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You saw this 59-year-old woman in the clinic last week and just looking at her and hearing a brief history, you made a plan for workup. You found the following: Vision with best correction:  20/200 in each eye Axial length measured with the A-scan:  OD 29 mm and OS 30 mm Retinoscopy:  OD -15.00 and OS -17.00 The MRI was done and you studied the images that you see here. Just to confirm the approximate onset of the esodeviation you asked the patient to bring in old pictures and you see that her eyes were aligned in her twenties and the ET was apparent about 20 years later.

1.	What do you see on the MRI?
	a. downward displacement of the lateral recti b. herniation of the globe supero-temporally c. a very large globe d. a reason for the strabismus e. all of the above
2.	What is your diagnosis?
	a. “falling eye” esotropia and hypotropia of high myopia b. progressive external ophthalmoplegia c. myasthenia gravis plus d. lateral rectus palsy e. none of the above
3.	Which of the following is the most likely procedure to succeed in aligning the eyes?
	a. large lateral rectus resection b. sub Tenon’s steroid injection c. medial rectus recession on an adjustable suture d. joining the lateral and superior rectus muscles to achieve a more physiologic position of the lateral rectus and recession of the medial rectus in both eyes e. none of the above

For answers to the above, click here on or after August 17, 2010.