To see views enlarged, click on the individual pictures...

This two-year-old boy was presented by his mother because of an intermittent “deviation” of the left eye.  The patient is the product of a normal pregnancy and delivery.  He is in good health except for the chief complaint. His vision is 15/30 in each eye and the remainder of the eye examination is normal.  Cycloplegic retinoscopy is + 1.00 in each eye.  The motility is normal. There has been no prior treatment and the child behaves normally.  No family member has been similarly affected.  The boy has three older siblings.  All are normal.  During the examination the left upper lid behaved as seen in the picture when the child’s jaw moved from side to side.

1.	The most likely diagnosis is:
	a. thyroid disease b. idiopathic lid retraction c. myasthenia d.  Marcus Gunn Jaw wink e.  none of the above
2.	The best treatment for this patient is:
	a. surgical lengthening of the left upper lid b. Botox to the left upper lid c. crutch glasses d.  no surgery or other treatment; just observe for now e.  none of the above
3.	This condition occurs because of the following:
	a. synkinesis between the 3rd and 9th cranial nerves b. fibrosis of the levator palpebri c. a variant of Duane syndrome d.  has no explanation e. none of the above

For answers to the above, click here on or after July 4, 2006.