History:  This 7-year-old boy presents with the clinical picture shown :  "A" pattern exotropia with "overaction" of the superior obliques.  Visual acuity is 20/20 in each eye, he is able to fuse the Worth four lights in the primary position but does no better on stereo testing.  The exodeviation is 6 prism diopters intermittent in the primary position, the boy is ortho in up gaze and has 45 prism diopters XT in down gaze.  There is 4+ overaction of the right superior oblique and 3+ overaction of the left superior oblique.  No dissociated vertical deviation or latent nystagmus is present.  The boy has very slight chin depression.  Refractive error is OD and OS +0.5 D.  This boy is having a very difficult time in school with reading, arithmetic, and concentrating in general.   Diagnosis:  "A" pattern exotropia To see views enlarged, click on the individual pictures...

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