Changes in the ocular autonomous nerves during recovery in patient with Fisher’s syndrome

Abstract

We tracked the changes in the pupillary light reflex and near pupil constriction, as well as refractive values and ocular pressure, in the recovery process in patient with Fisher’s syndrome. The patient, a 61-year-old woman, became aware of double vision after awakening two days after developing upper respiratory inflammation. She was referred to our hospital for pupil dilation in both eyes and exotropia. Her visual acuity was 1.2 in the right eye and 0.9 in the left eye, indicating mild hyperopia. Ocular hypertension was noted, with ocular pressure of 22.2 mmHg in the right eye and 23.7 mmHg in the left eye. Disturbance of eye movement, blepharoptosis, and convergence paralysis were observed. In a bright room, the pupil diameter increased to 6.5 mm in both eyes, while the light reflex and near pupil constriction had disappeared. Based on the patient’s dizziness, a lack of knee reflex, and anti-GQ1b antibody positivity, a diagnosis of Fisher’s syndrome was made. As the patient had severe ocular motility disorder, immunoglobulin therapy was administered. On day 11 after onset, the light reflex had started to improve but near pupil constriction had not returned. Repeat administration of immunoglobulin therapy resulted in improvement in adduction, but the convergence insufficiency remained. The diopter value of hyperopia increased and ocular pressure exhibited marked variation. Our findings imply dissociation of the light reflex and near pupil constriction, as well as dissociation between adduction and convergence insufficiency, suggesting that Fisher’s syndrome causes not only peripheral neuropathy but also central neuropathy.