PMC6379256_01
Eyelid symptoms before and after the neostigmine test. (A) Before the test. Both eyes, especially the left one, showed ptosis. (B) 30 min after the test. Ptosis improved dramatically, to a greater extent in the left eye. (C) 60 min after the test. Both eyelids recovered nearly to a normal state. Relative score = 100% (positive). In the neostigmine test, the most severely affected muscle group was chosen, the muscle power at baseline was scored, then neostigmine (1.5 mg) and atropine (0.5 mg) were administered intramuscularly. The patient was then evaluated every 10 min for a total of 60 min. Relative Score = (score at baseline - score when improvement was greatest after injection) / (score at baseline) x 100%. Relative scores <= 25% were classified as negative; >25% and < 60%, suspected positive; and >=60%, positive.
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F1
The Ptosis was apparently alleviated, based on the positive response in the neostigmine test (Figure 1), but restricted eye movement and diplopia remained.
Eyelid symptoms after cessation of pyridostigmine bromide therapy. (A) At 1 month after cessation of therapy (Dec. 2017). (B) At 3 months after cessation of therapy (Feb. 2018). At both time points, the left eyelid was nearly unaffected, showing only mild abnormality.
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F2
A follow-up in December 2017 and February 2018 showed only mild abnormality in the left eyelid (Figure 2).