Case Report: Treatment of Myasthenic Ptosis with Topical Ocular Oxymetazoline

Significance Ptosis is often the hallmark finding in ocular and general myasthenia gravis. Reduction of ptosis has been achieved with oral and topical ocular medications. However, these medications can result in systemic and ocular side effects. A novel eye drop appears to be effective in reducing ptosis while minimizing side effects. Purpose This case report aimed to demonstrate the efficacy of topical oxymetazoline hydrochloride 0.1%, an alpha-adrenergic agonist in temporary elimination of ptosis associated with myasthenia gravis. Case report A 68-year-old female with a history of myasthenia gravis and longstanding ptosis in the right eye presented to improve the asymmetrical appearance of her eyelids. One drop of oxymetazoline hydrochloride 0.1% was instilled in the right eye of the patient. Within two hours, the ptosis was eliminated, the margin-reflex distance 1 increased by 2.0 mm, and the superior visual field measured by a superior 36-point screening test increased by 15 points. The effect lasted for at least 7 hours. Of note, there was a decrease in elevation of the contralateral non-ptotic eyelid that did not receive a drop of oxymetazoline, which might occur only in myasthenia gravis. Further evaluation is warranted. Conclusions Oxymetazoline 0.1% is effective in reducing and potentially eliminating ptosis related to ocular myasthenia gravis for up to 7 hours.