title: Active management in patients with ocular manifestations of myasthenia gravis.
abstract: OBJECTIVE
  Myasthenia gravis can cause variable strabismus with disabling diplopia and/or poor cosmesis. A retrospective study of a group of patients with myasthenia gravis or 'myasthenia gravis like' syndromes was made.
  
  
  METHODS
  The study group consisted of patients who had undergone botulinum toxin treatment and/or surgery for disabling diplopia, poor cosmesis or both. Surgical treatment was by conventional techniques including recess/resect, posterior fixation, superior oblique tenotomy and adjustable sutures.
  
  
  RESULTS
  There were 9 patients in the study group (8 female, 1 male). Age at surgery ranged from 21 to 59 years (mean 46 years). Six were symptom-free following treatment. Two, although symptomatically improved, had occasional diplopia. One patient failed treatment and required an occlusive contact lens.
  
  
  CONCLUSIONS
  The ocular manifestations of myasthenia gravis or 'myasthenia gravis like' syndromes may respond to surgery and/or botulinum toxin injection. Active intervention should be considered when deviations become stable. To our knowledge this is the first report of the use of botulinum toxin in such patients.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Bentley
authors.forename: E
authors.initials: E
authors.lastname: Dawson
authors.forename: J P
authors.initials: JP
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001905:Botulinum Toxins / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004172:Diplopia / Q000209:etiology / Q000628:therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications*; D015835:Ocular Motility Disorders / Q000209:etiology / Q000628:therapy*; D009801:Oculomotor Muscles / Q000601:surgery; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins