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

Pre-operative pictures:

Post-operative pictures:

This 10-year-old girl has had a drooping lid since birth. Vision is OD 6/6 and OS 1/60. The child, according to her parents, does not raise her chin to look under the lid. No fusion could be measured. Refraction is OD +0.75 and OS +0.50 +0.50 x 90. The motility is as shown in the images. The left eye fails to elevate and there is severe ptosis in the left upper lid with no levator function. On forced lid closure, the left eye elevates above the midline. The child is otherwise in good health.

1.	The diagnosis in this case is likely to be:
	a. post trauma b. myasthenia c. fibrosis of the extraocular muscles d. double elevator palsy e. none of the above
2.	The reduced vision in the left eye is most likely due to:
	a. amblyopia b. optic nerve hypoplasia usually seen in this condition c. improper vision testing methods d. there is no way to know e. none of the above
3.	Striking features in the post-operative pictures are:
	a. lower lid ptosis on the left b. left upper lid lag on downgaze c. good appearance of lid height in primary position d. ability to close the lids with some effort e. all of the above

For answers to the above, click here on or after October 26, 2010.