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This 20-year-old woman presents with a history of a drooping lid and a left eye deviated down and out for as long as she can remember. Vision is OD 20/20 and OS 20/40. Her refraction is OD -.50 and OS -.75. She does not wear glasses. Her general health is good and she does not have diplopia. She does not report fusion on any tests. Note the ptosis when fixing OD and the normal lid height fixing OS. The vertical deviation is greater when the head is tilted to the right, or higher eye.

1.	A likely diagnosis in this case is:
	a. third nerve palsy affecting at least two muscles in the left eye b. myasthenia c. double elevator palsy, left eye d. inferior oblique palsy, left eye e. inferior rectus palsy, right eye
2.	The most likely cause is:
	a. brain tumor b. unknown (idiopathic) c. convergence insufficiency d. Moebius e. Duane
3.	A likely treatment would be:
	a. prism b. right inferior rectus resection c. right superior rectus recession d. left inferior rectus recession e. none of the above

For answers to the above, click here on or after August 16, 2011.