PURPOSE OF REVIEW: To update our current concepts of ocular myasthenia gravis medical management and to provide a short overview of upcoming treatments. RECENT FINDINGS: Cholinesterase inhibitors and corticosteroids have been the first-line treatment for ocular myasthenia gravis. Several studies on other immunosuppressants, either as a steroid-sparer, steroid adjuvant or initial monotherapy, have demonstrated significant clinical efficacy. Preventing progression to generalized myasthenia gravis is still under debate and needs to be further studied. Novel techniques that target specific components of the autoimmune cascade are forthcoming. SUMMARY: Currently, limited evidence favors the use of corticosteroids, azathioprine, and mycophenolate mofetil in ocular myasthenia gravis. There is a need for rigorous clinical trials on the efficacy and safety of these medical therapeutic options in improving ocular symptoms and decreasing the risk of developing generalized myasthenia gravis. Studies on emerging immunomodulators that dampen autoreactivity without affecting general immunity should be pursued.