ABSTRACT
The most frequent single symptom is double vision (diplopia). The patient is immediately aware of it, as it occurs acutely. A common situation is the onset in the evening after a long, busy day, e.g. whilst driving a car or watching television. It may have disappeared the next morning and reappear in the evening, or persist in a variable intensity. No consensus is found in the literature about the ocular sign that most frequently appears first: ptosis or diplopia, or which muscle is involved . In many patients with ocular signs, both are present some time after the onset, when they see a doctor. Double vision is always noticed by the patient, but a mild ptosis may escape his attention. The first sign(s) mentioned by my own patients are given in table 2.1. Some patients notice the fluctuation of the diplopia from onset and are able to analyse the double images themselves . (Fig. 2.1) Others only complain of blurred vision, which becomes normal when looking with one eye. Short lasting vertical diplopia after eye opening is mentioned by some patients as the first sign of eye muscle weakness . The diagnosis of MG in that stage is rarely made by the ophthalmologist nor by the neurologist.
