 Kogan's lid twitch sign is another sign that's infrequently seen with ocular myostenia. Ask the patient to look down and then we fixate on your nose. Look at the right eye now you're gonna see an overshoot of that lid and then it'll twitch back down. See that? You don't see that very often in ocular myostenia but in a patient with Tulsa's it's worth performing this exam to see if you can elicit it.