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

This 71-year-old man presented as shown above.  He is generally in good health.  There is no history of thyroid disease or any known neurologic disorder.  Visual acuity is difficult to determine, but with either eye he can see the 20/400 optotype at least.  He gives a history of having had eye muscle surgery two years before.  The report states that the medial rectus muscles were recessed 6.0 mm and the lateral rectus muscles resected 8.0 mm.  There has been no communication with the surgeon.

1.	The most striking feature of this patient is:
	a. clinical anophthalmos b. microcornea c. sclerocornea d.  a "huge" angle esotropia
2.	The work up of this patient would include:
	a. forced ductions b. MRI of the orbit c. blood studies for thyroid activity d.  all of the above
3.	The most likely treatment for this patient would include:
	a. additional strabismus surgery b. systemic steroids c. orbitotomy d.  insertion of a prosthetic extraocular muscle

For answers to the above, click here: