In some cases, corneal transplant may be necessary to restore corneal clarity, but the results are often disappointing even when the underlying disease can be controlled. Myasthenia Gravis Myasthenia Gravis is an autoimmune disease of the muscles leading to weakness and easy fatigability. The symptoms are typically highly variable, intermittent, and may be asymmetrical between the two eyes. There may also be speech and swallowing difficulties, problems with facial expression, and weakness of the muscles of the arms and legs. The symptoms tend to improve after rest and in the morning, and tend to be worse later in the day and after exercise.
Symptoms tend to appear in the middle age years for men and women.
Some cases have occurred after bone marrow transplantation. Patients with prominent ocular symptoms often develop a fairly severe drooping of one or both upper eyelids, worse when tired, that may interfere with vision. The double vision associated with myasthenia can be variable, and does not usually fit into a typical pattern of any one specific eye muscle being involved. Two recent tests that can be suggestive of myasthenia are the sleep test, and the ice pack test. In the sleep test, the degree of eyelid drooping and double vision lessens after the patient sleeps, or rests in a quiet, darkened room, for 30 minutes.