Involuntary Eye Movements in a Patient with Myasthenia and Hyperthyroidism

A patient with myasthenia gravis, hyperthyroidism, and exophthalmos developed spontaneous involuntary movements of the eyes. These movements were unique in our experience, and reference to similar movements has not been found in the literature. It is the purpose of this communication to describe these abnormal movements in the hope that others may recall having seen similar cases.

Report of Case  A 40-year-old white female with myasthenia gravis of 7 years' duration was seen because of watering, bulging eyes of 2 months' duration. In the past she had recurrent weakness of the fourth and fifth fingers of the left hand which subsided spontaneously (Fig. 1). She subsequently developed limitation of extraocular movements and variable degrees of ptosis which was sometimes aggravated at the time of her menses. Neostigmine was said to have produced no improvement in her ocular symptoms, but later a brief trial on pyridostigmine bromide (Mestinon) improved vocal weakness.