Fig 1. Variability of the ice test in myasthenia gravis.

A patient with bilateral ptosis in myasthenia gravis, showing inconsistent results of the ice test performed on separate days in the right eye. (A) Asymmetric ptosis was present in both eyes prior to the ice test. (B) Immediately after 2-minute application of ice, ptosis in the left eye significantly improved with a fissure change of 2.5 mm. In contrast, the right eye showed a negative result. (C) Bilateral ptosis in the same patient on a different day prior to the ice test. (D) After the ice test, ptosis in the right eye improved with a fissure change of 1.0 mm, showing an equivocal negative response. (E) Bilateral ptosis in the same patient on a different day prior to the ice test. (F) After the test, ptosis improved with a fissure change of 2.0 mm in the right eye, showing a positive result.