Effect of local heat versus ice on blepharoptosis resulting from ocular myasthenia.

OBJECTIVE: To determine the effect of heat versus ice application to a ptotic eyelid in patients with ocular or systemic myasthenia.

DESIGN: Observational case series.

PARTICIPANTS: Three consecutive patients and one subsequent patient with ptosis and clinical or laboratory signs of myasthenia were initially evaluated.

METHODS: In all four patients, the heat test and the ice test were performed. In three patients, the modified sleep test was also performed. In the heat or ice test, the patient was asked to hold a heat or ice pack, respectively, over the closed ptotic eye for 10 to 15 minutes. The modified sleep test was performed by having the patient close both eyes for a 10- to 15-minute period. Photographs were taken before and immediately after each test.

MAIN OUTCOME MEASURE: The effect of heat or ice on ptosis.

RESULTS: Transient complete improvement of ptosis in three patients and marked improvement in one patient was noted after each test. The results of the heat, ice, and modified sleep tests were identical.

CONCLUSIONS: Marked improvement of myasthenic ptosis in all four patients occurred regardless of local warming or cooling. The common denominator of all these tests, rest, seems to be the relevant factor in the study as designed.