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This girl has an obvious right exotropia. According to the report of the examiner, there is no shift on cover testing.

This 6-year-old girl presented for examination because the right turned out and has done so as long as the family can remember. Vision in the right eye is 20/40 (6/12) and 20/20 (6/6) in the left. Refraction is OD plano +2.00 X 80 and OS +1.00 +1.00 X 100. On cover test there is no shift in spite of the obvious exodeviation. According to the family, the child was two weeks premature and spent time in the neonatal intensive care unit.

1.	An obvious horizontal deviation, especially an exodeviation, with no shift on the cover test and a history of prematurity is most likely caused by:
	a. medial rectus palsy b. anisometrropic amblyopia c. incomplete congenital third nerve palsy d. temporal macular ectopia e. (a) and (c)
2.	The next examination that should be done to establish the diagnosis is:
	a. examination of the retina, preferably with the indirect ophthalmosope b. ocular tomography c. MRI of the orbit d. forced ductions e. forced generation
3.	The most likely diagnosis in this case is:
	a. Coats' disease b. retinopathy of prematurity c. an unspecified retinal infection d. amblyopic eccentric fixation e. none of the above
4.	The best treatment would be:
	a. medial rectus resection b. lateral rectus recession c. pleoptic training to improve the fixation d. nothing; just follow e. none of the above

For answers to the above, click here on or after April 27, 2010.