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61 Year Old Suspected For Myasthenia Gravis Avails Best Ptosis and Squint Surgery From Advanced Eye Hospital

61-year-old Vijay Phutane* presented himself at Advanced Eye Hospital Institute (AEHI) located near Vashi, Navi Mumbai, with exotropia in the right eye i.e. squint in  the eye, mild double vision and droopy eyelids in his both eyes.

Vijay Phutane was referred to Dr. Akshay Nair, an Oculoplastic Surgeon specialising in treatment of the eyelid and Ocular Cancer at AEHI. Detailed eye check-up revealed that Vijay had moderate ptosis i.e. droopy eyelids. His eye motility was reduced and there was Exotropia.

Ice pack test was found to be positive. The ice pack test is a safe, inexpensive, and quick to perform procedure. In this test, a covered pack of ice is applied to the eye lids for 2–5 minutes. If the patient shows improvement in the eye motility or level of eyelids by more than 2mm after the ice pack is removed, the result is deemed to be positive. It is thought that by cooling the tissues, and more specifically the skeletal muscle fibres, the activity of the acetylcholinesterases are inhibited.

Dr. Akshay suspected him to have myasthenia gravis (MG) as the initial main symptom of MG is painless weakness of specific muscles, not fatigue. So, he advised him to undergo a test for presence of anti- AChR (Acetylcholine receptor) antibodies.

Acetylcholine Receptor

Myasthenia gravis is a chronic autoimmune neuromuscular disorder associated with the presence of anti- AChR antibodies and with their effects on muscle control. This causes the voluntary skeletal muscles to weaken that are responsible for breathing and moving. The most commonly affected muscles are those of the eyes, swallowing and face resulting in symptoms like drooping eyelids, double vision, trouble talking, and trouble walking.

Acetylcholine is a chemical that transmits messages between nerve cells. AChR antibodies delay communication between nerves and skeletal muscles, inhibit muscle contraction, and cause rapid muscle fatigue by preventing activation of the acetylcholine receptors. One of the ways these antibodies block communication is probably by attaching to the receptors thus preventing Acetylcholine from binding.

Luckily, AChR autoantibodies were subsequently found to be negative.

Vijay was then prescribed with prism glasses to improve the diplopia (double vision) and recommended to be reviewed by Dr. Prachi Agashe for squint evaluation. MRI was advised to rule out any other cause for the squint and the double vision, which was found to be normal.

Dr. Prachi Agashe, a Paediatric Ophthalmologist and a Squint Surgeon at AEHI diagnosed him with severe grade of squint. After a few months of observation he was advised to undergo squint surgery.


After Vijay was convinced with the squint procedure, he underwent the surgery and followed up with Dr. Agashe. Subsequently, Ptosis surgery was planned for him by Dr. Akshay.

For accurate diagnosis, of Strabismus and Diplopia occurring at a later age, several tests are required. Eye doctor needs to rule out myasthenia gravis, diabetes related nerve palsy, any intracranial lesion etc. Only after this confirmation further course of action can be planned. Prisms glasses are very supportive devices in restoring the ability to maintain visual focus but for small deviations. While surgery is recommended for higher deviations, it can also be performed when prism are not tolerated.

About Dr. Akshay Nair
Dr. Akshay Nair, (MBBS, DNB, FLVPEI) is an Ophthalmic Plastic Surgeon and Ocular Oncologist at Advanced Eye Hospital, near Vashi in Navi Mumbai. Dr Nair has a strong academic background and expertise in performing basic and advanced treatment for tearing eyes, ptosis, eye cancers, orbital diseases and aesthetic oculoplastic surgeries. He also has many publications and presentations to his credit and has received many awards at national and international forums. Consult Dr. Akshay Nair by booking an appointment.
About Dr. Prachi Agashe
Dr. Prachi Agashe, (Pediatric Ophthalmology, DNB (Ophth), MBBS) is a Squint Surgeon and Pediatric Ophthalmologist at the Advanced Eye Hospital. She has several years of experience and expertise in dealing with eye problems like Strabismus, Amblyopia (aka lazy eye), Congenital Abnormalities, Childhood Cataract, squint, and all kinds of eye diseases in infants, toddlers, children and babies etc. Consult Dr. Prachi Agashe by booking an appointment.