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		*Note: The child is sucking in the picture above and to the left

This 1-year-old boy was noted by his parents to have what they termed as peculiar movements of his right upper lid. This lid drooped most of the time; but at other times, especially when feeding, the right eye looked different, more open. His birth and delivery were unremarkable. He has two older siblings in good health and with no eye problems. Both parents wear glasses but have otherwise healthy eyes. This child has aligned eyes, a normal anterior and posterior segment and cycloplegic refraction of OD +1.00 +1.00 X 90 and OS +1.00 sph. He is in no apparent discomfort. The cornea is normal and has normal sensation.

1.	What is the likely diagnosis?
	a. congenital ptosis alternans b. Moebius variant c. Wilson’s syndrome d. Marcus-Gunn jaw winking e. none of the above
2.	What is the cause of this condition?
	a. synkinetic relationship between the VII cranial nerve and the nerve to the levator palpebri b. an abnormal Bell reaction c. third nerve misdirection d. (a) and (b) e. (b) and (c)
3.	Treatment of this child at this time should be:
	a. right levator resection b. levator extirpation on the right and frontalis suspension of the right upper lid c. observation; no treatment now d. Phospholine iodide drops in the right eye twice a day e. none of the above

For answers to the above, click here on or after May 12, 2009.