History:  This child is 2 years old and has had eyes crossed since shortly after birth.  Cycloplegic refraction is OD +3.00 D and OS+4.00 D.  He has two aunts with strabismus.  Vision appears to be okay in both eyes with free alternation.  An "A" pattern is present with  the slight depression of the adducting eye in lateroversions.  The inferior obliques "underact" and the superior obliques "overact" in their principal field of action.  Prism and cover testing demonstrates 25 prism diopters of esotropia in up gaze and 20 prism diopters of exotropia in down gaze both measured in the distance.  The media are clear and the fundus is normal in each eye.  Diagnosis:  "A" pattern esotropia

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