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This 7-year-old girl was presented by her family who noticed her right eye did not go up fully when she looks up and to the left.  Visual acuity is 20/20 in each eye.  Refraction is OD +.50, OS +.50.  She has good stereo acuity being able to fuse to 40 seconds with the Titmus Vectograph.  She does see double looking up and to the left, but can avoid this.  This girl is tall for her age; her father is over 6 feet tall and her mother is of average height.

1.	The diagnosis in this patient is:
	c -- Brown syndrome This is an example of mild Brown syndrome.  The deviation is minimal and is limited to elevation in adduction.
2.	The best treatment would be:
	d -- none of the above Some of the options presented are suitable for this particular patient.  Both options a and b would be suitable for a more severe Brown, but in this patient there is no abnormal head posture, the patient’s eyes are aligned in the primary position, and fusion is good.
3.	The most likely course for this patient is:
	d -- all of the above A patient with a mild Brown who has NO symptoms and the likelihood of growing tall, something which makes a Brown less troublesome, ordinarily requires NO surgery.