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This four-year-old boy presented with a chronic chin up position as shown. He is unable to elevate his eyes even to the midline and he has bilateral ptosis. When he attempts to look up, his eyes converge. He is able to look to either side reasonably well. Vision is 20/40 in either eye and his refraction is OD +1.00 +0.50 x 90 and OS +2.50 +0.50 X 90. The remainder of his eye and physical examination is unremarkable. There are no other similarly affected relatives.

1.	The most likely diagnosis in this case is:
	a. juvenile thyroid disease b. myasthenia c. bilateral superior rectus palsy d. congenital fibrosis syndrome e. none of the above
2.	Treatment for this condition would most likely begin with:
	a. bilateral inferior rectus recession b. extraocular muscle transfer of the horizontal recti in each eye to the superior rectus c. superior rectus recession d. systemic steroids for a trial period of one week e. none of the above
3.	This condition is inherited as:
	a. no pattern; it is always sporadic b. X linked recessive c. autosomal recessive d. autosomal dominant e. none of the above

For answers to the above, click here on or after April 28, 2009.