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A seven-year-old boy presented with a variable small angle esotropia. Visual acuity was 20/20 OD and hand motions OS.  Fixation was central and steady with the right eye and unsteady with the left.  Refraction with cycloplegia was: right eye +.50 and left eye +.75 + 1.00 X 80.  The dilated fundus examination revealed the findings shown in the photographs.

1.	The first thing to do for this child  would include the following:
	d  -- This child has a condition which will not respond favorably to patching and which would not be helped by glasses.  There is an obvious physical abnormality of the left optic nerve which precludes vision development.
2.	The appearance of the optic nerves suggests the following:
	c -- The left optic nerve is actually much smaller than the right.  The apparent outer dimension of the left optic nerve is actually sclera and represents the so-called double ring sign of optic nerve hypoplasia.  The vessels are of normal size, but exit the nerve at different angles.
3.	The best treatment for this patient is:
	a -- The only treatment for this child would be safety glasses to protect the right eye.  Amblyopia treatment and surgery for a small variable angle are not indicated.