What are the symptoms of myasthenia gravis ocular?

The symptoms of ocular myasthenia gravis are mainly manifested in the extraocular muscles, such as inability to open the eyes, drooping eyelids, or restricted eye movement resulting in strabismus. In addition to the eye shape type, myasthenia gravis also includes systemic and medullary types.

(1) Ocular myasthenia gravis: Myasthenia gravis is usually mild in the morning and severe in the evening. It can also be variable and may lead to incomplete paralysis in the later stages. The muscles throughout the body are not evenly affected, with the extraocular muscles being the most commonly affected. This is an early symptom and may also be limited to the eye muscles for a long time. In mild cases, the eyes cannot be opened, the eyelids droop, the eyelids are distributed asymmetrically, and the frontalis muscle contracts and lifts up as a compensation. Eye movement is restricted, causing strabismus and diplopia, and in severe cases the eyeballs become fixed. The intraocular muscles are generally not affected, and the pupillary reflex is usually normal.

(2) Bulbar (or bulbar) myasthenia gravis: facial muscles, tongue muscles, masticatory muscles and pharyngeal muscles are also easily affected; eyes cannot be fully closed, forehead wrinkles and nasolabial grooves become flat; when smiling, the muscles retracting the corners of the mouth are weaker than the muscles lifting the upper lip, and the lips are lifted and the teeth are exposed as if roaring; chewing is weak, swallowing is difficult, and tongue movement is not smooth; soft palate muscles are weak, and pronunciation is nasal; the voice becomes low or hoarse after talking for a while.

(3) Generalized myasthenia gravis: The muscles of the neck, trunk, and limbs may also be affected, with symptoms such as difficulty in raising the head, often supporting the head with the hands; chest tightness and shortness of breath, fatigue when walking, and inability to walk for long periods of time; difficulty in washing the face, combing the hair, and dressing; tendon reflexes are present, with no sensory impairment; and muscle atrophy is occasionally seen.