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This 73-year-old woman had cataract surgery elsewhere in both eyes under local anesthesia, apparently without incident, two years earlier. Shortly after surgery she began to experience vertical diplopia. The history is vague as to whether the diplopia came on immediately or after a delay. Now the vertical diplopia is very bothersome and the patient experiences a great deal of difficulty looking up with the right eye. Vision is 20/20 in each eye. The remainder of the eye examination demonstrates a healthy pseudophakic woman with no apparent eye pathology. She would like to have the diplopia relieved. Her general health is otherwise excellent.

1.	This vertical strabismus is best described as:
	a. vertical Duane b. acquired Brown c. double elevator palsy d. occult thyroid myopathy e. blow out fracture
2.	What is a likely cause of this strabismus?
	a. trauma b. endocrine imbalance c. neurologic “miswiring” d. reaction to local anesthetic e. none of the above
3.	The most likely treatment would be:
	a. surgery b. prism c. medical d. patch one eye e. none of the above

For answers to the above, click here on or after October 5, 2010.