Treatment of Ocular Myasthenia Gravis Current Treatment Options in Neurology, 11/01/2011

Haines SR et al. – Topical agents may be useful as additional therapy for mild or moderate ptosis. Nonpharmacologic treatments include occlusive devices, prisms, eyelid supports, contact lenses, and (in long-standing, stable cases) strabismus surgery or eyelid elevation surgery.

• Treatment of ocular MG is aimed at relieving the symptoms of ptosis and diplopia, as well as preventing the development of generalized MG symptoms.
• Immune suppression with steroids is often the main therapy.
• Steroid doses must be increased slowly because of a risk of precipitating myasthenic crisis.
• After achieving the highest target dose, steroids are then slowly tapered down to the lowest effective dose.
• Often, acetylcholinesterase inhibitors such as pyridostigmine and neostigmine are also employed to help control symptoms.
• When steroids are contraindicated, acetylcholinesterase inhibitors can be tried as the primary therapy.
• Steroid-sparing agents such as azathioprine and mycophenolate may also have a role in treating ocular MG.
• Other treatments for MG include plasmapheresis, intravenous immunoglobulin, and other immunosuppressive agents, but these are rarely required for ocular MG.
• Patients should also be evaluated for thymoma.
• Thymoma should be resected surgically.
• Ocular MG without thymoma is not usually treated with thymectomy.