Shanti, aged 27 yrs presented with complaints of difficulty in reading near print. There is ptosis and diplopic in all directions. She is having:
Myasthenia gravis is characterized by abnormal fatigability of striated muscles after repetitive contraction that improves after rest and often is first manifested by weakness of the extraocular muscles. Unilateral fatiguing ptosis is a frequent first sign, with subsequent bilateral involvement of extraocular muscles, so that diplopia is often an early symptom along with failure of convergence. Unusual ocular presentations may simulate gaze palsies, internuclear ophthalmoplegia, veical nystagmus, and progressive external ophthalmoplegia. Ref: Riordan-Eva P., Hoyt W.F. (2011). Chapter 14. Neuro-Ophthalmology. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.
III CN palsy
Myasthenia gravis
Presbyopia
VI CN palsy