Turkiye Klinikleri Journal of Ophthalmology

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Superior Oblik Felcini Taklit Eden Miyastenia Gravis
Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy
Feray KOÇa, Turan AKBALIKa
aİzmir Atatürk Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, İzmir, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(1):92-5
doi: 10.5336/ophthal.2018-64125
Article Language: TR
Full Text
ÖZET
 Bu çalışmada, sırasıyla tek ve çift taraflı superior oblik felcini taklit eden bir oküler miyastenia gravis olgusu sunularak, superior oblik felcinin ayırıcı tanısında oküler miyastenia gravisın dikkate alınması gerektiği vurgulanmak istenmiştir. Bir yıldır devam eden çift görme şikâyeti olan 53 yaşındaki erkek olgu, sağ superior oblik felci tanısı almış ve cerrahi planlanmıştı. İkinci bir görüş için gelen olguya primer pozisyonda sol intermittan hipertropya ve ekzotropya saptandı ve üç basamak testi ile bilateral superior oblik felci tanısı konuldu. Subjektif torsiyon yoktu, ancak çift Maddox testinde 10°ekstorsiyon saptandı. Takipte, üç ay içinde göz hareketleri tüm yönlerde kısıtlanma ve sağ pitozis gelişti. Pupil tutulumu olmayan hastada bu bulgularla oküler miyastenia gravisten şüphe edildi. Pitozisin buz testi ile tamamen düzelmesi ile oküler miyastenia gravis tanısı konuldu. Superior oblik felci, vertikal şaşılığın en sık izlenen nedenidir. Ancak ayırıcı tanıda oküler miyastenia gravis akılda tutulmalı ve klinik stabilite gözlemlenmeden tedavi planlanmamalıdır.

Anahtar Kelimeler: Diplopi; miyastenia gravis; superior oblik felci
ABSTRACT
 We aimed to draw attention to ocular myasthenia gravis to be considered in the differential diagnosis of superior oblique palsy by presenting a case who mimicked both unilateral and bilateral superior oblique palsy. A 53-year old male patient with a history of double vision for one year was diagnosed as having right superior oblique palsy and was planned for surgery. He came for the second opinion. Left intermittent hypertropia and exotropia was detected in the primary position and bilateral superior oblique palsy was diagnosed with three-step test. There was no subjective torsion, but a 10° extorsion was detected in the double Maddox test. In follow-up less than three months, eye movements restricted in all directions and right ptosis developed. The patient had no pupil involvement. ocular myasthenia gravis was diagnosed after observing complete resolution of ptosis with ice-pack test. Superior oblique paralysis is the most common cause of vertical strabismus. However, ocular myasthenia gravis should be kept in mind in the differential diagnosis and treatment should not be planned without clinical stability.

Keywords: Diplopia; myasthenia gravis; superior oblique palsy
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