A gentleman in his forties presented with drooping of his right eye (Panel A). A test was done and there was improvement (Panel B). What is the diagnosis and what ‘test’ was done? Answer: refer to page 155

(Refer to page 133) Answer: Ocular myasthenia gravis and an ‘ice pack test’, a two minute application of ice (wrapped in a clean towel or other protective covering) to the affected levator muscle. Myasthenia gravis (MG) is an acquired autoimmune disease caused by antibodies to the acetylcholine receptors at the neuromuscular junction of skeletal muscle. The resultant defect in neuromuscular transmission causes muscle fatiguability and weakness. Weakness may localise purely to eye muscles termed ocular myasthenia or may affect other skeletal muscle termed generalised MG. About 50 to 70% of ocular myasthenia will eventually develop generalised MG.