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This 20-year-old man has noted increasing drooping of his lids over the past several years.  He holds his chin up to see.  Several male members of his family have been similarly affected.

1.	When confronted with a patient like this, the most important test to obtain among the following is:
	a -- electrocardiogram Patients with this history are likely to have a diagnosis of chronic progressive external ophthalmoplegia.  Such patients could have the triad of retinal pigmentary disorder, external ophthalmoplegia, and complete heart block of Kerns-Sayre syndrome.  This heart block is treated with a pacemaker.
2.	The patient on further examination demonstrates a severe limitation of ocular movements in all directions.  He reports double vision on direct questioning, but does not complain spontaneously. The signs do not improve when testing is done with Tensilon.  The most likely diagnosis is:
	d -- chronic progressive external ophthalmoplegia
3.	Ocular treatment for this condition could include the following:
	d -- all of the above These patients are extremely symptomatic from their ocular symptoms which include dry eye, blockage of vision from the ptosis, and occasional diplopia.