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

This 10-year-old girl had undergone bimedial rectus recession for congenital esotropia at age 2 years.  Over the past several years she has developed a moderate exodeviation.  Her vision is OD 20/40 and OS 20/20.  Refraction is OD +1.00 sph and OS 0.75 sph.  Her media are clear and the fundus is normal in each eye.

1.	The most important feature(s) present in this girl's presentation is (are):
	a. widened palpebral fissure on the right b. limited adduction in the right eye c. exotropia d.  none of the above e. all of the above except (d)
2.	A likely cause of the above is:
	a. a slipped right medial rectus muscle b. a tight right lateral rectus muscle c. an excessive recession of the left lateral rectus muscle d.  combined oblique dysfunction in the right eye hampering adduction e. none of the above
3.	Appropriate management in this case would be:
	a. no intervention b. weakening of both oblique muscles in the right eye c. recession of the lateral rectus muscle d.  resection and advancement of the right medial rectus muscle e. none of the above

For answers to the above, click here on or after March 13, 2007.