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This 6-year-old girl had a bimedial rectus recession and right lateral rectus resection for a large angle esotropia performed at age two years.  She has no fusion as measured in the usual clinical setting but her alignment is excellent in the primary position.   But lately, the family has noticed a new problem.

1.	Significant strabismus can be seen in this girl.  The following describes the condition(s):
	a. "A" pattern b. overaction of the superior obliques c. dissociated vertical deviation d.  all of the above
2.	In order to diagnose an "A" pattern the following is required:
	a. chin down head posture b. 10 prism diopters more exodeviation or less esodeviation in downgaze compared to upgaze measured at the distance with  accommodation controlled c. oblique muscle dysfunction d.  (a) and (c)
3.	This strabismus could be treated with the following:
	a. superior rectus recession b. inferior oblique resection c. superior oblique weakening d.  (a) and (c)

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