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Background: Ocular myasthenia is a localised form of myasthenia clinically involving the extraocular muscles, the m. levator palpebrae superioris and the m. orbicularis oculi. Various symptoms can masquerade peripheral and supranuclear eye muscle palsies and ptosis., Materials and Method: This literature review of recent years focuses on the diagnostic tests that may be helpful to confirm myasthenia especially in patients without acetylcholine receptor antibodies., Conclusions: Ocular dysfunction accounts for 50-80% of the initial manifestation of myasthenia gravis. Clinical manifestations, diagnostic tests and treatment assessment are reviewed. Early recognition of the disease is important for better prognosis.

In the last two decades, botulinum toxin A (BtxA) has become the treatment of choice for spasmodic torticollis, blepharospasm and hemifacial spasm. Since 1999 Dysport and Botox are approved in Austria for the treatment of these indications. BtxA is applied in the hospital (out- and in-patient clinics) and by specialists (especially neurologists) in private practices. Complete reimbursement of the costs by the health insurance is provided only if the treatment has taken place in the specialist's private practice. The costs of BtxA application in the hospital are partially covered by the so called "LKF points" (Austrian system for reimbursement of costs in the hospital) or by the flat rate fee for out-patients. Approval for other indications for BtxA is expected in the next years, therefore appropriate cost reimbursement for BtxA is of immense importance. Different reimbursement systems are discussed in the following article. It seems useful to adopt approved procedures in special situations, such as reimbursement for the ambulatory application of chemotherapy and Betainterferon in Austria. The appropriate reimbursement system has to consider the indication and documentation of Btx-treatments as well as the qualification of the Btx-user.