A 33-year-old woman presents with bilateral ptosis that reportedly improves with rest

The image is consistent with a diagnosis of myasthenia gravis. 

• Myasthenia gravis is an autoimmune disease that results in muscle fatigability and weakness throughout the day. Symptoms improve with rest.
• Its main ophthalmologic symptoms include eyelid drooping, diplopia, variable extraocular muscle palsies or incomitant strabismus, and external ophthalmoplegia.
• Unfortunately, the underlying disease process of myasthenia gravis is systemic and cannot be cured, but medical treatment is available to help manage symptoms. 

• Primary care can diagnose MG clinically or via pharmacologic testing.
• If the test results are positive, the physician can refer the patient to the ophthalmologist to follow up on improvement of ocular symptoms with medical treatment.
• In a case of a myasthenic crisis, the emergency room physician should admit the patient and treat with intravenous immunoglobulin and plasma exchange.

Observe patterns of ptosis, diplopia, etc. and track improvement with medical management.

Assess the possibility of double vision and treat with patching, accordingly.