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This 3-year-old boy has a chronic chin up position as a result of bilateral ptosis and inability to elevate his eyes.  He has no apparent vision difficulty but cycloplegic refraction is +4.00 +1.00 X 90 in both eyes. His eyes are aligned in down gaze and his eyes move laterally with no apparent difficulty. There are no other family members so affected.

1.	The most important feature used in determining the classification in this patient is:
	a. gender b. refraction c. family history d. alignment in down gaze e. head posture
2.	If ptosis surgery is planned, the following should be considered:
	a. corneal sensation b. Bell’s reaction c. restricted up gaze d. (a), (b), and (c) e. none of the above
3.	Treatment for this type of case should begin with:
	a. inferior rectus recession b. frontalis sling for the ptosis c. superior rectus resection d. inferior oblique weakening e. none of the above

For answers to the above, click here on or after May 1, 2012.