To describe the clinical characteristics of patients with neuroimmune diseases presenting with ophthalmological symptoms. To analyze the time to diagnosis, factors associated with diagnostic and treatment delay and the frequency of initial misdiagnoses. 

Myasthenia gravis(MG) and demyelinating diseases can present with visual symptoms. Early detection is key to an adequate diagnosis and therefore improve neurological prognosis. However, barriers to initial care are not clearly defined.

 A descriptive, retrospective cohort study of the last 412 consultations of patients older than 18 years diagnosed with ocular MG, multiple sclerosis(MS), neuromyelitis optica spectrum disorder(NMOSD), and anti-MOG antibody disease(MOGAD) whose intial presentation was with ophthalmologic symptoms.

75 patients were included; 41(54.7%) with demyelinating diseases and 34(45.3%) with MG. 

Patients with demyelinating diseases and bilateral optic neuritis had a longer diagnostic delay compared to those with unilateral presentation (median 12.5 days[IQR 18.25] vs. 5 days[IQR 7], p=0.04).

A significant difference in diagnostic delay was observed when the first consultation was neurology vs. ophthalmology (median days, 3[IQR 3.5] vs. 4[IQR 5], p=0.024).

In patients with MG, Acetylcholine Receptor Antibody testing was requested earlier when the initial symptom was ptosis than in those without this symptom (median days, 21 [IQR 32] vs. 150 [IQR 142], p=0.02). 33% (n=25) of patients had an initial misdiagnosis, with no significant differences between specialties. However, those with a prior ophthalmologic history had a higher rate of misdiagnosis (50% vs. 23.4%; p=0.03).

Finally, there was a significant negative correlation between the year of symptom onset and diagnostic delay(r=–0.46; p<0.001), indicating a shorter time to diagnosis in more recent years.