Objective To collect evidence of treatment for the patients with ocular myasthenia gravis. Methods We searched The Cochrane Library (Issue 1, 2010), PubMed (1966 to April, 2010), CNKI (1979 to April, 2010) and VIP (1989 to April 2010) to identify systematic reviews, randomized controlled trials, controlled clinical trials and prospective avaicohort studies about efficacy and safety of treatment for ocular myasthenia gravis. Results We identified 2 guidelines, 5 systematic reviews and 4 observational studies on inhibitor of acetylcholinesterase, immunosuppressive agents, intravenous immunoglobulin, corticosteroids, and thymectomy for ocular myasthenia gravis. The first choice for ocular myasthenia gravis was inhibitor of acetylcholinesterase. When the symptom could not be remitted, the corticosteroids should be considered. Immunosuppressive agents might be added if the effect of corticosteroids was not good. Plasma exchange was not recommended. Thymectomy should be performed if the patients suffered from thymoma. Conclusion The best clinical evidence can be available by the evidence-based method.
Myasthenia gravis (MG) is an autoimmune disease characterized by antibody-mediated acquired neuromuscular junction transmission disorders. Based on the different muscles involved, MG can be classified into ocular MG (OMG) and generalized MG. Eighty percent of MG patients initially present with OMG, leading to ptosis and diplopia, which significantly impair their quality of life. Approximately 50% to 69.7% of OMG patients may progress to generalized MG within two years, exhibiting symptoms such as limb weakness, dysphagia, and even respiratory failure that threatens life. Due to the diverse manifestations and fluctuating symptoms of OMG, it is often prone to missed and/or misdiagnosis. To further standardize the understanding of OMG among neuro-ophthalmologists, Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Neuro-Ophthalmology Society of Chinese Research Hospital Association, in conjunction with relevant domestic and international literature and guideline consensuses and based on the actual situation in China, have developed the Chinese Expert Consensus on the Clinical Diagnosis and Management of Ocular Myasthenia Gravis (2025). The consensus comprehensively covers clinical diagnosis and management of OMG, including epidemiology, mechanisms of ocular extraocular muscle involvement in MG, clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis, treatment, assessment and prevention strategies for generalized transformation of OMG, and diagnosis and management of refractory OMG, with detailed recommendations provided in nine sections. This consensus is applicable to ophthalmologists, neuro-ophthalmologists, neurologists, and medical personnel engaged in the diagnosis and management of OMG. It aims to standardize the diagnosis and management process of OMG, improve early identification and treatment capabilities, alleviate ocular symptoms of OMG and reduce the risk of generalized transformation.