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This 7-year-old girl had a bimedial rectus recession at age 5 years. She presents today with an intermittent left hyperdeviation. Versions and ductions are full. She has a small angle esodeviation, and vision is 20/20 in each eye. Refraction is + 0.75 in both eyes, the media are clear, and the fundus is normal. Stereo vision is nil. At times the left hyperdeviation is not apparent, but it always goes up when occluded and often, but not always, comes down when the occluder is removed. It is difficult to see in the picture, but the right eye goes up a slight bit when occluded and returns to primary when the cover is removed.

1.	The most likely diagnosis is:
	a. right superior oblique palsy b. left inferior rectus palsy c. myokymia d. dissociated vertical deviation e. none of the above
2.	This girl could be treated with:
	a. Botox b. base down prism each eye c. eye muscle surgery d. eye muscle exercises e. alternate patching
3.	This condition is:
	a. a rare form of muscle palsy b. occasionally seen after surgery for congenital esotropia c. best treated medically d. best treated optically e. none of the above

For answers to the above, click here on or after October 12, 2010.