Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis

Abstract

Hyera Kang,1,2 Yasuhiro Takahashi,1 Masayoshi Iwaki,1 Shinichi Asamura,3 Hirohiko Kakizaki,11Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Ophthalmology, Presbyterian Medical Center, Jeonju, Korea; 3Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, JapanAbstract: Patients with Graves' orbitopathy have a higher probability of myasthenia gravis than does the normal population. Overlapping clinical features cause diagnostic confusion in such a situation. We herein report a patient with Graves' orbitopathy and myasthenia gravis (GO-MG) with normal left eyelid height, but in whom upper eyelid retraction was shown after edrophonium chloride administration. Upper eyelid retraction in GO-MG is occasionally masked by a myasthenia effect. The upper eyelid height must be carefully monitored in patients with Graves' orbitopathy to detect the presence of concomitant myasthenia gravis.Keywords: Graves' orbitopathy, myasthenia gravis, eyelid retraction, edrophonium chloride