As many of you know, I'm an MD (psychiatrist) with a background in internal medicine as well. However, ophthalmology was never my strong point. One of my good friends is a dentist who's wife is undergoing some visual problems. She recently had a neuro exam and here were the findings. No dx was made, as of yet, and no tx plans were discussed. A 35 year-old female with a year long h/o ptosis and strabismus OU. Recent lab work was + for acetylcholine receptor antibodies (0.9). A CT of the brain was WNL. No h/o diplopia, dysphagia, or dysarthria, although she does have an intermittent Cogan's OS. PERRLA. VA sc 20/25 OU. VF WNL. She does have some ophthalmoplegia OS. It's been a while, but to me, it sounds like it might be ocular myasthenia gravis. What do you think? Any recommendations or ideas? I referred her to a neuro-ophthalmologist at the Univ. of Mich Med. Center. In the past, I remember similar sxs being treated with Mestinon (~ 90 mgs QID), with improvement post pharm tx. It's been awhile, but this is my take on her sxs. Her treating neuro hasn't rendered a dx yet. Ideas?