فلج پیشرونده خارج چشمی همراه مردمک گشاد

ABSTRACT Progressive external opnthalmoplegia plus anisocoria is a slowly progressive myopathy primarily involving and often limited to the extraocular muscles .Simultaneous involvement of all extraocular muscles permits the eyes to remain in a central position , so that strabismus and diplopia are uncommon ( in rare instances,one eye is affected before the other one ). This disorder usually begins in childhood,sometimes in adolescence ,and rarely in adult life. The pattern of inheritance is autosomal dominant, in some recessive or uncertain in others. As the patient attempts to raise his eywlids and to see under them, the head is thrown back and frontalis muscle is contracted , wrinkling the forehead (Hutchinsonian faces). This case is a 37 year old woman that since two years noticed diplopia and then ptosis of left side.At now in examination ,total movements of eyes are decreaesd and Hutchinsonian faces and left anisocoria are seen.