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This 4-year-old boy has a life-long history of both lids drooping, a chin-up head posture, and exotropia increasing on down gaze. Vision is OD 20/60 and OS 20/40. He is unable to look up voluntarily and no Bell’s reaction is elicited. The fundus is normal and the media clear. Cycloplegic refraction is OD +1.25 sph and OS +1.25 sph.  No other family member is affected and there is no history of consanguinity.

1.	The important clinical feature(s) in this case include:
	a. limitation of elevation b. hyperopia c. ptosis d. exotropia e. (a), (c), and (d)
2.	The most likely diagnosis is:
	a. congenital fibrosis of the extraocular muscles b. Marcus Gunn syndrome c. Moebius syndrome d. blepharophimosis syndrome e. none of the above
3.	This condition is:
	a. a well defined and consistent acquired condition b. variably expressed and overlaps with other expressions of the condition  c. usually managed successfully  with one surgical procedure d. known as “Class 2” e. none of the above

For answers to the above, click here on or after June 26, 2012.