“Mummy I promise I am not doing it on purpose”, pleaded Manraj*. Otherwise a happy 12 year old school going kid, things changed when the lockdown struck. With Manraj spending more (all) the time indoors, his mother noticed an occasional squinting of his eye especially towards the end of the day. She assumed that the increased screen time in the lockdown was making his eyes tired, leading to the squint. The natural solution was, “Nothing doing. No more mobile games for you now. After your online school hours you will not use any mobile phone or laptop. Let’s see if that helps your squint.”

A new symptom comes up…

However to her dismay, this screen discipline did not seem to work and Manraj’s squinting continued. In addition, she noticed that he’d occasionally squeeze his eyes while standing in the balcony in the sunlight. His mother thought that to be a little odd and scolded him for doing so. Poor Manraj was absolutely stumped. He wasn’t doing it on purpose and so was not at all able to decipher his mother’s anger. What was he to do?

The mystery of the evenings…

Over the next two weeks, Manraj’s eye started appearing smaller. Interestingly it used to look fine in the morning and smaller in the evening. “This seems so bizarre”, thought his mother. “Was he doing it to gain my attention?” she wondered. This time she decided to ignore this behaviour for a week to see if he stopped doing it. However, the condition kept progressing and the squint eye and small eye persisted and got worse. Manraj continued to insist that it was all beyond his control.

That`s when Manraj`s mother got worried and brought him for an eye consult to me. The moment I heard Manraj’s symptoms, I realised what was ailing the poor child. I did a few confirmatory tests. One test included using ice packs on his eye. This miraculously opened his eye to the previous, normal size.

The mystery is solved…

With a heavy heart, I informed Manraj’s mother that he was suffering from Myasthenia Gravis. You see, this was not just a simple squint that would simply get corrected with glasses. It was a case of a dangerous disease masquerading as a simple innocent squint. Myasthenia is a rare and serious disorder of the nerves and muscles in which there is weakness of muscles. What was happening was, Manraj’s immune system was mistakenly attacking his own body’s junctions where the eye muscles received signals from the nerves. This resulted in weakness of his eye muscles causing his squint as well as the eye looking smaller. It is quite common for this weakness to worsen in evenings after the day’s activities. (This is the same illness that is also affecting Amitabh Bachhan.)

Wondering about the ice pack? Cooling the muscles works because nerve – muscle transmissions are improved at cooler temperatures. Off course, the condition reverses as soon as the temperature comes back to normal.

Manraj was treated with a course of tablets which normalised his eye shape and squint. While it’s true that this disease has no cure, an early diagnosis can help to start the right treatment on time and thereby watch & prevent potentially dangerous complications like the breathing muscles getting affected. I was really glad to see his mother’s positive spirit when she was just grateful for the timely diagnosis before his disease had a serious impact on his life.

* Real pictures | Not his real name

Dr. Prachi Agashe is a Pediatric Ophthalmlogist and Adult Squint Specialist practicing at Mumbai. Dr. Prachi can be consulted at Agashe Hospital, Mumbai by contacting on 98677539883 / 7304989552 or writing in to Dr. Prachi at contactus@agashehospital.com