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This 7-year-old boy presented with a history of keeping his chin down and looking up when he concentrates on seeing clearly. This has been present since birth. His vision with chin down and looking up is between 20/40 and 20/30 without correction. Refraction is: OD + 1.50 – 0.75 X 5 and OS + 1.50 – 1.00 X 180. He does not wear glasses. He has a slow, low amplitude horizontal nystagmus which disappears in upgaze. The remainder of his eye examination is normal. He is otherwise healthy, is doing satisfactorily in school, and has no complaints.

1.	The chin down position is assumed by this boy because:
	c -- his vision is better The boy holds his chin down and looks up because he can see better.  These children will often have a normal head posture and poorer vision (for neck comfort) when they are not looking carefully at something.  They are sacrificing a little bit of vision for a more comfortable head posture.
2.	Of the following statements, the most likely to be true is:
	e -- The boy has congenital nystagmus with a null point in upgaze. This boy is likely to have congenital motor nystagmus with null point in upgaze.  It is unlikely that any significant neurological disease exists.
3.	This boy could be treated with:
	d -- bilateral superior rectus recession This is the appearance of this boy after having undergone bilateral superior rectus recession, 7.0 mm.

This case was submitted by Dr. Teresita Sanchez of Havana, Cuba.