To see views enlarged, click on the individual pictures...

This 14-year-old girl had right medial rectus recession and right lateral rectus resection for  esotropia four years ago.  Visual acuity is right eye (OD) 20/30 and left eye (OS) 20/20.  Her cycloplegic refraction is OD +1.50 and OS +1.00 and is fully corrected with her glasses.  Her eyes are aligned for the most part in the primary position, but the parents note the right eye deviated upward occasionally.  The girl has no complaints.  Picture 1 is of the patient in the primary position.  In picture 2 a translucent occluder is held in front of the right eye and in picture 3 the occluder is in front of the left eye.

1.	The significant finding on examination of this patient who has a history of intermittent right hypertropia is:
	a. good alignment in the primary position b. mild amblyopia c. a hyperdeviation in each eye behind a translucent occluder d.  the fact that she is aligned with glasses e. none of the above
2.	The most likely diagnosis is:
	a. bilateral superior oblique palsy b. bilateral inferior oblique overaction c. increased intracranial pressure d.  dissociated vertical deviation e. none of the above
3.	The next thing to do is:
	a. no treatment now; just observe b. obtain an MRI of the brain c. perform a Tensilon test for suspected myasthenia d.  perform surgery now e. none of the above

For answers to the above, click here on or after July 18, 2006.