Active management in patients with ocular manifestations of myasthenia gravis

Purpose Myasthenia gravis can cause variable strabismus with disabling dipl opia and/or poor cosmesis. A retrospective study of a group of patients wit h myasthenia gravis or 'myasthenia gravis like' syndromes was made. Methods The study group consisted of patients who had undergone botulinum t oxin treatment and/or surgery for disabling diplopia, poor cosmesis or both . Surgical treatment was by conventional techniques including recess/resect , posterior fixation, superior oblique tenotomy and adjustable sutures. Results There were 9 patients in the study group (8 female, 1 male). Age at surgery ranged from 21 to 59 years (mean 46 years). Six were symptom-free following treatment. Two, although symptomatically improved, had occasional diplopia. One patient failed treatment and required an occlusive contact l ens. Conclusions The ocular manifestations of myasthenia gravis or 'myasthenia g ravis like' syndromes may respond to surgery and/or botulinum toxin injecti on. Active intervention should be considered when deviations become stable. To our knowledge this is the first report of the use of botulinum toxin in such patients.