Ocular myasthenia gravis: diagnosis often delayed

When a patient complains of a fluctuating ptosis or diplopia the diagnosis 'ocular myasthenia gravis' must be considered. The diagnosis can be difficult because of the subtle symptoms and less sensitive diagnostic testing. Because of this, there is often a patient and doctors delay. We describe 3 patients, a 63-year-old man, a 49-year-old woman and a 77-year-old woman, who received the right diagnosis only after 22 months, 4 months and even 9 years after the first symptom occurred. At the neurological examination the provocation tests are of high importance. Confirmation of the diagnosis can be established with the following diagnostic procedures: neostigmine test, serological testing for antibodies against acetylcholine receptors and single fibre EMG.