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A 21-year-old woman developed diplopia, rhinolalia, and movement imbalance 3 weeks after COVID-19. On neurologic examination, she presented with left mydriasis, mild bilateral lateral rectus palsy, and horizontal gaze-evoked eyelid nystagmus (Video 1). The patient's generalized hyporeflexia and ataxic gait were consistent with symptoms of Miller Fisher syndrome (MFS). A test for GQ1b antibodies returned positive. Despite immunoglobulin therapy, the patient developed respiratory failure requiring mechanical ventilation. The symptoms improved over the succeeding days. MFS has been associated with COVID-19, but this is the first case with positive GQ1b antibodies. 1 Eyelid nystagmus is an intermittent upward jerking of eyelids associated with posterior fossa lesions that can also be present in MFS. 2

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