Signs and symptoms of ocular myasthenia

1. Unilateral or bilateral ptosis, usually variable through the day, with diplopia
2. Chief complaint may be blurred vision if lid covers pupil and ptosis is not recognized.
3. Hyper-retraction of the less affected lid can cause a complaint of ocular irritation due to exposure.Hyperretraction is a compensatory mechanism with increased neuronal firing in less affected eye.
4. Dizziness, gait instability, blurring of "visual confusion" that improves with closing one eye
5. SPECIFIC SIGN OF MG: WHEN PTOTIC LID IS MANUALLY (passively) ELEVATED, THE CONTRALATERAL LID DROOPS
6. Cogan lid twitch sign: The patient looks down for 15 seconds, then rapidly up at the examiner's finger. The ptotic eyelid overshoots and is transiently higher than the contralateral lid then drops to its normal position. Its due to transient strengthening of the lid after resting the levator muscle.
7. Any pattern of EOM weakness
8. Dissociated gaze evoked nystagmus contralateral to the paretic eye.This is adaptive and due to increased pulses of innervation.
9. Orbicularis oculi weakness with ptosis is a strong suggestor of MG.
10. Peekaboo sign with gradual appearance of lagopthalmos after forceful lid closure of over a minute with fatigue and incomplete lid closure showing sclera, hence the name, is also seen in facial nerve disorders
11. Pupils are always normal, unlike botulism and IIIn palsy.
12. The "other" Babinski sign (aka "brow lift sign)-- "when orbicularis oculi contracts and the eye closes, the internal part of the frontalis contracts at the same time and the eyebrow raises during eye occlusion." This sign is helpfulin differentiating MG from blepharospasm.