Background Management of Ocular Myasthenia Gravis (OMG) patients with immunosuppression is variable due to limited evidence.

Aims i) Audit practice against recently published guidelines

ii) Present natural history data and identify predictive factors of generalisation

Methods We retrospectively analysed 96 patients with ocular presentation of MG presenting to Birmingham Midlands Eye Centre (BMEC) from January 2004 until July 2015. With few exceptions, patients were not treated with immunosuppression prior to generalisation. Data collection was as per the Late Onset Myasthenia Study. We used binary logistic regression to identify predictive factors of generalisation and Kaplan-Meier analysis on time to generalisation.

Results Patients seropositive for acetylcholine receptor antibodies (AChR) (HR: 5.03; 95% CI: 1.48–17.14, p=0.001) and less than 50 years old at disease onset (HR: 3.58; 95% CI: 1.18–10.90, p=0.035) were independent risk factors for generalisation. During follow-up, 46.9% (45/96) patients generalised. Median time to generalisation was 7 months. Time to generalisation was earlier in patients with seropositive AChR (median 5 months vs 21 months, p<0.0001) and bilateral ptosis at onset (p=0.015).

Conclusions As patients were steroid naïve prior to generalisation, our cohort reflected the natural history of the condition. We found most OMG patients can be managed without immunosuppression.