Seeing double: Eye health and myasthenia gravis

Last updated Jan. 2, 2025, by Agata Boxe
Fact-checked by Patrícia Silva, PhD

While generalized myasthenia gravis (gMG) can affect your eye health, there are steps you can take to protect it.

gMG is a rare neuromuscular condition that interferes with nerves talking to muscles. The resulting communication issues can cause muscle weakness, which tends to affect the eyes first, followed by other muscle groups. Common eye symptoms include ptosis or droopy eyelids and diplopia or double vision.

It can become challenging to do activities involving the eyes, such as reading, driving, and studying. Luckily, treatments, lifestyle changes, and other strategies can help you manage the potential effects of gMG on the eyes.

How gMG affects the eyes

One of the main ways gMG affects the eyes is by weakening eye muscle strength, which can lead to symptoms such as droopy eyelids, double vision, and eye fatigue.

The eye muscles are often affected by gMG first. One reason is that the eye muscles contract much more rapidly than other muscles, which makes them more vulnerable to fatigue — one of the main gMG symptoms.

Eye symptoms may fluctuate from day to day and even over the course of a day. They often get more fatigued as the day progresses, especially if you’ve been actively using your eyes for prolonged periods, such as when working or studying.

The most common gMG eye symptoms are:

• droopy eyelids or ptosis, where one or both eyelids fall over the eye
• double vision or diplopia, seeing two images of one object, which may force you to try to align them by straining your eyes
• blurred vision, when the world looks as if it is viewed through a fog
• eye fatigue, when your eyes are unusually tired, especially after a long period of activity involving your eyes, such as reading or looking at a computer
•  limited eye movement, when it is difficult to move your eyes.

How gMG differs from ocular MG

gMG is different from ocular MG, another type of MG. In generalized MG, muscle weakness tends to begin in the eyes and then affect other muscle groups. In ocular MG, the disease only impacts the muscles of the eye and eyelid movements.

About 85% of all people who have MG have the generalized form, which tends to be more severe than ocular MG.

Most people living with gMG who have eye symptoms experience muscle weakness in other areas — such as those involved in speech, chewing, and swallowing.

Breathing problems such as air hunger, severe breathlessness, may also occur from weakness impacting the muscles responsible for breathing.

Treating eye symptoms

Treatments for gMG eye symptoms include medications, surgery, and lifestyle changes, such as special glasses and eye patches.

Members of your gMG care team should be able to advise you on the best way to address your eye gMG symptoms.

Treatment options may include gMG medications that improve nerve-muscle communication and those that regulate the immune system, which plays a role in the disease.

For severe symptoms, your doctor may suggest other solutions.

In cases of severe gMG, certain treatments can be used to ease disease symptoms, including those affecting the eyes. These treatments include: intravenous immunoglobulin (IVIG) therapy, in which antibodies from healthy donors are administered to help regulate a person’s immune system, and plasmapheresis or plasma exchange, where plasma (the liquid component of blood) is replaced with a substitute without the self-reactive antibodies that cause gMG.

Thymectomy (removal of the thymus gland) is another treatment option that might be recommended. The surgery may help to decrease the production of the self-reactive antibodies that mistakenly attack proteins involved in nerve-muscle communication.

Making lifestyle-specific changes can support your treatment. Examples include:

•  taking regular breaks from computer work or reading to protect your eyes from strain
• ensuring good lighting to avoid overexerting your eyes
• selecting a comfortable chair and desk for work or study to reduce or prevent whole-body muscle fatigue that could also impact the eyes
• using eyelid tape to hold your eyelids up if you have ptosis
• managing double vision by applying a patch to one eye, though it’s important to alternate eyes to avoid vision loss
• wearing prism glasses for double vision, with special lenses that help to realign the images perceived by each eye.

For temporary relief of ptosis, you can also try to open up the eyelids by cooling them with ice cubes wrapped in a cloth. The cold temperature may help to lift them up by contracting the muscles, similar to how the ice pack test is often used in MG diagnosis.

Managing long-term eye health

Regular consultations with your gMG healthcare team and introducing long-term lifestyle adjustments are key to maintaining long-term eye health.

Schedule eye check-ups with your ophthalmologist or neuro-ophthalmologist — a specialist for eye problems related to the nervous system — as often as they recommend. Once a year tends to be the minimum for all people with gMG, but more often may be necessary if your doctor says so or if you experience worsening eye symptoms.

Consider working with an occupational therapist who can check your workstation at home, work, or school and recommend adjustments. They can ensure the lighting is optimized to protect your eyes from strain and that your chair and desk are positioned in a way to reduce overall muscle fatigue.

If possible, schedule your most visually demanding tasks for the times of the day when you feel like you have more energy. Remember to also include scheduled breaks throughout each day to prevent fatigue that might impact your eyes.

Using adaptive technologies such as screen readers, screen magnifiers, and speech-to-text technologies can help prevent or limit eye strain.

Learning to manage stress — known to trigger gMG symptoms, including those affecting the eyes — can also indirectly benefit your eye health. Stress can impact gMG and its potential effects on the eyes by leading to fatigue, which can affect the delicate eye muscles, resulting in ptosis or diplopia.

You may find advice for managing both stress and gMG eye symptoms by maintaining a strong social network through support groups, such as the Myasthenia Gravis News forums.

You can also stay up to date on the latest news about gMG, including eye health, on Myasthenia Gravis News.

Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.