Abstract: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by muscle weakness and fatigue, often exacerbated by repetitive movements. This article provides a comprehensive review of MG, exploring its etiology, clinical manifestations, diagnostic modalities, treatment options, and emerging therapies. By delving into the complexities of MG, ophthalmologists can enhance their understanding and management of this condition.

Introduction: Myasthenia gravis is a rare but significant autoimmune disorder affecting neuromuscular transmission, leading to muscle weakness and fatigability. Despite its low prevalence, MG can have profound implications for patients’ quality of life and requires multidisciplinary management.

Etiology: MG is primarily caused by autoantibodies targeting components of the neuromuscular junction, particularly the acetylcholine receptor (AChR) or, less commonly, other proteins such as muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4). Genetic predisposition and environmental factors may also contribute to disease development.

Clinical Manifestations: The hallmark symptom of MG is muscle weakness that worsens with activity and improves with rest, often affecting ocular, bulbar, and limb muscles. Ocular manifestations, including ptosis and diplopia, are common initial symptoms in many patients, highlighting the importance of ophthalmologists in early recognition and diagnosis.

Diagnostic Modalities: Diagnosis of MG involves a combination of clinical evaluation, serological testing for autoantibodies, and electrophysiological studies such as repetitive nerve stimulation and single-fiber electromyography. Imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) may be utilized to assess thymic abnormalities in some cases.

Treatment Strategies: Management of MG aims to alleviate symptoms, improve neuromuscular transmission, and prevent disease exacerbations. Treatment modalities include acetylcholinesterase inhibitors, immunosuppressive agents (e.g., corticosteroids, azathioprine, mycophenolate), intravenous immunoglobulin (IVIg), plasma exchange (PLEX), and, in selected cases, thymectomy.

Emerging Therapies: Recent innovations in MG management include the development of targeted immunotherapies such as monoclonal antibodies directed against B cells (e.g., rituximab) or complement proteins (e.g., eculizumab), as well as investigational treatments focusing on immune tolerance induction and novel neuromuscular junction stabilizers.

Conclusion: Myasthenia gravis represents a complex autoimmune disorder with diverse clinical presentations and treatment challenges. By staying abreast of the latest research and therapeutic advancements, ophthalmologists can play a crucial role in the timely diagnosis and comprehensive management of MG.

For further reading and reference:

• Myasthenia Gravis Foundation of America (MGFA) – Patient Information: https://myasthenia.org/
• National Institute of Neurological Disorders and Stroke (NINDS) – Myasthenia Gravis Information Page: https://www.ninds.nih.gov/
• Neurology – Recent Advances in Myasthenia Gravis Research: https://n.neurology.org/