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Eye movement disorders typical of Miller Fisher syndrome

This picture shows eye movement disorders typical of Miller Fisher syndrome characterized by symmetric almost total ophthalmoplegia with bilateral pupillary mydriasis associated with anti-GQ1b IgG antibodies. Note bilateral ptosis (D) and weakness in bilateral orbicularis oculi (B). (A) on looking to the right; (B) tight closure of the eyes; (C) upward gaze; (D) primary position; (E) downward gaze; (F) on convergence; (G) pupil reaction to light; (H) on looking to the left. (Contributed by Dr. Iizuka.)

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