The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.
	The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Ocular myasthenia gravis

Photo by Professor Chua Chung Nen

A 46 year-old woman presented with a one-year history of bilateral ptosis which worsened towards the end of the day. An ice test in which ice was applied to both eyelids for one minute showed improvement of the ptosis. When the patient was asked to maintain a sustained upgaze there was a proressive worsening of the ptosis.

Bilateral ptosis.

Application of ice to both eyelids.

Improved ptosis following ice test.

Increased ptosis on sustained upgaze.

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