DR. ARNAB MANDAL

DR. MOUSUMI BANERJEE, DR.SHALIMA KHATUN, DR. SATABDI SARKAR

Abstract

11 years old male patient presented with drooping of the upper eyelid, diplopia and inward deviation of right eye since one and half months. History of recent onset fever, headache and systemic symptoms was absent. Ptosis in right eye (OD) worsened as the day progressed. On ocular examination, visual acuity was 6/6 in both eyes, extraocular movement was full and free in all gazes; anterior segment, pupillary light reaction and fundus examination were normal in both eyes. On squint evaluation, there was concomitant esotropia in OD with 15 degree deviation. On ptosis evaluation, marginal reflex distance (MRD-1) was 2mm and levator function was normal in OD; ptosis worsened on prolonged up gaze and there was improvement of ptotic lid on icepack test. Thyroid profile and MRI brain & orbit report was normal. Serum acetyl choline receptor antibody level was elevated. Anticholinesterase drug (pyridostigmine) was started; signs & symptoms of ocular myasthenia was improved over period of time.