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“Ice-on-eyes”, a simple test for myasthenia gravis presenting with ocular symptoms
  1. Aravind R Reddy, Fellow in Paediatric Ophthalmology and Strabismus,
  2. Oliver C Backhouse, Consultant Ophthalmologist with Special Interest in Neuro-ophthalmology
  1. Department of Ophthalmology, St James’ University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
  1. Correspondence to:
 MrA R Reddy
 Department of Ophthalmology, Chancellor Wing, St James’ University Hospital, Beckett Street, Leeds LS9 7TF, UK; ar{at}

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Myasthenia gravis is a protean disorder with varied clinical presentations. Common presenting symptoms are ocular—droopy eyelids and double vision, in 50–70% of cases.1 And myasthenia gravis can remain purely ocular in up to 20% of patients.1 Therefore, neurologists have to be able to investigate ocular symptoms and signs, without evidence of any problem elsewhere in the neuromuscular system.

There are various tests for the diagnosis of myasthenia gravis, but their relative merits in clinical practice remain unclear.1 With the help of a photographic illustration (fig), we have revisited an easy yet highly specific bedside test—the “ice-on-eyes” test—that can be used in patients presenting with a droopy lid (ptosis) and myasthenia is suspected. The simplicity of the test allows it to be used even in a primary …

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