Treatment of Ocular Myasthenia:  Steroids Only When Compelled

MYASTHENIA gravis (MG) preferentially involves the ocular muscles.¹ Ocular myasthenia manifests as weakness of the levator palpebrae superioris leading to ptosis, or the extraocular muscles producing diplopia. The precise reasons for this predilection are poorly understood.^2- 3 As with all therapies for MG, there are few well-controlled studies of treatments of ocular myasthenia.⁴ Immunosuppressive therapies, in particular the corticosteroid prednisone, are the mainstay of treatment for generalized MG that compromises an individual's daily activities. Prednisone is also commonly used for ocular myasthenia. However, 4 factors should be considered prior to the use of steroids for patients with MG isolated to the ocular muscles: (1) Could the patient's symptoms improve with safer forms of therapy? (2) Will steroid treatment lead to resolution of symptoms? (3) Does the severity of the symptoms warrant the risk of steroid adverse effects? (4) Do steroids reduce the chance of generalization? We consider each of these questions and reach the conclusion that only the occasional case of ocular myasthenia should be treated with steroids.