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This 22-year-old woman has had an exotropia as shown in the pictures. This has been present since shortly after birth. She is in good health otherwise. Visual acuity is OD 20/300 and OS 20/20. Refraction is OD -0.25 and OS plano. She does not experience double vision. There is no apparent generated force to adduction in the right eye. Forced ductions are slightly restricted to elevation, depression, and adduction in the right eye. Her main complaint is with her appearance. She would like to have straighter eyes.

1.	What is the most likely diagnosis?
	a. myasthenia b. congenital exotropia c. congenital/infantile third nerve palsy d. a secondary manifestation of a brain tumor e. none of the above
2.	What is the most likely reason that the right eye neither elevates or depresses?
	a. deficiency of aceteycholine effect b. diminished vertical vergence c. canine tooth syndrome d. aberrant regeneration e. none of the above
3.	An accepted treatment for this condition would be:
	a. Faden to the left lateral rectus b. resection of the right medial rectus muscle c. systemic steroids d. recession of the right lateral rectus and transfer of the right superior oblique to the area of the insertion of the right medial rectus e. none of the above

For answers to the above, click here on or after August 26, 2008.