This 19-year-old woman has had four prior surgeries for what was originally diagnosed as congenital esotropia.  Her eyes are aligned in the primary position, but she complains that when she is tired and at other times for simply no apparent reason her left eye drifts upward.  Her visual acuity is 20/20 in the right eye and 20/30 in the left.  Refractive error is low hypertropia.  She has no fusion and denies diplopia. The left hyperdeviation is apparent behind the translucent occluder.

1.	The most likely diagnosis in this case is:
	a.  dissociated vertical deviation, greater on the left b.  left inferior rectus paresis c.  intermittent overaction of the left inferior oblique d.  none of the above
2.	The cause of this deviation is:
	a.  a complication of earlier surgery b.  an idiopathic condition frequently occurring in cases of congenital esotropia c.  amenable to treatment with prism d.  best dealt with by carrying out a series of eye exercises
3.	Surgical treatment of this hyperdeviation :
	a.  should never be undertaken b.  is advisable if the deviation bothers the patient and is noticeable to      others c.  should be done on the right eye according to Hering's law d.  requires muscle transfer

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