Myasthenia gravis with ocular involvement in older patients

Background: There has been little previous study reporting the eye findings and presentation of elderly patients with myasthenia gravis. The purpose o f this study was to review the findings and course of myasthenia gravis aft er the sixth decade of life. Methods: Retrospective observational case series. The authors reviewed the clinical records of 27 patients with onset of myasthenia gravis at age 60 y ears or more who were seen at a tertiary care academic ophthalmology centre in Houston between January 1992 and March 1999. The diagnosis of myastheni a gravis was based on conventional clinical and laboratory criteria. Results: Twenty patients (74%) were men. Of the 16 patients who underwent t esting for anti-acetylcholine receptor antibodies, 11 (69%) were seropositi ve. Concurrent thyroid disease was found in seven patients (26%), including five (71%) of the seven women. No patient had thymoma. Sixteen patients (5 9%) manifested generalized symptoms during follow-up; 12 did so within 1 ye ar of disease onset. Patients responded well to both anticholinesterase and corticosteroid therapy. At the most recent follow-up visit 18 patients (67 %) were clinically improved, and no patient was clinically worse. Interpretation: Myasthenia gravis in this study was characterized by a male predominance, high rate of concurrent thyroid disease, high rate of progre ssion to mild generalized symptoms, absence of thymoma, good response to me dical therapy and minimal life-threatening complications. Clinicians should consider the diagnosis of myasthenia gravis in an older patient presenting with diplopia or ptosis.