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This 29-year-old woman complains that her right eye sometimes goes down. At 18 years of age she had bimedial rectus recession for esotropia present since birth. At age 23 she underwent right superior rectus recession for a variable right hyper deviation diagnosed as dissociated vertical deviation. On motility examination the right hypotropia is variable and the eye moves up to the primary position and then downward periodically over a matter of minutes or else remains in the downward position approximately 10 to 15 prism diopters. Her visual acuity is OD 20/600 and OS 20/20; refraction is OD +3.50 and OS +0.50. She does not wear glasses. The remainder of the eye examination is within normal limits.

1.	The main reason for reduced vision in the right eye is:
	a. right variable hypotropia b. anisometropia c. not apparent from the history or examination d. duration of the strabismus e. none of the above
2.	This motility pattern is compatible with a diagnosis of:
	a. Heimann-Bielschowksy phenomenon b. Waverly syndrome c. right superior rectus paresis d. left inferior rectus paresis e. strabismus fixus
3.	A reasonable treatment would be:
	a. Yokoyama procedure b. nothing; just observe c. right inferior rectus recession d. right inferior oblique transposition e. none of the above

For answers to the above, click here on or after April 5, 2011.