Ocular : Ocular myasthenia gravis affects the muscles of the eyes. It often begins with drooping eyelids or double vision, usually less in the morning than at night. According to the neurological literature, over 50% of people with ocular involvement develop generalized myasthenia in 2 years. Some studies have been done looking at treatment with Prednisone to reduce that incidence. Removal of the thymus gland is sometimes done. There are treatments available that modify the immune reaction such as plasmapheresis, intravenous immune globulins and some anti-immune drugs. The first drug used is called an anti-cholinesterase. Acetylcholine is the chemical released by nerve endings that activates muscle cells. In myasthenia gravis the problem is loss of receptor sites or "docking stations" the ach has to attach to to activate. Anticholinesterases inactivate the cholinesterase that would break down the ach before it finds a place to sit. It's a little like an odd game of musical chairs. These docking stations and acetyl choline are present on all muscle cells both in the eyes and in the limbs. Careful follow-up will keep the process under control.
Answered 5/26/2021
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