Bilateral ptosis when looking straight ahead. Cover test: slight exophoria (20 seconds). 30 seconds: Limited range of horizontal eye movements to the right and to the left. 40 seconds: Limited range of eye movements in the vertical plane for upward and downward eye movements. 1 minute 20 seconds: ptosis. 1 minute 40 seconds: Vestibulo-ocular reflex. It is evident that the range of eye movements driven via the vestibulo-ocular reflex is still very limited. Vertical plane and (2 minutes) horizontal plane. These findings are typical of an infranuclear gaze palsy, in this case chronic, progressive external ophthalmoplegia (CPEO).
Cover test shows a slight exophoria. Examination of the range of horizontal eye movements (20 seconds) shows severe limitation to the right and to the left. Examination of the range of vertical eye movements (25 seconds) also shows a severe impairment for upward and for downward eye movements. Smooth pursuit (45 seconds) is smooth, but shows a limited range of movements for horizontal and vertical eye movements. Horizontal saccades (1 minute 5 seconds): limited range and slowing. Vertical saccades (1 minute 15 seconds): slowing and limited range of movements. Examination using the head-impulse test shows that the range of movement is still significantly limited in the horizontal and (1 minute 42 seconds) the vertical plane. These findings are typical of an infranuclear gaze palsy, in this case chronic, progressive external ophthalmoplegia (CPEO).