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This 20-year-old man has a complaint of the left eye being lower. He wants it “fixed”. He has visual acuity of 6/6 in the right eye and 6/18 in the left. Refraction is OD plano and OS -2.00 + 1.00 x 25. He recently had refractive surgery in the left eye for what presumably was a higher refractive error; was it hyperopia? No information on this is available. The reduced vision in the left eye is presumably amblyopia. Examination of the eyes reveals no abnormality except for the alignment, refractive error, and reduced vision in the left eye. No more information is available. The man was told he needs surgery on the left eye and is coming to you for a second opinion.

1.	Looking at the pictures of the lids, it is likely that:
	a. ptosis is present OS b. nothing can be determined about the lids c. the lids are normal in appearance d. the left eye demonstrates pseudo ptosis e. none of the above
2.	Your best response to the patient’s request for surgery would be:
	a. Yes, perform surgery on the muscles of the left eye. b. No surgery is indicated. c. If surgery is done, it should be on the right eye. d. No decision can be made with the information at hand. e. none of the above
3.	If you were asked to make a diagnosis, you would most likely say the patient has:
	a. right superior oblique palsy b. left eye ptosis/rule out myasthenia c. double elevator palsy d. primary deviation strabismus e. none of the above

For answers to the above, click here on or after November 2, 2010.