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This 48-year-old man has had "prominent" eyes for the past four years. He has occasional double vision. Visual acuity is 20/20 in each eye with OD plano -0.50 X 40 and OS plano -0.50 X 110 with a +1.75 add. The upper lids appear to be retracted and there is some limitation of ocular movements in both eyes. The forced duction test reveals a “tight” medial and inferior rectus in the right eye and a tight lateral rectus in the left eye.

1.	The most likely diagnosis is:
	a. progressive external ophthalmoplegia b. myasthenia c. fibrosis syndrome d. thyroid associated ophthalmopathy (Graves disease) e. none of the above
2.	The extraocular muscle affected most commonly in this condition is the:
	a. medial rectus b. inferior rectus c. superior rectus d. lateral rectus e. inferior oblique
3.	The following test(s) can be useful for evaluating optic neuropathy:
	a. visual acuity b. red saturation c. visual fields d. (a), (b), and (c) e. none of the above

For answers to the above, click here on or after March 30, 2010.