Unilateral Traumatic Ptosis Turned Out to Be Juvenile Ocular Myasthenia Gravis

Juvenile myasthenia gravis is a rare disorder with an incidence of 0.1 per one lakh of which ocular myasthenia gravis is reported in 10-35% cases. Juvenile myasthenia gravis is challenging, due to variations in serological testing, technical difficulty while performing electrophysiological testing, risk of high ocular morbidity when it overlaps with critical periods of vision development. Mainstay of treatment is acetyl cholinesterase inhibitors and immunosuppression. Once the underlying disease is stabilised, surgery can be considered if ptosis persists. Hence any clinical suspicion warrants early involvement of paediatric neurologist and an ophthalmologist. We report a rare case of 4 year old girl whose initial symptom of ocular myasthenia gravis, acute right ptosis with characteristic diurnal variation was manifested after local peri-orbital trauma. Repetitive nerve stimulation showed decremental response. She responded to pyridostigmine and ptosis improved gradually