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This 12-year-old girl has a history of "downward deviation" of the left eye since early childhood. This is associated with drooping of the left upper lid. She has a slight left head tilt and slight mid-facial hypoplasia on the left. The right hyper increases with left eye fixation. The left eye has some limitation of elevation and the right eye a limitation of depression. Visual acuity is 6/6 in each eye and the refraction is +0.50 in each eye. The girl does not record stereo acuity. She denies double vision. The right hyper/left hypo measures around 45 prism diopters in all fields of gaze, but is more with right head tilt.

1.	The ptosis of the left upper lid in the primary position seen in this patient is an example of:
	a. myasthenia b. pseudo ptosis c. herniation of the levator aponeurosis d. high insertion of the levator e. none of the above
2.	The left facial hypoplasia, left head tilt, increased right hyper in right head tilt, overaction of the right inferior oblique, and underaction of the right superior oblique all shown by this patient suggest a diagnosis of:
	a. right superior oblique palsy b. congenital origin c. inhibitional palsy of the contralateral antagonist d. primarily a vertical muscle palsy e. all of the above
3.	At the time of surgery it would be appropriate to:
	a. do the superior oblique traction test b. measure forced ductions especially to elevation in the left eye c. check for the presence of the right superior oblique d. reserve judgment on the type of surgery to be done until after evaluating the patient while asleep e. all of the above

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