The eye as a diagnostic key: the ophthalmologist's role in an atypical case of Miller Fisher Syndrome.

Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Diagnosis can be particularly challenging when the clinical presentation is incomplete or atypical, especially in early stages. We report the case of a 54-year-old woman who presented to the emergency department with blurred vision and nonspecific dizziness, without diplopia or other relevant neurological findings. Hospital discharge was initially considered. However, ophthalmologic examination revealed severe bilateral ophthalmoplegia with supranuclear involvement and convergence impairment, in the absence of pupillary abnormalities. These findings prompted hospital admission and neurological evaluation, which confirmed the diagnosis of MFS. Treatment with intravenous immunoglobulins led to complete recovery. This case represents an atypical form of MFS, lacking all three classical components at onset and showing no positive findings on serologic or neuroimaging studies. The initial clinical suspicion raised by the ophthalmology team was essential to prevent premature discharge and allowed early diagnosis and treatment. This report underscores the importance of thorough ocular examination in patients with nonspecific visual symptoms and highlights the key role of ophthalmologists in the early recognition of rare neurological disorders with ocular manifestations.