Woman rubbing her eyes

Spot the Ophthalmic Signs & Symptoms of LEMS

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On This Page PREVALENCE OPHTHALMIC SIGNS & SYMPTOMS DIFFERENTIATING LEMS

Recognizing Lambert-Eaton myasthenic syndrome (LEMS) early may help reduce diagnostic delay1,2

OCULOBULBAR SYMPTOMS

ARE THE CHIEF

COMPLAINT
FOR UP TO

of people with LEMS3

MAY AFFECT UP TO

of people with LEMS
as the disease progresses2,4-7

*Based on a single-center observation study in patients with LEMS (n=23).

Ophthalmic signs and symptoms of LEMS8

Chart showing the percentage of LEMS patients with Ophthalmic signs - 26% Ptosis, 8.5% abnormal ocular mobility, 8.0% strabismus, 7% pupillary dysfunction, and 2% dry eye
Chart showing the percentage of LEMS patients with Ophthalmic symptoms - 23% Ptosis, 20.5% diplopia, 14% decreased vision, and 7% dry eye

*Data from a retrospective review of 176 medical records of all patients diagnosed with LEMS at the Mayo Clinic from 1976-2010.

Clinical insights

  • An indicator of autonomic dysfunction seen in LEMS is pupillary dysfunction, most commonly presenting as sluggish pupils8
  • Decreased vision may result from dry eyes, reflecting underlying autonomic involvement8
Background texture of eye

LEMS and myasthenia gravis (MG) share certain clinical features, but these typically differ in severity and temporal pattern of symptom onset1,2,4,5

MG
LEMS4,5
Symptoms at onset
  • Rare limb weakness
  • Oculobulbar symptoms in the vast majority of patients
  • Most patients present with mild proximal lower 
extremity weakness
  • Later in the disease, patients may develop oculobulbar symtoms, which may affect up to 51% of people with LEMS
Disease pattern
  • Asymmetric weakness common
  • Craniocaudal progression
  • Symmetric weakness common
  • Caudocranial progression
Oculobulbar
symptoms
  • Often predominate early
  • Ptosis may be severe and asymmetric, worsened with extended upgaze
  • Mild and later in disease course
  • Ptosis mild and symmetric, and may improve after short upgaze
  • Autonomic symptoms (eg, difficulty in focusing sight)
Ophthalmoplegia (internal)
  • Possible but rare
  • Sluggish pupillary reflexes
If your patient is presenting with any of these symptoms, you can order an anti-voltage-gated calcium channel antibody test and/or an electrodiagnostic test to confirm the diagnosis.4

References: 1. Harms L, Sieb J-P, Williams AE, et al. Long-term disease history, clinical symptoms, health status, and healthcare utilization in patients suffering from Lambert Eaton myasthenic syndrome: results of a patient interview survey in Germany. J Med Econ. 2012;15(3):521-530. 2. Titulaer MJ, Lang B, Verschuuren JJ. Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies. Lancet Neurol. 2011;10(12):1098-1107. 3. Burns TM, Russell JA, LaChance DH, Jones HR. Oculobulbar involvement is typical with Lambert-Eaton myasthenic syndrome. Ann Neurol. 2003;53:270-273. 4. Costello F, Lee MS. Lambert-Eaton myasthenic syndrome: shaping patient journeys through eye care. MedEdicus. February 11, 2025. Accessed March 23, 2026. https://www.aao.org/Assets/8830465b-c692-42a5-b9e3-bd3625aa0c1c/638775743511930000/march-2025-eyenet-supplement-pdf?inline=1. 5. Wirtz PW, Smallegange TM, Wintzen AR, Verschuuren JJ. Differences in clinical features between the Lambert-Eaton myasthenic syndrome with and without cancer: an analysis of 227 published cases. Clin Neurol Neurosurg. 2002;104(4):359-363. 6. Merino-Ramírez MÁ, Bolton CF. Review of the diagnostic challenges of Lambert-Eaton syndrome revealed through three case reports. Can J Neurol Sci. 2016;43(5):635-647. 7. Titulaer MJ, Lang B, Verschuuren JJ. Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies. Lancet Neurol. 2011. (appendix 1) 8. Young JD, Leavitt JA. Lambert–Eaton myasthenic syndrome: ocular signs and symptoms. J Neuro-Ophthalmol. 2016;36(1):20–22.