To see views enlarged, click on the individual pictures...

This 2-year-old girl presented as shown.  Her parents say that the eyes have looked like this since birth. She is in good health otherwise demonstrating milestones of development as expected.  There is no family history of strabismus and the child's birth history and early development are unremarkable.  Visual acuity is approximately 20/400 in the right eye and 20/40 in the left.  Refractive error is +1.00 in each eye after cycloplegia and the media, and posterior aspect of the eyes including the optic nerves appear normal in both eyes.

1.	The most likely diagnosis in this case is:
	a. congenital fibrosis syndrome b. double elevator palsy c. congenital third nerve palsy d.  Brown syndrome
2.	The muscles involved are:
	a. superior oblique and superior rectus b. medial rectus, inferior rectus, superior rectus, and inferior oblique c. medial rectus, superior oblique, and lateral rectus d.  inferior oblique and superior rectus
3.	The logical order of treatment would be:
	a. align the eyes, treat the amblyopia, raise the lid b. treat the amblyopia, raise the  lid, align the eyes c. treat the amblyopia, align the eyes, raise the lid d.  The order of treatment makes no difference.  Any of the above would be acceptable.

For answers to the above, click here on or after March 15, 2005.