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A 10-year-old boy presents with droopy left upper eyelid, since birth (figure 1). Eyelid evaluation revealed severe ptosis with faint lid crease, levator function of 3mm and MRD1 (Marginal Reflex Distance) of -1.5mm. Visual acuity examination revealed 6/6 in the right eye and 6/60 in the left eye. Marcus jaw winking reflex was negative. Anterior and posterior segment examination was well within normal limits.

1.	The next thing to find out about this patient is:
	a. ice pack test & intravenous neostigmine test b. CT scan to rule out a lesion within levator muscle c. thorough systemic evaluation d. motility and status of the pupils e. intraocular pressure
2.	The most important differential diagnosis is between:
	a. neurofibromatosis vs. Brown syndrome b. third nerve palsy vs. double elevator palsy c. third nerve-seventh nerve synkinesis vs. Moebius d. myasthenia vs. internuclear ophthalmoplegia e. blow out fracture vs. third nerve palsy
3.	Treatment for a condition like this would most likely be:
	a. crutch glasses b. intravenous steroids c. muscle surgery d. lid surgery e. (c) and (d)

For answers to the above, click here on or after May 31, 2011.