WHEN VISION THERAPY IS NOT SUCCESSFUL: A CASE OF MYASTHENIA GRAVIS

Title WHEN VISION THERAPY IS NOT SUCCESSFUL: A CASE OF MYASTHENIA GRAVIS
Author, Co-Author Valerie Kattouf, Paula Meiring, Geoffrey Goodfellow
Topic
Year
2001
Day
Sunday
Program Number
Poster 84
Room
Exhibit Hall C
Affiliation
Illinois College of Optometry
Abstract BACKGROUND: Myasthenia Gravis is an autoimmune disorder which affects acetylcholine receptors within the neuromuscular junction. The common ocular signs of ptosis and diplopia are often first presentations of the disease. Ocular misalignment associated with Myasthenia may mimic any pattern of strabismus. The associated signs will increase with fatigue and fluctuate with exacerbation or remission of the condition. Myasthenia Gravis often goes undiagnosed because ocular and physical signs are intermittent until later in the disease.



CASE REPORT(S). A 27-year-old African American male was referred to our clinic for intermittent diplopia causing asthenopia and headaches. The diplopia began years prior and was diagnosed as a late onset esotropia. The patient''s medical and neurologic work up were negative for any pathology. A habitual spectacle prescription with 5^ base out OU offered little relief. A strabismus evaluation was completed, and a vision therapy plan was implemented to improve motor vergence control.
Nine sessions of therapy were completed with minimal symptom improvement. The spectacle prism was reduced to the minimum amount needed to alleviate diplopia. Vergence skills improved during therapy, but control; of the esotrpic deviation was variable. On several office visits, a mild ptosis of the upper lid was noted. Investigation of photographs from years earlier suggested the ptosis was of recent onset. A tensilon test was ordered to rule out Myashthenia Gravis; the patient is currently in the process of finalizing the diagnosis and is receiving appropriate treatment.
CONCLUSIONS. Myasthenia Gravis is a neurologic condition whose ocular manifestaions may be extensive. Also known as the great masquerader, Myasthenia may present with vague symptoms which elude the proper diagnosis. The presentation of a 27-year-old with late onset esotropia always poses a concern. Because this patient presented with a complete battery of medical tests which came up negative, little suspicion of pathology existed. Nonetheless, it was the minimal success of vision therapy with this motivated and compliant patient that initiated further medical evaluation and the eventual diagnosis of Myasthenia Gravis
Affiliation of Co-Authors Illinois College of Optometry, Illinois College of Optometry
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