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This 37-year-old female was referred by her cataract surgeon who wanted to have the eyes aligned before attempting to remove mature cataracts from this patient.  The surgeon felt that with the eyes deviated as they are, cataract surgery would be difficult or even impossible.  This woman reported having very poor vision all of her life, even before the cataracts developed.  She never wore glasses, but said that she could see things reasonably clear only if they were held just a few inches in front of her eyes.  Both eyes are down and there is no abduction.  Actually the eyes are nearly fixed. It is impossible to do a refraction because of the lens opacities.  The woman has very “prominent” eyes and she states that this has been so all of her life.  She is otherwise in good health.  She denies any recent weight loss or rapid heart beat.

1.	The patient is eager to have her eyes aligned so that she can go ahead with the surgery.  What is the first test that you would perform?
	a. forced ductions b. thyroid studies c. axial length measurement with the A or B scan d.  tensilon test e. none of the above
2.	What test would you do next?
	a. MRI of the orbits b. CT scan of the orbits c. ice test d.  differential intraocular pressure e. none of the above
3.	The most likely treatment for this condition would be:
	a. orbital decompression b. lateral tarsorraphy c. eye muscle surgery d.  radiation to the orbital fat e. none of the above

For answers to the above, click here on or after September 18, 2007.