NANOSNET

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital

Dear all,

I have a 38 year old female with new onset painless left upper lid ptosis and supraduction deficit since June 2025, which she says started over 2-5 days, and has not improved. Exam shows fatigable LUL ptosis, which improves with ice pack, left supraduction deficit and large L hypotropia of > 35 PD.

Testing with MRI brain/ orbits WWO, myasthenia panel, VGCC antibodies and SF EMG non revealing and almost no response to Mestinon and steroids.

Given the fatigable nature of her exam, I still have neuromuscular junction disorder at the top of my differential and wanted to know if there would be a role in genetic testing for congenital myasthenia syndromes?
Are there any further tests you might recommend or would recommend/consider a surgical referral for ptosis/ strabismus consults?

Would love any inputs. The patient is a business owner and very distressed and unable to work from her symptoms.

Thank you,

Shruthi Harish
Neuro ophthalmology

Wills Eye Hospital