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For most patients, the muscles of the eyes and eyelids are typically the first to be affected, regardless of whether patients continue to have an ocular form of the disease or progress to the generalized type

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When inflammatory cells release highly reactive nitrogen and oxygen species, repeated tissue damage and regeneration of tissue may cause permanent genomic alterations in proliferating epithelium, including point mutations, deletions, or rearrangements, and induce neoplastic transformation [193]