Something’s fishy ocular hypertension in miller fisher syndrome / [author]: Adriel Mark R. Del Castillo, Miriam Louella D. Fermin, Alobert Vergel A. Capati,

Includes bibliographical references

ABSTRACT
This is a case report of 57 year old male who was diagnosed with Miller fishy syndrome who presented with ocular hypertension. Initially the patient presented with sore throat and headache and was treated as a case of tonsillitis. 2 days prior, patient had same sign and symptoms now with dysphagia. Few hours prior, patient and hoarseness and difficulty opening his eyes and was the brought to the hospital for further evaluation and management.
Ocular examination revealed near visual acuity of J12, 3-4mm sluggishly-reactive pupil, Intact macular function, Intact color vision, elevated intraocular pressure (28mmHg), open angles, and cup to disc ratio of 0.3 on the right eye. The other eye presented with same findings but with maintained normal pressure. Neurologic examination showed ophthalmoplegia, ataxia, areflexia, bilateral ptosis, hypernasality of voice with limb weakness more prominent on the upper extremities than the lower extremities.
During the hospital; stay, Plaine Cranial CT scan, 12L ECG, Chest Xray, Blood tests, Lumbar tap and EMG was done. Intraocular pressure-lowering and lubricating medication was given to the patient. IVIg 0.4/kg/day for 5 days was given to the patient. Patient also underwent physical and occupational rehabilitation. Patient was subsequent discharged with no symptomatologic improvement ophthalmologic wise.
One moment after discharge, Patient came in for follow-up with resolution of neurologic symptoms, improves visual acuity, mild ptosis and evident scleral show, full and equal extraocular muscle movements with IOP of 22 on the right and 15 on the left hence patient was maintained on timolol maleate + Brimonidine Tartrate eyedrops on the right eye and is subjected for follow up after 3 months.

Research - Department of Ophthalmology