Ocular Myasthenia Gravis (OMG) Steroid Hackneyed: A Case Report

Abstract

Myasthenia Gravis is an auto-immune disorder that affects the post-synaptic neuromuscular junction membrane. Acetylcholine receptor (AChR) antibodies are frequently present, and the number of functioning postsynaptic receptors is reduced. Muscle-specific kinase antibodies may be identified in individuals with and without AChR antibodies. It is called the great masquerader owing to its varied clinical presentations. Ocular myasthenia gravis (OMG) is a subtype of the systemic disease which affects only the eye but many patients do progress to generalized form. The mainstay of treatment is acetylcholine esterase inhibitors along with corticosteroids and/or immunosuppressant drugs which is aimed at disease remission and prevention of progression to the generalized form.  We report a case of a 9 year old male patient who was diagnosed as OMG. He was on oral steroids, unmonitored from the past 4 years and came to us for persistent variability of symptoms and was found to have disc changes suspicious of glaucoma with IOP on normal side in both eyes with variable ptosis and diplopia. Systemically she had mild stunting of growth for which the pediatrician and the endocrinologist advised tapering and regular monitoring. We hope to stress upon the importance of ophthalmic and systemic monitoring of patients on steroids for ophthalmologic conditions, specially the pediatric age group. With increasing trends of steroid-induced glaucoma in children over the last few years, probably signifying increasing use of unmonitored steroid use, we would like to stress upon the importance of counseling and regular monitoring of patients on steroid therapy to prevent adverse local and systemic adverse effects.