Diagnosis of Tensilon-Negative Ocular Myasthenia Gravis By Daily Selfie

Abstract

The initial symptoms of myasthenia gravis are usually ptosis and diplopia. The diagnosis is often confirmed by testing for anti-acetylcholine receptor antibodies or by observing the effects of intravenous edrophonium (Tensilon) injection. However, these standard tests may be negative in patients with isolated ocular findings. We present the case of an 83-year-old woman with negative serologic and Tensilon testing. She was asked to photograph herself daily. The resulting sequence of daily selfies captured striking fluctuations in her ocular alignment and ptosis. Daily selfies may be a useful strategy for confirming the clinical diagnosis of ocular myasthenia gravis.

Unusual presentation of uncommon cause of ptosis

“…Hence, clinical judgement becomes a critical factor in making the clinical diagnosis, which can be aided by objective diplopia charting or repeated daily self photographs ('selfies') after careful exclusion of all other differential diagnoses. A case of an elderly women is reported in whom diagnosis of OMG was confirmed by recording fluctuations in ptosis and ocular alignment on daily 'selfies' 4 . In the case of inconclusive diagnostic tests, objective diplopia charting can support a clinical diagnosis of tSN‐MG.…”

“…A case of an elderly women is reported in whom diagnosis of OMG was confirmed by recording fluctuations in ptosis and ocular alignment on daily 'selfies'. 4 In the case of inconclusive diagnostic tests, objective diplopia charting can support a clinical diagnosis of tSN-MG.…”

Pediatric Ocular Myasthenia Gravis: A Review

“…• Fluctuation in ocular findings: A case has been reported in which daily selfies taken by a patient (suspected OMG but negative diagnostic tests) showed fluctuations in ptosis and ocular alignment. 37 Likewise, diplopia charting for a week (every day and evening) might show fluctuations. • Intrinsic muscles of eyes are characteristically spared with normal pupillary function and visual acuity.…”

Cell Phone Selfies: Clinching the Diagnosis of Iris Microhemangiomatosis

“…Ophthalmic photography has been utilized since the 1800s and is essential in diagnosis, documentation, and management of a variety of diseases [1]. With the ubiquitous use of smartphones today, many medical specialties are now utilizing patient-initiated self-photography to aid in screening, diagnosis, disease development, and treatment monitoring [2][3][4]. Utilization of this technology in ophthalmology has allowed implementation of teleophthalmology and the ability to extend sight saving care to many more individuals [5][6][7].…”