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This 9-year-old boy has had a droopy right upper lid since birth. He frequently tilts his head back as shown in the pictures. His vision is OD 20/50 and OS 20/20. Versions and ductions are normal in both eyes. Refraction is OD -.50 +1.50 x 85 and OS +.50.

1.	This most likely diagnosis for this boy is:
	c -- congenital ptosis This is an example of congenital ptosis. Inhibitional palsy of the contralateral antagonist occurs when the paretic eye is used for fixation in superior oblique palsy. The eyes move normally, ruling out double elevator palsy. The head tilt is not constant.
2.	What is the most important to know about this patient before proceeding to treatment?
	a -- the Bell’s response and the corneal sensitivity Before considering ptosis surgery it is important to know if the Bell reaction is intact and if the corneal sensation is normal. When these are normal they function to guard against cornea damage from exposure after ptosis surgery.
3.	An appropriate treatment is likely to be:
	d -- frontalis suspension In cases with no levator function, as in this child, levator resection is not effective. Instead, a frontalis suspension is indicated.