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Abstract
An 85-year-old man with progressive external ophthalmoplegia and a history of COAD is reported. He presented with diplopia followed by a right partial and left complete ptosis. His impaired ocular motility mimicked 1V2 syndrome. Full blood count, ESR, urea, electrolytes, anti-acetyl-choline receptor antibodies, Tensilon test, thyroid function tests, CT brain and orbit and chest X-ray did not reveal the aetiology. Histological study of his sputum specimen showed oat cell carcinoma of the lung. Electromyography confirmed the diagnosis of Eaton Lambert syndrome (ELS). Involvement of extraocular muscles can be a presenting sign of ELS and is not as rare as previously speculated.