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This girl has an obvious right exotropia. According to the report of the examiner, there is no shift on cover testing.

This 6-year-old girl presented for examination because the right turned out and has done so as long as the family can remember. Vision in the right eye is 20/40 (6/12) and 20/20 (6/6) in the left. Refraction is OD plano +2.00 X 80 and OS +1.00 +1.00 X 100. On cover test there is no shift in spite of the obvious exodeviation. According to the family, the child was two weeks premature and spent time in the neonatal intensive care unit.

1.	An obvious horizontal deviation, especially an exodeviation, with no shift on the cover test and a history of prematurity is most likely caused by:
	d -- temporal macular ectopia Temporal traction on the macula will cause the visual axis to deviate temporalward simulating an exotropia. The key to recognizing this is that in spite of the exodeviated eye, there is no shift on cover testing. This means that the visual axis of the eye dictated by the macular position is not in line with the anatomic axis.
2.	The next examination that should be done to establish the diagnosis is:
	a -- examination of the retina, preferably with the indirect ophthalmosope Examination of the retina of both eyes will reveal the temporal traction in the right eye. This is a classic example of temporal traction of the retina with displacement of the macula caused by retinopathy of prematurity.
3.	The most likely diagnosis in this case is:
	b -- retinopathy of prematurity This is clearly an example of retinopathy of prematurity.
4.	The best treatment would be:
	d -- nothing; just follow No treatment is indicated in this patient. Muscle surgery to move the eye (visual axis) would actually cause diplopia.