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This 6-year-old girl presented with a recent history of intermittent ptosis. She appeared as shown here and this is typical of how she looks at her worst. She had been healthy until the onset of the condition several weeks ago. There is no family history of ptosis. Her vision is normal. There is nothing else remarkable about her eyes or her physical examination.

1.	The most likely diagnosis in this case is:
	a. bilateral congenital ptosis appearing late b. acquired double elevator palsy c. a possible autoimmune defect d. ocular myasthenia e. (c) and (d)
2.	The most likely next step in this case would be:
	a. an intramuscular injection of prostigmine b. a trial of crutch glasses c. an assay for anticholinesterase antibodies d. oral quinine e. none of the above
3.	Treatment for this condition would most likely be:
	a. exercise b. surgical c. medical d. surgery followed by medicine e. (a) and (b)

For answers to the above, click here on or after August 3, 2010.