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This 10-year-old boy has had an exodeviation as seen here since birth. He is otherwise healthy and active. Motility examination is shown in the pictures. He has a moderate exodeviation in primary position with right upper lid ptosis. Elevation, depression and adduction are limited in the right eye. The ptosis on the right decreases when the eye is looking down. The right upper lid is retracted on levoversion. Visual acuity is OD 20/200 and OS 20/20.  Refraction is OD +1.50 –1.00 X 60 and OS +2.50 -.50 X 100. The right pupil is dilated and reacts sluggishly. Media are clear, and the fundus is normal in both eyes. The boy has no complaints and denies diplopia.

1.	The most likely diagnosis is:
	a. double elevator palsy b. Marcus-Gunn c. congenital ptosis d. congenital third nerve palsy e. none of the above
2.	Which eye muscle(s) function essentially normally in the right eye according to the pictures?
	a. none b. lateral rectus c. lateral rectus and superior oblique d. superior rectus and inferior rectus e. not enough information
3.	The right upper lid function is influenced by:
	a. nerve impulses from some of the extraocular muscles in the right eye b. aberrant regeneration c. third nerve impulses d. the direction of gaze e. all of the above

For answers to the above, click here on or after January 4, 2010.