Ocular Myasthenia Gravis (OMG) Steroid Hackneyed: A Case Report
Asian Journal of Research and Reports in Ophthalmology, Volume 5, Issue 4,
Myasthenia Gravis is an auto-immune disorder that affects the post-synaptic neuromuscular junction membrane. Acetylcholine receptor (AChR) antibodies are frequently present, and the number of functioning postsynaptic receptors is reduced. Muscle-specific kinase antibodies may be identified in individuals with and without AChR antibodies. It is called the great masquerader owing to its varied clinical presentations. Ocular myasthenia gravis (OMG) is a subtype of the systemic disease which affects only the eye but many patients do progress to generalized form. The mainstay of treatment is acetylcholine esterase inhibitors along with corticosteroids and/or immunosuppressant drugs which is aimed at disease remission and prevention of progression to the generalized form. We report a case of a 9 year old male patient who was diagnosed as OMG. He was on oral steroids, unmonitored from the past 4 years and came to us for persistent variability of symptoms and was found to have disc changes suspicious of glaucoma with IOP on normal side in both eyes with variable ptosis and diplopia. Systemically she had mild stunting of growth for which the pediatrician and the endocrinologist advised tapering and regular monitoring. We hope to stress upon the importance of ophthalmic and systemic monitoring of patients on steroids for ophthalmologic conditions, specially the pediatric age group. With increasing trends of steroid-induced glaucoma in children over the last few years, probably signifying increasing use of unmonitored steroid use, we would like to stress upon the importance of counseling and regular monitoring of patients on steroid therapy to prevent adverse local and systemic adverse effects.
- Ocular myasthenia
- side effects
How to Cite
Hoch W, McConville J, Helms S, Newsom-DavisJ, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptorantibodies. Nat Med. 2001;7(3):365-368.
López‑ Cano M, Ponseti‑Bosch JM, Espin‑ Basany E, Sánchez‑ García JL, Armengol‑ Carrasco M. Clinical and pathologic predictors of outcome in thymoma associated myasthenia gravis. Ann ThoracSurg. 2003;76:1643‑9.
O’Brien MD. The miracle at St Alfege’s: Seventy years on. J R Soc Med. 2007; 100:257.
Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect ofthymectomy. Ann N Y Acad Sci. 1981; 377:678-690.
Ferrara G, Petrillo MG, Giani T, Marrani E, Filippeschi C, Oranges T, Simonini G, Cimaz R. Clinical Use and Molecular Action of Corticosteroids in the Pediatric Age. Int J Mol Sci. 2019;20(2):444.
DOI:10.3390/ijms20020444.PMID:30669566; PMCID: PMC6359239.
Dinning WJ. Steroids and the eye-indications and complications. Postgrad Med J. 1976;52(612):634-8.
STANBURY RM, GRAHAM EMSystemic corticosteroid therapy—side effects and their managementBritish Journal of Ophthalmology 1998;82:704-708.
Bae JS, Go SM, Kim BJ. Clinical predictors of steroid-induced exacerbation in myasthenia gravis. J ClinNeurosci. 2006; 13(10):1006-10.
Kochar, Dhanpat, Shubhakaran, Khichar, Kumawat Bl, Thanvi, Indu, Joshi, Vyas A, SP. Ophthalmoscopic abnormalities in adults with falciparum malaria. QJM: Monthly Journal of the Association of Physicians. 1998;91.
Kaur S, Dhiman I, Kaushik S, Raj S, Pandav SS. Outcome of ocular steroid hypertensive response in children. J Glaucoma. 2016;25(4):343–347.
Gupta S, Shah P, Grewal S, Chaurasia AK, Gupta V. Steroid-induced glaucoma and childhood blindness. Br J Ophthalmo. 2015;99(11):1454–1461.
Yang ZX, Xu KL, Xiong H. Clinical characteristics and therapeutic evaluation of childhood myasthenia gravis. Exp Ther Med. 2015;9:1363-8.
Kim JH, Hwang JM, Hwang YS, Kim KJ, Chae J. Childhood ocular myasthenia gravis. Ophthalmology 2003; 110:1458-62.
Ishigaki K, Shishikura K, Murakami T, Suzuki H, Hirayama Y, Osawa M. Benefits of FK 506 for refractory eye symptoms in a young child with ocular myasthenia gravis. Brain Dev. 2009;31:634-7.
Parr JR, Jayawant S. Childhood myasthenia: Clinical subtypes and practical management. Dev Med Child Neurol. 2007;49:629-35.
Chappaz A, Knirsch U, Gerth-Kahlert C. Alternating IV nerve palsy and ptosis as a first sign of childhood ocular myasthenia gravis. Pediatr Neurol. 2015;52:460-1.
Abstract View: 51 times
PDF Download: 24 times