Rare ocular presentation in Miller Fisher syndrome

Abstract

We report case of a young gentleman who presented with bilateral lower limb weakness and associated with bilateral ophthalmoplegia and reduced optic nerve function. His anti-GQ1b antibody was found to be positive, hence, we confirmed the diagnosis of Miller Fisher syndrome (MFS). A 24-year-old gentleman presented with bilateral lower limb weakness for 6 days preceded by one week of influenza-like illness. It was associated with sudden onset of painless bilateral eyes reduced vision and diplopia. On examination, his vision was 6/60 both eyes, relative afferent pupillary defects were equivocal and there were reduced red saturation, color vision and light saturation in both eyes. His bilateral extra-ocular muscle movements were restricted at medial, lateral, and superior gazes. Bilateral anterior segment examinations were normal. Fundus examination showed bilateral optic disc swelling. His Humphrey visual field showed generalized visual field defects in both eyes. Neurological examination showed marked bilateral upper and lower extremities weakness and absent of upper and lower deep tendon reflexes and Babinski’s reflexes. Lumbar puncture was done, and cerebrospinal fluid analysis showed albumin-cytological dissociation. His blood was sent for anti-GQ1b antibodies, and it was found to be positive. Optic neuritis was a rare presentation in MFS other than the classic triad of ophthalmoplegia, ataxia and areflexia. This was more commonly seen in anti-GQ1b antibodies positive MFS. Unfortunately, the patient defaulted treatment and no further follow-ups documented for this patient.