What is your step-wise approach to treating worsening ocular myasthenia gravis symptoms?

I will assume that the patient is AChR antibody positive or seronegative (MuSK is a different discussion).

Usually, I start with pyridostigmine, with gradual titration of dose up to approximately 240 mg (60 mg 4 times a day). Higher doses are not likely to provide additional benefit, and cholinergic ...