A 32-year-old woman reports drooping of her right upper lid that varies through the day and is worse when tired. Application of an ice pack over the closed lid for 2 minutes measurably improves the ptosis. This response supports a diagnosis of:
- A Myasthenia gravis ✓
- B Chronic progressive external ophthalmoplegia
- C Oculomotor nerve palsy
- D Aponeurotic dehiscence
Correct answer: A. Myasthenia gravis
Explanation
Fatigable ptosis that improves after the ice pack test is characteristic of myasthenia gravis, where cooling improves neuromuscular transmission. Variable diurnal worsening and Cogan lid twitch further support it. Chronic progressive external ophthalmoplegia causes fixed progressive ptosis with external ophthalmoplegia that does not fluctuate, and aponeurotic ptosis improves in the morning and worsens later, but neither responds to cooling.
Reference: Parsons' Diseases of the Eye, 22nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.