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chronic_progressive_external_ophthalmoplegia [2026/09/08 12:39] – Scott Larsonchronic_progressive_external_ophthalmoplegia [2026/09/08 12:40] (current) – Scott Larson
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 ===== Overview ===== ===== Overview =====
  
-**CPEO** is a **mitochondrial myopathy** that predominantly affects the extraocular muscles and the levator palpebrae, producing slowly progressive, generally **symmetric ophthalmoparesis** and **ptosis**. Because progression is gradual and symmetric, patients frequently do **not** report diplopia (<30%) and may be unaware of their motility deficit, often adopting a compensatory chin-up head posture ((Larson)).+**CPEO** is a **mitochondrial myopathy** that predominantly affects the extraocular muscles and the levator palpebrae, producing slowly progressive, generally **symmetric ophthalmoparesis** and **ptosis**. Because progression is gradual and symmetric, patients frequently do **not** report diplopia (<30%) and may be unaware of their motility deficit, often adopting a compensatory chin-up head posture.
  
 ===== Onset and Course ===== ===== Onset and Course =====
  
-  * Typical onset in **adulthood** (commonly 18–40 years), with **ptosis** often the first sign ((Larson)).+  * Typical onset in **adulthood** (commonly 18–40 years), with **ptosis** often the first sign.
   * **Slowly progressive** over years; forced ductions are free (myopathic, not restrictive) and **pupils are spared**.   * **Slowly progressive** over years; forced ductions are free (myopathic, not restrictive) and **pupils are spared**.
   * **"CPEO-plus"**: pigmentary retinopathy, cerebellar ataxia, peripheral neuropathy, sensorineural hearing loss, cardiac conduction block, and diabetes.    * **"CPEO-plus"**: pigmentary retinopathy, cerebellar ataxia, peripheral neuropathy, sensorineural hearing loss, cardiac conduction block, and diabetes.