Brow motility in mitochondrial myopathy

PURPOSE:: To quantify the range of brow excursion in patients with mitochondrial myopathy and chronic progressive external ophthalmoplegia (CPEO). METHODS:: Comparative case series. Digital image processing techniques were used to quantify the upper eyelid resting position, brow excursion, and monocular eye movements (ductions) in 19 patients with mitochondrial myopathy and CPEO and in 27 healthy control subjects. RESULTS:: All patients with CPEO had ptosis ranging from 0.6 to 8 mm. For most patients, eye motility limitation was symmetrical. Elevation was the most affected eye movement. Patient's brow motility was on average 56.7% of the motility seen in the control group, and did not correlate with age or eye motility in any direction. Seventy-six percent of the brows displayed more than 2 mm of excursion. CONCLUSIONS:: In patients with CPEO, the occipitofrontalis muscle is less affected than the extraocular muscles. Most patients display a useful degree of brow excursion that theoretically can be used to clear the visual axis after a conservative brow suspension.