EFNS/ENS Guidelines for the treatment of ocular myasthenia.
OBJECTIVE
The symptoms of acquired autoimmune ocular myasthenia are restricted to the extrinsic eye muscles, causing double vision and drooping eyelids. These guidelines are designed to provide advice about best clinical practice based on the current state of clinical and scientific knowledge and the consensus of an expert panel.


METHODS
Evidence for these guidelines was collected by searches in the MEDLINE and Cochrane databases. The task force working group reviewed evidence from original articles and systematic reviews. The evidence was classified (I, II, III, IV) and consensus recommendation graded (A, B or C) according to the EFNS guidance. Where there was a lack of evidence but clear consensus, good practice points are provided.


CONCLUSIONS
The treatment of ocular myasthenia should initially be started with pyridostigmine (good practice point). If this is not successful in relieving symptoms, oral corticosteroids should be used on an alternate-day regimen (recommendation level C). If steroid treatment does not result in good control of the symptoms or if it is necessary to use high steroid doses, steroid-sparing treatment with azathioprine should be started (recommendation level C). If ocular myasthenia gravis is associated with thymoma, thymectomy is indicated. Otherwise, the role of thymectomy in ocular myasthenia is controversial. Steroids and thymectomy may modify the course of ocular myasthenia and prevent myasthenia gravis generalization (good practice point).
Department of Neurology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
E
E
Kerty
A
A
Elsais
Z
Z
Argov
A
A
Evoli
N E
NE
Gilhus
D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D016208:Databases, Factual / Q000706:statistics & numerical data; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000601:surgery; D013934:Thymectomy / Q000379:methods / Q000592:standards
D002800:Cholinesterase Inhibitors; D007155:Immunologic Factors
myasthenia gravis; ocular myasthenia; treatment