Heavy duty.

Area of Science:

• Ophthalmology
• Neurology
• Immunology

Background:

• Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions.
• Anti-low density lipoprotein receptor-related protein 4 (LRP4) antibodies are implicated in some MG cases.
• Heavy eye syndrome (HES) is a rare condition characterized by globe displacement and motility issues.

Purpose of the Study:

• To describe a case of myasthenia gravis with anti-LRP4 antibodies that progressed to heavy eye syndrome.
• To discuss the clinical and radiological features of heavy eye syndrome.
• To review the differential diagnosis of heavy eye syndrome.

Main Methods:

• Case report of a 54-year-old woman with a history of myopia, hypothyroidism, and asthma.
• Diagnosis of myasthenia gravis based on positive anti-LRP4 antibodies and clinical symptoms.
• Magnetic resonance imaging (MRI) to evaluate ocular structures and globe position.

Main Results:

• The patient presented with double vision, later diagnosed as myasthenia gravis.
• Initial MG treatments were ineffective.
• MRI revealed characteristic findings of heavy eye syndrome, including muscle displacement and globe prolapse.

Conclusions:

• Heavy eye syndrome can occur in patients with myasthenia gravis, particularly those with anti-LRP4 antibodies.
• Ocular motility limitations and globe displacement on imaging are key diagnostic features of HES.
• Early recognition and appropriate imaging are crucial for diagnosing HES in the context of refractory MG symptoms.