{"id":3765,"date":"2026-10-21T16:09:59","date_gmt":"2026-10-21T14:09:59","guid":{"rendered":"https:\/\/www.first-sight.ch\/?post_type=glossary&#038;p=3765"},"modified":"2026-10-21T16:11:24","modified_gmt":"2026-10-21T14:11:24","slug":"myasthenia-gravis-and-the-eyes","status":"publish","type":"glossary","link":"https:\/\/www.first-sight.ch\/en\/glossar\/myasthenia-gravis-and-the-eyes\/","title":{"rendered":"Myasthenia Gravis and the Eyes"},"content":{"rendered":"<p>Myasthenia gravis is an autoimmune disease in which the body's own immune system disrupts communication between nerves and muscles. Antibodies block the receptors on the muscle, so that nerve signals no longer arrive in full. The result is an exertion-dependent muscle weakness that increases over the course of the day. The eye muscles are particularly often affected, and frequently the first to be involved.<\/p>\n<h2>Ocular and generalised forms<\/h2>\n<p>In <strong>ocular myasthenia<\/strong> the weakness is confined to the eye muscles and the lid elevators. About half of the patients who begin with eye symptoms nevertheless develop a generalised form within two years, in which the muscles of the arms, legs, face or airways can also be involved.<\/p>\n<h2>Symptoms affecting the eyes<\/h2>\n<ul>\n<li><strong>Ptosis (drooping upper lid):<\/strong> one or both upper lids droop, typically increasing over the course of the day and improving after periods of rest<\/li>\n<li><strong><a href=\"https:\/\/www.first-sight.ch\/en\/glossar\/double-vision\/\">Double vision (diplopia)<\/a>:<\/strong> the eye muscles work unevenly, so that the eyes are no longer aligned in a synchronised way<\/li>\n<li><strong>Changing eye position:<\/strong> the squint can vary from day to day and even within a single day<\/li>\n<li><strong>Fatigability:<\/strong> symptoms worsen with exertion and improve after rest<\/li>\n<\/ul>\n<h2>Diagnosis<\/h2>\n<p>Diagnosing myasthenia gravis can be demanding, since the symptoms fluctuate. The following investigations help to confirm it:<\/p>\n<ul>\n<li><strong>Ice pack test:<\/strong> an ice pack is placed on the closed lid for a few minutes. If the lid then lifts noticeably, this points to myasthenia.<\/li>\n<li><strong>Blood test:<\/strong> detection of antibodies against acetylcholine receptors (positive in about 85 % of patients with the generalised form, less often in the purely ocular form)<\/li>\n<li><strong>Electromyography (EMG):<\/strong> measures the electrical activity of the muscles and shows characteristic fatigue on repeated stimulation<\/li>\n<li><strong>CT or MRI of the chest:<\/strong> to assess the thymus gland, which can play a role in the development of the disease<\/li>\n<\/ul>\n<h2>Treatment<\/h2>\n<p>Treatment aims to improve neuromuscular transmission and to control the immune response:<\/p>\n<h3>Drug treatment<\/h3>\n<ul>\n<li><strong>Cholinesterase inhibitors (e.g. pyridostigmine):<\/strong> improve signal transmission between nerve and muscle and relieve the muscle weakness<\/li>\n<li><strong>Corticosteroids:<\/strong> suppress the excessive immune response<\/li>\n<li><strong>Immunosuppressants (e.g. azathioprine, mycophenolate mofetil):<\/strong> for long-term control of the disease<\/li>\n<li><strong>Plasmapheresis and intravenous immunoglobulins:<\/strong> for acute deterioration, to remove the harmful antibodies rapidly<\/li>\n<\/ul>\n<h3>Surgical treatment<\/h3>\n<p>Where the thymus gland is enlarged or abnormal, a thymectomy (surgical removal) can be considered. In many patients this procedure leads to a long-term improvement in symptoms.<\/p>\n<h3>Eye surgery<\/h3>\n<p>Surgical correction of ptosis or an eye misalignment is only considered once the disease has been stable for one to two years. Because the muscle weakness can fluctuate, operating too early would carry an unpredictable result.<\/p>\n<h2>Living with myasthenia gravis<\/h2>\n<p>The condition requires long-term medical care. With well-adjusted treatment, most of those affected lead a largely normal life. It is important to know the warning symptoms of deterioration, particularly difficulty swallowing or breathing, and to seek medical help immediately. Ophthalmological check-ups serve to adjust prism lenses for double vision and to monitor the eye muscles.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Myasthenia gravis is an autoimmune disease in which the body&#8217;s own immune system disrupts communication between nerves and muscles. Antibodies block the receptors on the muscle, so that nerve signals no longer arrive in full. The result is an exertion-dependent muscle weakness that increases over the course of the day. The eye muscles are particularly [&hellip;]<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_wpce_doc":"eyJndWlkIjoiYzcxMTRiZjItOWZhNy00NTdjLWI4YTMtNzQwNGQ3MzVlYTlkIiwiaWQiOiJyb290IiwiY2hpbGRyZW4iOlt7InZpc2libGUiOnRydWUsInByb3BlcnRpZXMiOnsiY29udGVudCI6IjxwPk15YXN0aGVuaWEgZ3JhdmlzIGlzIGFuIGF1dG9pbW11bmUgZGlzZWFzZSBpbiB3aGljaCB0aGUgYm9keSdzIG93biBpbW11bmUgc3lzdGVtIGRpc3J1cHRzIGNvbW11bmljYXRpb24gYmV0d2VlbiBuZXJ2ZXMgYW5kIG11c2NsZXMuIEFudGlib2RpZXMgYmxvY2sgdGhlIHJlY2VwdG9ycyBvbiB0aGUgbXVzY2xlLCBzbyB0aGF0IG5lcnZlIHNpZ25hbHMgbm8gbG9uZ2VyIGFycml2ZSBpbiBmdWxsLiBUaGUgcmVzdWx0IGlzIGFuIGV4ZXJ0aW9uLWRlcGVuZGVudCBtdXNjbGUgd2Vha25lc3MgdGhhdCBpbmNyZWFzZXMgb3ZlciB0aGUgY291cnNlIG9mIHRoZSBkYXkuIFRoZSBleWUgbXVzY2xlcyBhcmUgcGFydGljdWxhcmx5IG9mdGVuIGFmZmVjdGVkLCBhbmQgZnJlcXVlbnRseSB0aGUgZmlyc3QgdG8gYmUgaW52b2x2ZWQuPFwvcD5cbjxoMj5PY3VsYXIgYW5kIGdlbmVyYWxpc2VkIGZvcm1zPFwvaDI+XG48cD5JbiA8c3Ryb25nPm9jdWxhciBteWFzdGhlbmlhPFwvc3Ryb25nPiB0aGUgd2Vha25lc3MgaXMgY29uZmluZWQgdG8gdGhlIGV5ZSBtdXNjbGVzIGFuZCB0aGUgbGlkIGVsZXZhdG9ycy4gQWJvdXQgaGFsZiBvZiB0aGUgcGF0aWVudHMgd2hvIGJlZ2luIHdpdGggZXllIHN5bXB0b21zIG5ldmVydGhlbGVzcyBkZXZlbG9wIGEgZ2VuZXJhbGlzZWQgZm9ybSB3aXRoaW4gdHdvIHllYXJzLCBpbiB3aGljaCB0aGUgbXVzY2xlcyBvZiB0aGUgYXJtcywgbGVncywgZmFjZSBvciBhaXJ3YXlzIGNhbiBhbHNvIGJlIGludm9sdmVkLjxcL3A+XG48aDI+U3ltcHRvbXMgYWZmZWN0aW5nIHRoZSBleWVzPFwvaDI+XG48dWw+XG48bGk+PHN0cm9uZz5QdG9zaXMgKGRyb29waW5nIHVwcGVyIGxpZCk6PFwvc3Ryb25nPiBvbmUgb3IgYm90aCB1cHBlciBsaWRzIGRyb29wLCB0eXBpY2FsbHkgaW5jcmVhc2luZyBvdmVyIHRoZSBjb3Vyc2Ugb2YgdGhlIGRheSBhbmQgaW1wcm92aW5nIGFmdGVyIHBlcmlvZHMgb2YgcmVzdDxcL2xpPlxuPGxpPjxzdHJvbmc+PGEgaHJlZj1cImh0dHBzOlwvXC93d3cuZmlyc3Qtc2lnaHQuY2hcL2VuXC9nbG9zc2FyXC9kb3VibGUtdmlzaW9uXC9cIj5Eb3VibGUgdmlzaW9uIChkaXBsb3BpYSk8XC9hPjo8XC9zdHJvbmc+IHRoZSBleWUgbXVzY2xlcyB3b3JrIHVuZXZlbmx5LCBzbyB0aGF0IHRoZSBleWVzIGFyZSBubyBsb25nZXIgYWxpZ25lZCBpbiBhIHN5bmNocm9uaXNlZCB3YXk8XC9saT5cbjxsaT48c3Ryb25nPkNoYW5naW5nIGV5ZSBwb3NpdGlvbjo8XC9zdHJvbmc+IHRoZSBzcXVpbnQgY2FuIHZhcnkgZnJvbSBkYXkgdG8gZGF5IGFuZCBldmVuIHdpdGhpbiBhIHNpbmdsZSBkYXk8XC9saT5cbjxsaT48c3Ryb25nPkZhdGlnYWJpbGl0eTo8XC9zdHJvbmc+IHN5bXB0b21zIHdvcnNlbiB3aXRoIGV4ZXJ0aW9uIGFuZCBpbXByb3ZlIGFmdGVyIHJlc3Q8XC9saT5cbjxcL3VsPlxuPGgyPkRpYWdub3NpczxcL2gyPlxuPHA+RGlhZ25vc2luZyBteWFzdGhlbmlhIGdyYXZpcyBjYW4gYmUgZGVtYW5kaW5nLCBzaW5jZSB0aGUgc3ltcHRvbXMgZmx1Y3R1YXRlLiBUaGUgZm9sbG93aW5nIGludmVzdGlnYXRpb25zIGhlbHAgdG8gY29uZmlybSBpdDo8XC9wPlxuPHVsPlxuPGxpPjxzdHJvbmc+SWNlIHBhY2sgdGVzdDo8XC9zdHJvbmc+IGFuIGljZSBwYWNrIGlzIHBsYWNlZCBvbiB0aGUgY2xvc2VkIGxpZCBmb3IgYSBmZXcgbWludXRlcy4gSWYgdGhlIGxpZCB0aGVuIGxpZnRzIG5vdGljZWFibHksIHRoaXMgcG9pbnRzIHRvIG15YXN0aGVuaWEuPFwvbGk+XG48bGk+PHN0cm9uZz5CbG9vZCB0ZXN0OjxcL3N0cm9uZz4gZGV0ZWN0aW9uIG9mIGFudGlib2RpZXMgYWdhaW5zdCBhY2V0eWxjaG9saW5lIHJlY2VwdG9ycyAocG9zaXRpdmUgaW4gYWJvdXQgODUgJSBvZiBwYXRpZW50cyB3aXRoIHRoZSBnZW5lcmFsaXNlZCBmb3JtLCBsZXNzIG9mdGVuIGluIHRoZSBwdXJlbHkgb2N1bGFyIGZvcm0pPFwvbGk+XG48bGk+PHN0cm9uZz5FbGVjdHJvbXlvZ3JhcGh5IChFTUcpOjxcL3N0cm9uZz4gbWVhc3VyZXMgdGhlIGVsZWN0cmljYWwgYWN0aXZpdHkgb2YgdGhlIG11c2NsZXMgYW5kIHNob3dzIGNoYXJhY3RlcmlzdGljIGZhdGlndWUgb24gcmVwZWF0ZWQgc3RpbXVsYXRpb248XC9saT5cbjxsaT48c3Ryb25nPkNUIG9yIE1SSSBvZiB0aGUgY2hlc3Q6PFwvc3Ryb25nPiB0byBhc3Nlc3MgdGhlIHRoeW11cyBnbGFuZCwgd2hpY2ggY2FuIHBsYXkgYSByb2xlIGluIHRoZSBkZXZlbG9wbWVudCBvZiB0aGUgZGlzZWFzZTxcL2xpPlxuPFwvdWw+XG48aDI+VHJlYXRtZW50PFwvaDI+XG48cD5UcmVhdG1lbnQgYWltcyB0byBpbXByb3ZlIG5ldXJvbXVzY3VsYXIgdHJhbnNtaXNzaW9uIGFuZCB0byBjb250cm9sIHRoZSBpbW11bmUgcmVzcG9uc2U6PFwvcD5cbjxoMz5EcnVnIHRyZWF0bWVudDxcL2gzPlxuPHVsPlxuPGxpPjxzdHJvbmc+Q2hvbGluZXN0ZXJhc2UgaW5oaWJpdG9ycyAoZS5nLiBweXJpZG9zdGlnbWluZSk6PFwvc3Ryb25nPiBpbXByb3ZlIHNpZ25hbCB0cmFuc21pc3Npb24gYmV0d2VlbiBuZXJ2ZSBhbmQgbXVzY2xlIGFuZCByZWxpZXZlIHRoZSBtdXNjbGUgd2Vha25lc3M8XC9saT5cbjxsaT48c3Ryb25nPkNvcnRpY29zdGVyb2lkczo8XC9zdHJvbmc+IHN1cHByZXNzIHRoZSBleGNlc3NpdmUgaW1tdW5lIHJlc3BvbnNlPFwvbGk+XG48bGk+PHN0cm9uZz5JbW11bm9zdXBwcmVzc2FudHMgKGUuZy4gYXphdGhpb3ByaW5lLCBteWNvcGhlbm9sYXRlIG1vZmV0aWwpOjxcL3N0cm9uZz4gZm9yIGxvbmctdGVybSBjb250cm9sIG9mIHRoZSBkaXNlYXNlPFwvbGk+XG48bGk+PHN0cm9uZz5QbGFzbWFwaGVyZXNpcyBhbmQgaW50cmF2ZW5vdXMgaW1tdW5vZ2xvYnVsaW5zOjxcL3N0cm9uZz4gZm9yIGFjdXRlIGRldGVyaW9yYXRpb24sIHRvIHJlbW92ZSB0aGUgaGFybWZ1bCBhbnRpYm9kaWVzIHJhcGlkbHk8XC9saT5cbjxcL3VsPlxuPGgzPlN1cmdpY2FsIHRyZWF0bWVudDxcL2gzPlxuPHA+V2hlcmUgdGhlIHRoeW11cyBnbGFuZCBpcyBlbmxhcmdlZCBvciBhYm5vcm1hbCwgYSB0aHltZWN0b215IChzdXJnaWNhbCByZW1vdmFsKSBjYW4gYmUgY29uc2lkZXJlZC4gSW4gbWFueSBwYXRpZW50cyB0aGlzIHByb2NlZHVyZSBsZWFkcyB0byBhIGxvbmctdGVybSBpbXByb3ZlbWVudCBpbiBzeW1wdG9tcy48XC9wPlxuPGgzPkV5ZSBzdXJnZXJ5PFwvaDM+XG48cD5TdXJnaWNhbCBjb3JyZWN0aW9uIG9mIHB0b3NpcyBvciBhbiBleWUgbWlzYWxpZ25tZW50IGlzIG9ubHkgY29uc2lkZXJlZCBvbmNlIHRoZSBkaXNlYXNlIGhhcyBiZWVuIHN0YWJsZSBmb3Igb25lIHRvIHR3byB5ZWFycy4gQmVjYXVzZSB0aGUgbXVzY2xlIHdlYWtuZXNzIGNhbiBmbHVjdHVhdGUsIG9wZXJhdGluZyB0b28gZWFybHkgd291bGQgY2FycnkgYW4gdW5wcmVkaWN0YWJsZSByZXN1bHQuPFwvcD5cbjxoMj5MaXZpbmcgd2l0aCBteWFzdGhlbmlhIGdyYXZpczxcL2gyPlxuPHA+VGhlIGNvbmRpdGlvbiByZXF1aXJlcyBsb25nLXRlcm0gbWVkaWNhbCBjYXJlLiBXaXRoIHdlbGwtYWRqdXN0ZWQgdHJlYXRtZW50LCBtb3N0IG9mIHRob3NlIGFmZmVjdGVkIGx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