# A Breath of Relief: Oxymetazoline and Flunisolide Nasal Spray in the Management of Myasthenia Gravis Ptosis

## TL;DR

A nasal spray containing oxymetazoline and flunisolide may help treat ptosis in myasthenia gravis patients with fewer side effects.

## Contribution

This case report suggests intranasal oxymetazoline and flunisolide may be effective for MG ptosis.

## Key findings

- A 71-year-old patient's MG ptosis resolved after using intranasal oxymetazoline and flunisolide.
- The treatment showed rapid symptom resolution with a favorable side effect profile.
- The nasal spray is over-the-counter and may serve as an alternative or adjunct to current MG treatments.

## Abstract

The current pharmaceutical management of myasthenia gravis (MG) is widely accepted to be pyridostigmine and prednisone, both known to cause adverse effects and incur significant costs. This treatment may be particularly burdensome for patients primarily complaining of localized ocular MG, and little is known about the management of MG ptosis with topical medications. Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved by the FDA for the treatment of ptosis, but there have been limited studies in MG ptosis and no report to date of symptomatic improvement with the intranasal formulation. This case report discusses a 71-year-old female whose newly diagnosed MG ptosis resolved after three days of intranasal oxymetazoline hydrochloride 0.05%, followed by three days of intranasal flunisolide. Our patient’s rapid resolution of symptoms, along with the favorable side effect profile and over-the-counter availability, highlights the promising indication for the use of intranasal oxymetazoline and flunisolide as potential alternatives or adjuncts in MG management. Further research in larger cohorts is necessary to confirm the efficacy of these nasal sprays in treating MG ptosis.