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This 7-year-old boy had surgery one year ago for comitant esotropia that measured 20 prism diopters.  Both medial rectus muscles were recessed 3.5 mm from the original insertion.  His family reports that his eyes drift upward when he is tired.  They also note that his eyes deviate outward when he looks down.  Vision is 20/20 in each eye.  Refractive error is +1.50 sphere in each eye.  He does not wear glasses.

1.	This patient has an 'alphabetic pattern' of vertical incomitance described as:
	a. 'V' b. 'A' c. 'X' d.  none of the above
2.	In downgaze it would appear that there is overaction of the:
	a. superior oblique muscles b. medial rectus muscles c. lateral rectus muscles d.  inferior oblique muscles
3.	The view of the eyes behind the translucent occluder demonstrates:
	a. double depressor palsy b. double elevator palsy c. dissociated vertical deviation d.  no particular clinical pattern

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