The patient is a 17-year-old male who sought surgical improvement for his drooping right upper eyelid at the First Affiliated Hospital of Jinan University’s Ophthalmology Department on August 17, 2020. The patient’s family reported that the right eye ptosis appeared shortly after birth and was not treated. The drooping right upper eyelid is now affecting his vision and appearance, so he came to our hospital’s ophthalmology outpatient clinic for further diagnosis and treatment. He denies any birth trauma, eye trauma, surgical history, or similar eye diseases in the family. Ophthalmic examination: Right eye uncorrected visual acuity: +1.7 logMAR, corrected visual acuity: +5.50 DS/−0.75 DC130°→ +0.5 logMAR, left eye uncorrected visual acuity: +0.2 logMAR, corrected visual acuity: +1.25DS/−0.50DC160°→ 0 logMAR. The right upper eyelid droops, covering half of the pupil (Fig. 14.1a). The right palpebral fissure height is 3 mm, and when the left eye is covered, the right palpebral fissure height increases to 7 mm (Fig. 14.1b); the levator muscle strength is 5 mm, and the frontalis muscle strength is 8 mm; the left palpebral fissure height is 9 mm, the levator muscle strength is 10 mm, and the frontalis muscle strength is 10 mm. Hirschberg test: when looking straight ahead, the right eye is tilted downward by 15°. Eye movement examination: the right eye’s upward movement is completely restricted in the nasal and temporal directions (Fig. 14.2), the left eye’s eye movement is normal, and there is no compensatory head position. Prism examination: When the left eye is looking horizontally at a 33 cm target, the right eye is down by 35PD. The MRI results of the orbit and optic nerve show no obviousnn abnormalities. The outpatient clinic diagnosed “right eye double elevator palsy” and admitted him to the hospital. After admission, it was found that the patient’s right eye ptosis exhibited a pattern of being milder in the morning and worsening in the evening. Considering the past medical history and the fluctuating clinical manifestations of the right eye ptosis, it is considered to be ocular myasthenia gravis in children, so relevant examinations for ocular myasthenia gravis were carried out. Examination results: Neostigmine test (+) (Fig. 14.3), fatigue test (+) (Fig. 14.4), acetylcholine receptor antibody (+), repetitive nerve stimulation (−). Thyroid ultrasound: The size of the bilateral thyroid is normal, and the changes in the echo and blood flow inside it suggest a high possibility of a colloid cyst; no obvious abnormalities were found in the orbital MRI and chest CT. Combined with the medical history, clinical manifestations, and laboratory examinations, it was diagnosed as ocular myasthenia gravis in children. He was discharged with pyridostigmine bromide combined with a small dose of prednisone acetate for treatment. One week later, the right palpebral fissure increased to 9 mm (Fig. 14.5).

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发表日期：

2025年

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Qing Zhou,
Jian Chen

摘要

The patient is a 17-year-old male who sought surgical improvement for his drooping right upper eyelid at the First Affiliated Hospital of Jinan University’s Ophthalmology Department on August 17, 2020. The patient’s family reported that the right eye ptosis appeared shortly after birth and was not treated. The drooping right upper eyelid is now affecting his vision and appearance, so he came to our hospital’s ophthalmology outpatient clinic for further diagnosis and treatment. He denies any birth trauma, eye trauma, surgical history, or similar eye diseases in the family. Ophthalmic examination: Right eye uncorrected visual acuity: +1.7 logMAR, corrected visual acuity: +5.50 DS/−0.75 DC*130°→ +0.5 logMAR, left eye uncorrected visual acuity: +0.2 logMAR, corrected visual acuity: +1.25DS/−0.50DC*160°→ 0 logMAR. The right upper eyelid droops, covering half of the pupil (Fig. 14.1a). The right palpebral fissure height is 3 mm, and when the left eye is covered, the right palpebral fissure height increases to 7 mm (Fig. 14.1b); the levator muscle strength is 5 mm, and the frontalis muscle strength is 8 mm; the left palpebral fissure height is 9 mm, the levator muscle strength is 10 mm, and the frontalis muscle strength is 10 mm. Hirschberg test: when looking straight ahead, the right eye is tilted downward by 15°. Eye movement examination: the right eye’s upward movement is completely restricted in the nasal and temporal directions (Fig. 14.2), the left eye’s eye movement is normal, and there is no compensatory head position. Prism examination: When the left eye is looking horizontally at a 33 cm target, the right eye is down by 35PD. The MRI results of the orbit and optic nerve show no obviousnn abnormalities. The outpatient clinic diagnosed “right eye double elevator palsy” and admitted him to the hospital. After admission, it was found that the patient’s right eye ptosis exhibited a pattern of being milder in the morning and worsening in the evening. Considering the past medical history and the fluctuating clinical manifestations of the right eye ptosis, it is considered to be ocular myasthenia gravis in children, so relevant examinations for ocular myasthenia gravis were carried out. Examination results: Neostigmine test (+) (Fig. 14.3), fatigue test (+) (Fig. 14.4), acetylcholine receptor antibody (+), repetitive nerve stimulation (−). Thyroid ultrasound: The size of the bilateral thyroid is normal, and the changes in the echo and blood flow inside it suggest a high possibility of a colloid cyst; no obvious abnormalities were found in the orbital MRI and chest CT. Combined with the medical history, clinical manifestations, and laboratory examinations, it was diagnosed as ocular myasthenia gravis in children. He was discharged with pyridostigmine bromide combined with a small dose of prednisone acetate for treatment. One week later, the right palpebral fissure increased to 9 mm (Fig. 14.5).