Curtain Sign in Myasthenia Gravis

This post is an answer to the Case – Double Vision and Eyelid Drooping

Manual raising of the ptotic right eyelid resulted in drooping of the left eyelid. This finding — known as the curtain sign, or enhanced ptosis — is characteristically seen in myasthenia gravis.

Repetitive nerve stimulation of the patient’s orbicularis oculi muscle showed a decremental response, and acetylcholine receptor antibody levels were elevated. A diagnosis of myasthenia gravis was made. Computed tomography of the chest did not show thymic abnormalities.

In myasthenia gravis, extraocular muscle involvement is often asymmetric, which leads to one eyelid that is more ptotic than the other despite the maintenance of equal neuronal stimulation to the muscles on both sides.

In the curtain sign, passive elevation of the more ptotic eyelid decreases the neuronal stimulation to both sides, and the contralateral eyelid relaxes.

Treatment with pyridostigmine and prednisolone was initiated. At the 1-month follow-up, the severity of the patient’s symptoms was visibly reduced.

SIMILAR CASE: Unilateral Ptosis