Eyespy

An 83 year old woman presented with double vision and a droopy left eyelid. Myasthenia gravis was suspected, and the “ice pack” test was performed at the bedside: a glove packed with ice was placed over the left eye for two minutes. The ptosis improved by 2 mm. A provisional diagnosis of myasthenia gravis was later confirmed with a positive test for acetylcholine receptor antibodies and electromyography. The ice pack test is commonly used by ophthalmologists because of its ease of use and quick results and because it is less invasive in the outpatient setting, where patients with ptosis usually present.¹ (This item was previously published in the BMJ, 2007;335:944 doi: 10.1136/bmj.39381.454387.47).