Numbness and absent deep tendon reflexes suggest chronic inflammatory demyelinating polyradiculoneuropathy or Fisher variant of Guillain-Barré syndrome
Weakness of orbicularis oculi, neck flexion, proximal limbs; difficulty breathing, eating, or swallowing suggest myasthenia gravis
Ataxia and nystagmus suggest spinocerebellar ataxia
Perform muscle biopsy for DNA analysis, electroretinography for pigmentary retinopathy, electrocardiography for cardiac conduction defects, swallowing study for esophageal dysmotility
Provide genetic counseling if a genetic extraocular myopathy diagnosis is confirmed
Trap:
sudden death from cardiac arrhythmia and pneumonia from aspiration are major concerns in genetic extraocular myopathies