A Case of Ocular Myasthenia: An Eye-Opener

Sudden onset bilateral complete ophthalmoplegia is a challenge to the clinicians and vascular catastrophe or neuro-demyelinating diseases are considered in the first rank. Snake bite mimicking myasthenia-like syndrome in the tropical countries and botulinum toxin exposure in the developed countries are among the reasonable differential diagnoses. We report a 32-year-male patient presenting with an acute onset total ophthalmoplegia. Ice-cooling test, edrophonium test and the repeated nerve stimulation test were found to be normal. A diagnosis of myasthenia gravis was made after a positive anti-acetylcholine receptor antibody test and treatment with pyridostigmine showed gradual improvement over 11 days. Isolated ocular myasthenia is a well-known entity but sudden onset complete ophthalmoplegia is rarely reported in literature. Our case not only puts forward the atypical presentation of myasthenia gravis but also is a reminder of the pitfalls of the conventional diagnostic modalities and states the triumph of early suspicion and rational treatment.