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2008 Series -  October 21, 2008 Lecture 11 of 53  NEXT»

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This 12-year-old boy has had a ptosis of the right upper lid as long as the family can remember. His vison is 20/20 in each eye. The parents reported that their son has assumed some unusual head positions. They are not consistent and no apparent head posture is noted at this examination. Refraction is +1.00 in each eye. The examination of the anterior and posterior segments are normal. The boy denies diplopia and has no measurable fusion. His versions are as shown in the diagnostic positions. There is no change in the ptosis during chewing. His health is otherwise good and he has no difficulty swallowing.

1. This ptoisis is most likely associated with the following diagnosis:

a. double elevator palsy
b. Marcus-Gunn
c. congenital ptosis of the right upper lid
d. myasthenia
e. none of the above

2. The pictures of eye and lid movements in the diagnostic positions indicates the following:

a. there is limitation of elevation in the right eye
b. this is likely to be a third nerve palsy
c. the levator in the right eye appears to be functioning normally when the boy looks up
d. a trial of systemic steroids is indicated
e. none of the above

3. A possible diagnosis to consider in this case is:
a. inhibitional palsy of the contralateral antagonist
b. fixation with the paretic eye
c. fourth nerve palsy in the left eye
d. an example of Hering's and Sherrington’’s laws
e. all of the above

For answers to the above, click here on or after Octobar 28, 2008.



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