The Miller Fisher Syndrome: An Infranuclear Cause of Diffuse Ophthalmoplegia
Orthoptists are often confronted with patients with diffuse ophthalmoplegia of apparent supranuclear origin who have normal neuroimaging studies. Disorders like myasthenia gravis, vasculopathic, inflammatory and traumatic cranial nerve palsies are frequently encountered. A rare disorder for which the orthoptist should be familiar is called the Miller Fisher syndrome.
In 1956 C. Miller Fisher described three patients with diffuse ophthalmoplegia, ataxia and loss of tendon reflexes. He theorized that these patients had an unusual variant of the Guillian Barre syndrome. In order to fully appreciate the Miller Fisher syndrome, a review of Guillian Barre syndrome is in order.