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This 10-month-old child has eyes that are aligned in the primary position and a normal head posture. But, as can be seen in the pictures above, abduction is limited in the left eye and there is very great elevation in adduction in the left eye (overaction of the inferior oblique). The child is otherwise completely normal and there is no family history of a similar problem.

1.	This condition is likely:
	a. the result of infantile meningitis that was not diagnosed b. from trauma c. a common congenital strabismus d. from infection e. none of the above
2.	The most likely diagnosis is:
	a. primary overaction of the left inferior oblique b. left superior oblique palsy c. inverse Brown d. class III Duane e. none of the above
3.	The best immediate course of action is:
	a. prism treatment b. eye muscle surgery both eyes c. eye muscle surgery on the left eye only d. orthoptic training and exercises e. none of the above

For answers to the above, click here on or after June 29, 2010.