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To evaluate ocular signs and symptoms in Lambert–Eaton myasthenic syndrome (LEMS) and determine the frequency of ophthalmic involvement.A retrospective review of the medical records of all patients diagnosed with LEMS at the Mayo Clinic in Rochester, MN, from January, 1976, to December, 2010, was performed with special attention to ophthalmic symptoms and signs.One hundred seventy-six patients met the inclusion criteria. Ophthalmic symptoms included ptosis in 41 (23%), diplopia in 36 (20.5%), decreased vision in 24 (14%), and dry eye complaints in 12 (7%). Ophthalmic signs included ptosis in 45 (26%), abnormal ocular motility in 15 (8.5%), strabismus in 14 (8%), pupillary dysfunction in 12 (7%), and findings consistent with dry eyes in 4 (2%).A significant number of patients reported ophthalmic symptoms, and many had objective findings on clinical examination consistent with these symptoms. To our knowledge, this is the largest case series of ophthalmic findings in patients with LEMS and indicates that these patients warrant a complete ophthalmic examination.