Efficacy of apraclonidine eye drops in treating ptosis secondary to myasthenia gravis: A pilot clinical trial

Introduction/AimsMost patients with myasthenia gravis (MG) develop ocular manifestations during their illness and up to 22% may have isolated ocular myasthenia gravis (OMG). Apraclonidine elevates the eyelid by activating alpha-2 receptors on Muller's muscle, an accessory eyelid elevator muscle. In this study we evaluate the effect of apraclonidine in alleviating ptosis secondary to MG. MethodsThis clinical trial (NCT05045248) was done at the American University of Beirut Medical Center. Patients with ptosis secondary to MG were administered two drops of apraclonidine 0.5% solution to the most affected eye. We measured palpebral fissure height (PF), marginal reflex distance-1 (MRD1), marginal reflex distance-2 (MRD2), and levator function (LF) before drug administration and at 1, 5, 30, and 60 minutes after administration. ResultsTen participants were enrolled in the study. Improvement in all eyelid measurements was noted in all participants as early as 1 minute after apraclonidine administration. From baseline to 60 minutes after administration, average PF increased from 8.8 +/- 1.9 mm to 14.2 +/- 2.6 mm, MRD-1 from 1.7 +/- 1.4 mm to 5.4 +/- 2.9 mm, MRD-2 from 7.1 +/- 1.3 mm to 8.8 +/- 1.7 mm, and LF from 13.4 +/- 2.9 mm to 17.5 +/- 2.4 mm. All increases were statistically significant. DiscussionApraclonidine may alleviate ptosis secondary to MG and may be an effective alternative treatment for this group of patients.