Case Report: Treatment of Myasthenic Ptosis with Topical Ocular Oxymetazoline

Abstract

SIGNIFICANCE:Ptosis is often the hallmark finding in ocular and general myasthenia gravis. Reduction of ptosis has been achieved with oral and topical ocular medications. However, these medications can result in systemic and ocular adverse effects. A novel eye drop seems to be effective in reducing ptosis while minimizing adverse effects. PURPOSE: This case report aimed to demonstrate the efficacy of topical oxymetazoline hydrochloride 0.1%, an αadrenergic agonist, in temporary elimination of ptosis associated with myasthenia gravis.CASE REPORT: A 68-year-old woman with a history of myasthenia gravis and long-standing ptosis in the right eye presented to improve the asymmetrical appearance of her eyelids. One drop of oxymetazoline hydrochloride 0.1% was instilled in the right eye of the patient. Within 2 hours, the ptosis was eliminated, the margin-reflex distance 1 increased by 2.0 mm, and the superior visual field measured by a superior 36-point screening test increased by 15 points. The effect lasted for at least 7 hours. Of note, there was a decrease in elevation of the contralateral nonptotic eyelid that did not receive a drop of oxymetazoline, which might occur only in myasthenia gravis. Further evaluation is warranted.CONCLUSIONS: Oxymetazoline 0.1% is effective in reducing and potentially eliminating ptosis related to ocular myasthenia gravis for up to 7 hours.

A Breath of Relief: Oxymetazoline and Flunisolide Nasal Spray in the Management of Myasthenia Gravis Ptosis

“…Additionally, fewer adverse events were in the treatment group versus placebo (31 vs 35.6%), and 81% were considered mild [ 15 ]. Although patients with ptosis secondary to MG were excluded from this study, there have been case reports to date that have shown the efficacy of oxymetazoline 0.1% eye drops in MG ptosis, specifically in patients whose symptoms were refractory to pyridostigmine and prednisone [ 1 , 2 ]. To the best of our knowledge, our case report stands out as the first to explore the potential use of oxymetazoline intranasal formulation for the symptomatic treatment of MG ptosis.…”

“…Despite the prevalence of ocular myasthenia gravis (MG), literature on the acute treatment of these symptoms is sparse [1][2][3]. MG is an autoimmune disorder characterized by autoantibodies against postsynaptic acetylcholine receptors at neuromuscular junctions (NMJ) [4][5][6].…”

Oxymetazoline Hydrochloride Eye-Drops as Treatment for Myasthenia Gravis-Related Ptosis: A Description of Two Cases

“…The standard dosing is one drop of the solution in the affected eye one time each day. Only one case of a 68-year-old MG patient with temporary improvement of ptosis for seven hours after using topical ocular oxymetazoline has been documented to date [ 10 ]. However, the long-term efficacy of the drug for ptosis or its impact on MG treatment has not yet been described.…”