Original articleThe Ice Pack Test in the Differential Diagnosis of Myasthenic Diplopia
Section snippets
Patients and Methods
One hundred two patients seeking treatment at the Orthoptic Clinic conducted by one of the authors (KIC) from June 2005 through September 2006 were evaluated with orbital cooling in a prospective manner. Subjects were enrolled among consecutive patients with diplopia, ptosis, or both at presentation. Inclusion criteria were a recent (less than 1 month) onset or unclear cause of symptoms. Patients were excluded when there was a reliable history suggesting the presence of restrictive strabismus
Results
Eighty-nine patients, 56 males and 33 females aged 27 to 83 years (mean, 54 years), were included in the study and form the basis of this report. Thirteen patients were excluded because of loss to follow-up before establishment of diagnosis, history of posttraumatic restrictive strabismus, or inflammatory cause for blepharoptosis. Mean follow-up time was 9.3 months (range, 6–30 months). No adverse effects to the application of the ice pack, except for mild to moderate discomfort within the
Discussion
After physiologic studies demonstrating a temperature-sensitive effect on repetitive nerve stimulation from myasthenic patients with local cooling,11, 12 Saavedra et al6 suggested a cold test that favorably influences neuromuscular transmission for the diagnosis of ocular myasthenia.
Subsequent studies4, 8, 13, 14, 15 confirmed the diagnostic validity of the test in the evaluation of myasthenic ptosis and suggested 2 minutes as the optimum time of application of the ice pack, from the 5 to 10
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Manuscript no. 2008-1185.
Financial Disclosures(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.