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This 6-year-old boy has had an esodeviation beginning at three years of age. He was the product of normal pregnancy and delivery. Birth weight was 3.5 kg. Early development was normal until this strabismus was noted with all milestones reached on time. This visit at age 6 years is the first time the child has seen an ophthalmologist. He is an only child. At this examination, visual acuity is OD 20/100 and OS 20/20. Cycloplegic refraction is OD +3.75, OS +2.50. A right esotropia of 40 prism diopters is measured in the primary position. The child has strong preference for fixation with the left eye. Ductions are normal in each eye and versions demonstrate a comitant 40 prism diopter esodeviation. This deviation is also measured 40 prism diopters at near while fixing on an accommodative target. On further examination of the eyes, the anterior segment and media are clear and the fundus is normal.

1.	With the information as recorded above you can conclude the following:
	a. The child has congenital esotropia. b. His hyperopia is playing a significant role in this patient’s eye condition. c. A “V” pattern is present. d. The accommodative convergence/ accommodation ratio is high. e. all of the above
2.	Treatment for this child should start with:
	a. eye muscle surgery b. glasses 50% of the power measured with cycloplegia c. “eye exercises” d. pilocarpine drops e. none of the above
3.	When the parents ask about the prognosis for this child you can tell them:
	a. It is likely that he will be wearing glasses for an extended period. b. He is likely to need to wear a patch at some time during the treatment. c. Surgery may be required. d. The chances of the child having straight eyes when treatment is concluded is good. e. all of the above

For answers to the above, click here on or after March 29, 2011.