Persistent Diplopia in Miller Fisher Syndrome: A Case Report

Silvia Maddii CO

Orthoptic and Ophthalmologic Assistance Unit, Careggi Hospital, University of Florence, Italy

Miller Fisher syndrome is a rare variant of Guillain-Barre syndrome characterised by ataxia, ophthalmoparesis and areflexia. This case report describes a 57-year-old Caucasian woman who presented with acute diplopia, progressive areflexia and ataxic gait. Past ocular history reported an intermittent childhood esotropia. Clinical examination found a left esotropia, limited abduction on both right and left gaze, small amplitude nystagmus and mild left ptosis. After a two-year follow-up, her areflexia and ataxia were completely resolved. However, diplopia and strabismus were still present. As generally those with Miller Fisher syndrome show complete resolution of their symptoms, it was hypothesised that the persistent diplopia was likely to be related to a childhood intermittent strabismus which precluded total remission. A period of temporary fusion disruption may have led to decompensation of a pre-existing heterophoria, precipitating an acute acquired concomitant esotropia.