be excluded based on the presence of comitant ocular deviation.