Treatment of Ocular Myasthenia Gravis with Ophthalmoparesis or Ptosis
Clinical scenario
This protocol addresses ocular myasthenia gravis presenting with ophthalmoparesis or ptosis — specifically when these symptoms are not adequately controlled by anticholinesterase agents and are functionally limiting or troublesome to the patient, making escalation to immunosuppressant therapy appropriate.
Treatment approach
Corticosteroids are the recommended first-line immunosuppressant in this setting. The full protocol specifies the dosing strategy — including whether a lower-dose approach may achieve adequate control while reducing the burden of side effects associated with higher doses.
Treatment goal
Sustained minimal manifestation (MM) status
References
DOI: 10.1212/WNL.0000000000011124
Ophthalmoparesis or ptosis in ocular MG that is not responding to anticholinesterase agents should be treated with immunosuppressant agents if symptoms are functionally limiting or troublesome to the patient.
Corticosteroids should be used as the initial IS agent in ocular MG.
Data from a single small RCT suggest that low-dose corticosteroids may be effective for ocular MG and may avoid side effects associated with high-dose corticosteroids.
A small RCT comparing prednisone with placebo in patients with 11 ocular MG who had previously failed to achieve minimal manifestation (MM) status after 4–6 weeks of pyridostigmine found that 5 of 6 participants (83%) in the prednisone group achieved the primary end point of sustained MM status at a median of 14 weeks on prednisone.