Juvenile ocular myasthenia gravis: a report of two cases

Main Article Content

Ryan Gabbard, MD
Richard Yi, MD
James Pratt, BS
Kenneth Chang, MD
Katie Keck, MD


We report 2 cases of pediatric ocular myasthenia gravis. The first case was a 7-year-old girl who presented with bilateral ophthalmoplegia and ptosis that correlated with the onset of upper respiratory symptoms. Neuroimaging and acetylcholine receptor antibody testing were unremarkable. The ice pack test was positive. Symptoms greatly improved with pyridostigmine, with full resolution of ophthalmoplegia achieved by 8-month follow-up. The second case was a 4-year-old girl who presented emergently with ptosis and bilateral ophthalmoplegia. Acetylcholine receptor antibodies testing was positive. The patient was started on pyridostigmine and intravenous immunoglobulin and is scheduled to follow-up with pediatric ophthalmology in the outpatient setting.


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Gabbard R, Yi R, Pratt J, Chang K, Keck K. Juvenile ocular myasthenia gravis: a report of two cases. Digit J Ophthalmol. 2024;30(1):15-18. doi:10.5693/djo.02.2023.09.002
Case Reports
Author Biography

James Pratt, BS, University of South Carolina School of Medicine, Columbia, South Carolina

Medical Student 


Finnis MF, Jayawant S. Juvenile myasthenia gravis: a paediatric perspective. Autoimmune Dis 2011;2011:404101. DOI: https://doi.org/10.4061/2011/404101

Parr JR, Jayawant S. Childhood myasthenia: clinical subtypes and practical management. Dev Med Child Neurol 2007;49:629-35. DOI: https://doi.org/10.1111/j.1469-8749.2007.00629.x

Andrews PI. Autoimmune myasthenia gravis in childhood. Semin Neurol 2004;24:101-10. DOI: https://doi.org/10.1055/s-2004-829591

Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA. Ocular myasthenia gravis: a review. Indian J Ophthalmol 2014;62:985-91. DOI: https://doi.org/10.4103/0301-4738.145987

Benatar M. A systematic review of diagnostic studies in myasthenia gravis. Neuromuscul Disord 2006;16:459-67. DOI: https://doi.org/10.1016/j.nmd.2006.05.006

Della Marina A, Trippe H, Lutz S, Schara U. Juvenile myasthenia gravis: recommendations for diagnostic approaches and treatment. Neuropediatrics 2014;45:75-83. DOI: https://doi.org/10.1055/s-0034-1390532

Liew WK, Kang PB. Update on juvenile myasthenia gravis. Curr Opin Pediatr 2013;25:694-700. DOI: https://doi.org/10.1097/MOP.0b013e328365ad16

Pevzner A, Schoser B, Peters K, et al. Anti-LRP4 autoantibodies in AChR- and MuSK-antibody-negative myasthenia gravis. J Neurol 2012;259:427-35. DOI: https://doi.org/10.1007/s00415-011-6194-7

Bhatia S, Quinlan H, McCracken C, Price EW, Guglani L, Verma S. Serial stimulated jitter analysis in juvenile myasthenia gravis. Muscle Nerve 2018;58:729-32. DOI: https://doi.org/10.1002/mus.26319

Pitt M. Neurophysiological strategies for the diagnosis of disorders of the neuromuscular junction in children. Dev Med Child Neurol 2008;50:328-33. DOI: https://doi.org/10.1111/j.1469-8749.2008.02038.x

Grigg J. Extraocular muscles: relationship of structure and function to disease. Aust N Z J Ophthalmol 1999;27:369-70. DOI: https://doi.org/10.1046/j.1440-1606.1999.00253.x

Chatzistefanou KI, Kouris T, Iliakis E, et al. The ice pack test in the differential diagnosis of myasthenic diplopia. Ophthalmology 2009;116:2236-43. DOI: https://doi.org/10.1016/j.ophtha.2009.04.039

Ortiz S, Borchert M. Long-term outcomes of pediatric ocular myasthenia gravis. Ophthalmology 2008;115:1245-8.e1241. DOI: https://doi.org/10.1016/j.ophtha.2007.10.022

Andrews PI, Massey JM, Howard JF Jr, Sanders DB. Race, sex, and puberty influence onset, severity, and outcome in juvenile myasthenia gravis. Neurology 1994;44:1208-14. DOI: https://doi.org/10.1212/WNL.44.7.1208

Mansukhani SA, Bothun ED, Diehl NN, Mohney BG. Incidence and ocular features of pediatric myasthenias. Am J Ophthalmol 2019;200:242-9. DOI: https://doi.org/10.1016/j.ajo.2019.01.004

Restivo DA, Centonze D, Alesina A, Marchese-Ragona R. Myasthenia gravis associated with SARS-CoV-2 infection. Ann Intern Med 2020;173:1027-8. DOI: https://doi.org/10.7326/L20-0845