II. Indications

  1. Ptosis evaluation in suspected Myasthenia Gravis

III. Contraindications

  1. Not useful in extraocular Muscle Weakness evaluation

IV. Mechanism

  1. Neuromuscular transmission improves at cooler Temperatures

V. Preparation

  1. Fill small bag (or surgical glove) with ice

VI. Technique

  1. Evaluate Ptosis before applying ice
  2. Place filled ice bag over a closed lid for 2 minutes
  3. Remove ice after 2 minutes
  4. Evaluate Ptosis immediately after removing ice

VII. Interpretation

  1. Ptosis improves in 80% of Myasthenia Gravis with topical ice
  2. Ptosis does not tend to improve in the absence of Myasthenia Gravis

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