Hi, joeeed. Sorry to hear you are having a tough time getting diagnosed. The drooping of the eyelid is only one symptom and the vision issue is just a second issue. Not sure why you think you have MG if you have had symptoms for 19 months and not gone into crisis. Not saying you don't have it but there may be other issues. Your use of methatrexate could be masking some of it as it is an Immunosuppressive drug, but I don't think it is used to treat MG so that could be a toss up. My suggestion is to make sure that the neuro's that you see are well versed in MG and not just your run of the mill neuro. Since I was diagnosed and treated, I have seen 6 neuro's and all but 2 were in to see me more to learn than help. I now have two solid doctors that treat me together (at different practices) and confer on their thoughts and treatment plans. This is a tough disease and may differ from patient to patient and each one of us brings other baggage to the party. I first had symptoms back in April or May of 2016 and only went into my first crisis at the end of August 2016. After 5 more trips to the ER and being admitted each time, I was done with the hospital part of this in January or 2017. Only now am I starting to feel like a real person and that is a day by day deal. Some days I wake up with vision issues, or swallowing issues, or breathing issues. Muscle fatigue is real and still happens each day. My life is different now and I find planning my chores and taking naps daily help.

Methotrexate was one of the list of drugs my neurologist said was a possibility for treating MG. It was lower on the list than prednisone, Imuran or Cellcept, but one that might be used. So, yes, it could be helping if you have MG.
MG flares and so ptosis and double vision could coincide. I generally had both together and got used to letting one eye close as it wanted to and at the same time it got rid of the double vision by only using one eye. I had started patching one eye, then putting scotch tape on one of my glasses lens and finally just let one eye close on its own.
My own double vision and ptosis was least when I first woke up, but got worse as the day went by. You might ask your doctor to do a test of Mestinon -- take one pill when your vision is worst and see if it improves it in 30-60 minutes for a few hours. That is an indication you have MG.
Hope you find out what is wrong.
Good Luck Russ

@wakimball May thanks for your reply. I have been told that there is a suspicion of only ocular myastinia gravis. The neuros I have seen have been baffled. Trying to find a good neuro is like a needle in a haystack. I will have to say I was off methatrexate for three months last year and I did get other symptoms, really bad fatigue, my right leg was finding it difficult to get up from a sitting position.
I also have facial flushing which is embarrassing. I appreciate all your feedback and wish your journey all the best thank you

@rhanson you hit the nail on the head with what I was thinking, however it’s weird my symptoms are in the morning. And my double vision is in episodes. Light bothers me especially strip lighting (led) stress. An bring it on. I have been left on a 3 month wait to see the neuro end of jan which is annoying. I must add I’ve had neck and upper back pain which I’m having acupuncture to treat. It’s soooo frustrating. Your feedback is appreciated and welcomed as it’s calming to hear other people’s experiances and opinions , thank you