A TYPICAL CASE OF CHILDHOOD OCULAR MYASTHENIA GRAVIS: A LITERATURE REVIEW FROM OPHTHALMOLOGY PERSPECTIVE

Abstract

ABSTRACT Background: Childhood ocular myasthenia gravis (MG) is a rare autoimmune disease that has a benign course and provide a good overall prognosis. Diagnosis of ocular MG especially in children is often difficult especially in younger age group as the symptoms may be subtle and may mimic other pathology. There are many articles discussing MG in general, but only a handful elaborating on childhood ocular MG. This article is discussing a typical case of childhood MG and a review of current clinical approach particularly from ophthalmology point of view. Case Report: A one-year-old Malay girl who was previously well, presented with 2 weeks history of left eye ptosis and intermittent exotropia following a brief episode of fever. A provisional diagnosis of ocular MG was made. Unfortunately, the patient defaulted pediatric neurology follow up for confirmatory investigations. She came back 2 years later with bilateral ptosis. Upon her second presentation, blood investigation for acetylcholine receptor antibody showed positive result and finally she was diagnosed to have ocular MG. She was co-managed with a pediatric neurologist and was treated with oral pyridostigmine. Satisfactory improvement of ptosis was achieved with no amblyopia. There was no features of systemic MG during 2 years follow up. Conclusion: Although this is a typical presentation of childhood ocular MG, there are many interesting and useful learning points particularly from an ophthalmology point of view.