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This 19-year-old man presents complaining of vertical diplopia.  Three years earlier he had a valve placed periocularly in the right eye for drainage of aqueous to treat glaucoma. He has also undergone cataract surgery in the right eye and he had a keratoplasty in that eye for keratoconus. Vison is OD 20/20, OS 20/40.  Intraocular pressure is now controlled in both eyes.

1.	Further history reveals that this man used steroid drops regularly for one year without medical supervision to treat an ocular allergy. A likely cause of the glaucoma is:
	a. over use of topical steroids b. keratoconus induced glaucoma c. chronic simple glaucoma d.  none of the above
2.	The most likely cause of the diplopia is:
	a. right superior rectus paresis b. inferior rectus fibosis c. inhibitional palsy of the contralateral antoganist d.  mechanical restriction caused by the glaucoma valve
3.	Treatment for this is:
	a. removal of the valve b. strabismus surgery not disturbing the valve c. ptosis surgery and then strabismus surgery if needed d.  none of the above

For answers to the above, click here on or after April 26, 2005.