Effect of local heat versus ice on blepharoptosis resulting from ocular myasthenia

Objective: To determine the effect of heat versus ice application to a ptot ic eyelid in patients with ocular or systemic myasthenia. Design: Observational case series. Participants: Three consecutive patients and one subsequent patient with pt osis and clinical or laboratory signs of myasthenia were initially evaluate d. Methods: In ail four patients, the heat test and the ice test were performe d. In three patients, the modified sleep test was also performed. In the he at or ice test, the patient was asked to hold a heat or ice pack, respectiv ely, over the closed ptotic eye for 10 to 15 minutes. The modified sleep te st was performed by having the patient close both eyes for a 10- to 15-minu te period. Photographs were taken before and immediately after each test. Main Outcome Measure: The effect of heat or ice on ptosis. Results: Transient complete improvement of ptosis in three patients and mar ked improvement in one patient was noted after each test. The results of th e heat, ice, and modified sleep tests were identical. Conclusions: Marked improvement of myasthenic ptosis in all four patients o ccurred regardless of local warming or cooling. The common denominator of a ll these tests, rest, seems to be the relevant factor in the study as desig ned. (C) 2000 by the American Academy of Ophthalmology.