The ice test versus the rest test in myasthenia gravis

Objective: To compare the ice test with the rest test in subjects with myas thenic and nonmyasthenic ptosis. Design: Randomized, noninterventional trial. Participants: (1) Ten subjects with ptosis from previously undiagnosed myas thenia 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 improvemen t 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 pt osis more than rest alone does. Ophthalmology 2000;107:1995-1998 (C) 2000 b y the American Academy of Ophthalmology.