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This child is now 2 years old and was brought by the parents because they were concerned about the child tilting his head to the left. They brought two pictures taken at home to demonstrate what they saw. The child was extremely uncooperative at the examination, but he did not object severely to non-threatening occlusion of either eye; cycloplegic refraction was +0.50 in each eye; the media were clear and the fundus was normal. Of note, when the child straightened his head while drinking from a bottle, the right eye appeared to be hyperdeviated as seen in the picture. There was no family of strabismus and the child is otherwise healthy.

1.	What other things would you look for in this case?
	a. facial asymmetry b. slow motor development c. increasing right hyperdeviation on right head tilt d. normal head posture when supine e. all of the above
2.	The most likely diagnosis in this case is:
	a. right inferior rectus palsy b. dissociated vertical deviation c. left superior rectus paresis d. right superior oblique palsy e. (a) or (b)
3.	Treatment for this condition should be:
	a. sectioning of the left sternocleidomastoid muscle b. eye muscle surgery c. observation d. orthoptics e. none of the above

For answers to the above, click here on or after March 8, 2011.