Beyond Ocular Symptoms: Chronic Progressive External Ophthalmoplegia With Coexisting Facial Palsy and T-wave Inversion

Chronic progressive external ophthalmoplegia (CPEO) exists on a wide phenotypic continuum.The systemic propagation of cellular metabolic impairment frequently precipitates a heterogeneous spectrum of neurogenic, myopathic, and cardiovascular manifestations, clinically designated as CPEO-plus.Beyond the highly susceptible extraocular muscles, other metabolically intensive muscular tissues remain vulnerable to compromised function.Diagnosing CPEO remains challenging because its ocular signs overlap significantly with other conditions.Furthermore, CPEO-plus must be distinguished from Kearns-Sayre syndrome.This case report documents a 43-year-old female patient exhibiting classic ocular manifestations of CPEO, supported by a positive family history and elevated serum lactate levels.The clinical presentation is complicated by atypical features, including mild unilateral facial palsy and signs of cardiac electrical remodeling (T-wave inversion), illustrating the significant phenotypic heterogeneity characteristic of CPEOplus syndromes.