A Case of Pediatric Myasthenia Revealed by Marked Eyelid Ptosis After Using Cyclopentolate Eye Drops

Pediatric myasthenia gravis (PMG), while uncommon, poses significant diagnostic challenges due to its potential impact on development and its often subtle initial symptoms, such as ptosis and diplopia. This case report details an unusual presentation of PMG in a three-year-old female, initially diagnosed with a chalazion, highlighting the complexity of diagnosing this autoimmune neuromuscular disorder in children. Despite treatment for the assumed chalazion, the child's ptosis persisted, and disparities in visual acuity between her eyes became evident. The turning point in her diagnosis came during a routine ophthalmologic assessment using cyclopentolate hydrochloride, which exacerbated her ptosis, prompting further neuromuscular investigation. This led to the detection of acetylcholine receptor antibodies and a suspected diagnosis of PMG after a repetitive nerve stimulation test. This case underscores the critical role of detailed clinical observation and the consideration of neuromuscular etiologies in children presenting with ocular symptoms. It also emphasizes the importance of integrating the observations of family members and caregivers into clinical assessments. Oftentimes, subtle symptoms noted by those close to the patient can provide crucial clues in diagnosing complex conditions like PMG. Early detection is paramount to prevent complications such as amblyopia and to initiate timely interventions, as demonstrated by the subsequent implementation of an eye patch to preserve visual function in the affected eye of the patient. This report contributes to the growing literature on the variable presentations of PMG and underlines the necessity for vigilance and a comprehensive approach in pediatric ophthalmologic evaluations to ensure that significant underlying conditions are not overlooked.