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This 18-year-old girl was examined by the surgeon prior to LASIK. He noted that the patient might have strabismus and referred the patient to a strabismus surgeon. The girl has 20/30 vision in each eye wearing -6.00 D -3.00 D X 180 in both eyes. She has “fusion” at near but suppresses the right eye at distance. She has a left head tilt which was also seen in childhood pictures. Neither the patient nor her family were aware of or concerned about “squint”.

1.	Based on the history and study of the pictures, is it likely that this patient has strabismus?
	a. yes; based on the head tilt b. no c. not enough information is provided d. yes; it could be a right superior oblique palsy e. (a) and (d)
2.	What information about this patient is important when it comes to answering first question above?
	a. head tilt b. positive Bielschowsky c. primary position alignment d. fusion status e. (a), (b), and (c)
3.	When it comes to making a decision about how to deal with this patient, the strabismus consultant should:
	a. send her back for LASIK; no treatment needed b. recommend orthoptic exercises c. prescribe a base-up prism in the right lens for a two-month trial d. advise the family that muscle surgery should be done on both eyes e. none of the above

For answers to the above, click here on or after June 8, 2010.