Transient eyelid retraction in myasthenia gravis.

Abstract

SYNOPSIS Three patients with myasthenia gravis had transient retraction of the upper eyelids which usually followed prolonged upgaze and which persisted for many seconds. This could result from post-tetanic facilitation, myotonia, or a transient contracture. Retraction of this type is to be distinguished from both the long-standing unilateral retraction associated with ptosis of the contralateral eyelid and the fleeting lid twitch sign.

Presented with Uncommon Complaints in a Case of Pediatric Ocular Myasthenia Gravis

“…Due to Hering's law of equal innervation, weakness of the LPSM in the ptotic eyelid caused to increased innervation of both levators, thus resulting in pseudoretraction of the enhanced contralateral eyelid. 3,11 Since this retraction type persists for a long time, ocular irritation symptoms may be seen because of exposure in the affected side, as in our case. 3 For confirmation of this situation depend on MG, ophthalmologist should cover or elevate the ptotic eyelid manually (Figure 2).…”

“…11 The first type, fleeting eyelid retraction which is known as the 'lid twitch' or 'Cogan's sign' was described by Cogan. 8 When the patient look primary gaze from downward gaze, an overshoot which occurs less than one second in the ptotic eyelid is observed.…”

“…This fleeting is believed to be associated with easy fatigue and fast healing of levator palpebrae superioris muscle (LPSM). 8,11 The second type, transient eyelid retraction which lasts many seconds, may depend posttetanic fascilitation of LPSM. 11 The third type, characterized longstanding eyelid retraction (months or years) as seen in our patient.…”

“…8,11 The second type, transient eyelid retraction which lasts many seconds, may depend posttetanic fascilitation of LPSM. 11 The third type, characterized longstanding eyelid retraction (months or years) as seen in our patient. Due to Hering's law of equal innervation, weakness of the LPSM in the ptotic eyelid caused to increased innervation of both levators, thus resulting in pseudoretraction of the enhanced contralateral eyelid.…”

“…3 For confirmation of this situation depend on MG, ophthalmologist should cover or elevate the ptotic eyelid manually (Figure 2). When the ptotic eyelid is covered, improvement of eyelid retraction is commonly considered specific for MG. 3,11 For example, Graves Ophthalmopathy (GO) may imitate OMG, because it can cause limitations of extraocular muscles and eyelid retraction. Furthermore GO may coexistence with MG, because both of which are autoimmune disease.…”