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  • Study supports use of ice packs to diagnose myasthenia gravis

    Neuro-Ophthalmology/Orbit

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    This study describes the effect of heat and ice on ptosis in patients with myasthenia gravis (MG).

    Study design

    The authors applied latex balloons filled with iced or hot (45°C) water to 23 MG patients, 17 of which had significant ptosis (≥2 mm). Each test was performed for 2 minutes; ruler measurements and photographs were taken of the palpebral aperture before and immediately after each test.

    Outcomes

    In all patients, the mean improvement in ptosis with the ice, rest and heat tests were 2.3 mm, 1.3 mm and 0.33 mm, respectively.

    In 17 patients with ptosis greater than or equal to 2 mm, the mean improvement in ptosis with the ice, rest and heat tests were 2.9 mm, 1.8 mm and 0.83 mm, respectively.

    Limitations

    This study was limited by its small sample size.

    Clinical significance

    The study concluded that temperature had a significant effect on ptosis in patients with MG, and refutes the notion that measured changes in ptosis with application of heat or cold are purely due to the associated rest. Thus, it may be helpful to apply cold to the eyelid when testing for myasthenia to potentiate maximal improvement in ptosis.