A Case Series of Pediatric Ocular

Myasthenia Gravis

Cynthea Prima Destariani, Hardiono D Pusponegoro, Irawan Mangunatmadja,

Setyo Handryastuti, Amanda Soebadi, Achmad Rafli
Department of Child Health, Faculty of Medicine, University Indonesia,
Cipto Mangunkusumo General Hospital, Jakarta
 BACKGROUND
Ocular Myasthenia Gravis (OMG) is a disease subtype characterized by
weakness of extraocular muscles, eyelid elevator and orbicular muscle. It is
characterized by having variable pattern over the involved muscles, and its initial
sign is ptosis.

OBJECTIVE
To report case series of OMG in a 2 years old girls.
 CASE

Two 2 years old girls came to Cipto Mangunkusumo General Hospital. First case has main
complaint bilateral eyelid weakness in two months without other associated symptoms. The
second case has same complaint in three months. On their physical examination, the patients
seen with a compensating position of the head with chin elevation, visual activity were normal,
5mm palpebral opening, 8mm elevator function in the first case and 3mm palpebral opening,
5mm elevator function in the second case. The eyes movement were normal. The ice-pack test
was performed, resulting in a slight improvement of the ocular opening. In first case, anti
acetylcholine (AchR) antibodies were elevated and the second case was normal.
Pyridostigmine was administered in low dose in a week but no improvement on both cases. In
first case we increased the doses until maximum dose, the patient presented a significant
improvement of the symptoms. Second case, until maximum dose we didn’t get improvement,
and we gave corticosteroid 1mg/bodyweight/day in two weeks, patient got improvement of the
symptoms.
CASE 1 CASE 2
BEFORE BEFORE

AFTER AFTER
 CONCLUSION

OMG is a rare disease in pediatric population. Early diagnosis and

commencement of treatment is important to slow the progression of the disease.