Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation: A case report

Increased intraocular pressure as the first presenting sign of Miller Fisher syndrome

BACKGROUND

Miller Fisher syndrome (MFS) is a rare triad of ophthalmoplegia, ataxia, and areflexia. There have been few reports of acute angle-closure glaucoma induced by MFS in the literature. However, acute elevation of intraocular pressure in open angle glaucoma induced by MFS has not been reported.

CASE PRESENTATION

A 55-year-old male patient with open-angle glaucoma was admitted to the ophthalmology department due to ocular pain, moderate dilation of the pupils, and an acute increase in intraocular pressure. During diagnosis and treatment, neurofunctional deficits such as ophthalmoplegia, ataxia, and areflexia were presented. The blood ganglioside antibody panel was positive for anti-GQ1b IgG, and Miller Fisher syndrome was diagnosed. The symptoms gradually improved after intravenous immunoglobulin treatment. After 3 months of follow-up, ophthalmoplegia, ataxia and areflexia completely resolved, the patient's intraocular pressure stabilized at baseline, and his pupils returned to normal bilaterally.

CONCLUSION

This is the first case report of open-angle glaucoma with acute IOP elevation as the first symptom of Miller Fisher syndrome. The mechanism may be due to damage to the trabecular meshwork or maintenance of intraocular pressure, which results in acute intraocular pressure elevation in patients with preexisting open-angle glaucoma when the pupil dilates. Clinicians should be aware of the autonomic dysfunction caused by MFS, dilated pupils, and sudden increases in intraocular pressure, regardless of angle status.

Acute vision loss in Guillain–Barré syndrome: A case series and review of literature

Background

Acute vision loss in Guillain–Barré syndrome  is rarely reported in literature. No case of vision loss in Guillain–Barré syndrome due to Angle closure glaucoma  has been reported in AIDP variant GBS.

Case presentation

We report three patients with an acute inflammatory demyelinating polyradiculoneuropathy subtype of GBS who developed acute vision loss during the course of disease. Two patients had autonomic dysfunction with hypertension, in which  one patient presented with painful acute vision loss and was diagnosed with Angle closure glaucoma and another patient had painless vision loss which was due to posterior reversible encephalopathy syndrome. Third patient presented with bilateral papilledema with raised cerebrospinal fluid protein and intracranial pressure. Vision in all the three patients improved after treatment.

Conclusion

Patient with GBS, with autonomic dysfunction and hypertension or elevated cerebrospinal fluid protein may present with acute vision loss during the course of the disease. Early diagnosis and management  help to improve vision and prevent permanent vision loss in these patients.

SIMULTANEOUS BILATERAL ACUTE ANGLE-CLOSURE GLAUCOMA IN MILLER FISHER SYNDROME

PURPOSE

To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes.

METHODS

We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma.

RESULTS

The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years.

CONCLUSIONS

This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angle-closure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.