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This 10-month-old child has eyes that are aligned in the primary position and a normal head posture. But, as can be seen in the pictures above, abduction is limited in the left eye and there is very great elevation in adduction in the left eye (overaction of the inferior oblique). The child is otherwise completely normal and there is no family history of a similar problem.

1.	This condition is likely:
	c -- a common congenital strabismus This child has Duane syndrome. This is probably the most common congenital strabismus seen. It is characterized by under, or lack of, development of the sixth nerve nucleus followed by misdirection of the medial rectus innervations to the lateral rectus in the orbit in the involved eye.
2.	The most likely diagnosis is:
	d -- class III Duane This is likely to be a class III Duane syndrome characterized by limitation of both abduction and adduction with frequent up or downshoot (or both) of the involved eye in attempted adduction. These patients have eyes that are aligned in the primary position and do not usually have an abnormal head posture.
3.	The best immediate course of action is:
	e -- none of the above This child should receive no treatment at this time and should simply be followed. If the alignment remains straight in primary and no abnormal head posture develops, no treatment is indicated.