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This 10-year-old girl had undergone bimedial rectus recession for congenital esotropia at age 2 years.  Over the past several years she has developed a moderate exodeviation.  Her vision is OD 20/40 and OS 20/20.  Refraction is OD +1.00 sph and OS 0.75 sph.  Her media are clear and the fundus is normal in each eye.

1.	The most important feature(s) present in this girl's presentation is (are):
	e -- all of the above except (d) This girl demonstrates a widened palpebral fissure, limited adduction of the previously operated right eye, and limited adduction.  All of these are key to establishing the proper diagnosis.
2.	A likely cause of the above is:
	a -- a slipped right medial rectus muscle The most likely cause of the findings in this girl is a slipped right medial rectus muscle.
3.	Appropriate management in this case would be:
	d -- resection and advancement of the right medial rectus muscle The best treatment for this girl is a resection and advancement of the right medial rectus muscle.  The amount would depend in large part on the findings at surgery.