An ice test for the diagnosis of myasthenia gravis

Objective: To determine whether ice application to a ptotic eyelid can differentiate myasthenic from nonmyasthenic ptosis. Design: Prospective, multicenter, nonrandomized, comparative trial. Participants: Twenty patients with myasthenia gravis (MG) and ptosis were evaluated in the neuro- ophthalmology service. Control Subjects: Twenty patients with nonmyasthenic ptosis evaluated in the same locale. Methods: Palpebral fissures were measured before and immediately after a 2-minute application of ice to the ptotic eyelid. Main Outcome Measures: The difference in palpebral fissures in millimeters before and after ice application. Two or more millimeters of improvement after ice application was considered a positive ice test result. Results: A positive ice test result was noted in 16 of the 20 (80%) patients with MG and in none of the 20 patients without MG (P < 0.001). Of the 4 patients with MG and complete ptosis, 3 had a negative ice test result. Conclusions: The ice test is a simple, short, specific, and relatively sensitive test for the diagnosis of myasthenic ptosis. The sensitivity of the ice test in patients with complete ptosis decreases considerably.