In addition to atrophic changes, we also detected EOM MRI signal abnormalities in patients with CPEO, apparent qualitatively as an increased frequency of T1w hyperintense streaks with very occasional STIR hyperintensity. Central streaks of EOM hyperintensity on T1w MRI have previously been reported in CPEO [6], although we also saw similar appearances in some of the control EOMs. While the frequency of these hyperintensities was greater in the patient group, their presence in the healthy control images suggests such changes are not specific markers of CPEO pathology. Similar changes have also been shown to occur with muscle atrophy in patients with congenital fibrosis of the EOMs type 1 [12].