What is the role of the ice pack test in the evaluation of myasthenia gravis (MG)?

Updated: Aug 27, 2018
  • Author: Abbas A Jowkar, MBBS; Chief Editor: Nicholas Lorenzo, MD, CPE, MHCM, FAAPL  more...
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The ice pack test (ie, placing ice over the lid) has gained interest among ophthalmologists for assessing improvement in ptosis and diplopia in ocular MG. The rationale behind this test is that cooling might improve neuromuscular transmission.

Movaghar and Slavin questioned the validity of such a test by demonstrating that patients with ocular MG actually improve on the ice, heat, and modified sleep tests. [41] Hence, rest might be the cause of the improvement in ocular signs. Both the ice test and the rest test are sensitive and specific in ocular MG. [42]

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