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Right eye

Left eye

A 26-year-old female presents with a slight right head tilt, minimal “V” pattern, overaction of the right inferior oblique, underaction of the right superior oblique, and a small esotropia. She has 20/20 vision in each eye. There is a history of two prior eye muscle surgeries done before age 10 but no details are available. You are only hearing about this patient from a colleague who has just obtained fundus photos and is asking your opinion after the patient has left the clinic.

1.	What do you see in the photos?
	a. an entirely normal fundus b. possible fundus torsion c. occult papilledema d. severe optic nerve cupping e. none of the above
2.	What did you hear in the history or see in the photos that makes these photos possibly relevant?
	a. the fact that there were two prior surgeries b. the age of the patient c. overaction of the right inferior oblique d. underaction of the right superior oblique e. (c) and (d)
3.	What does history of the right head tilt suggest?
	a. a possible anomalous direction for tilt given the findings b. this condition is definitely acquired from the earlier surgery c. nothing at all d. the fact that diplopia will definitely be present e. none of the above

For answers to the above, click here on or after June 15, 2010.