History:  This 4-year-old girl has eyes that are aligned in the primary position, but the fissure on the left is slightly narrower even in primary position.  Abduction is limited in the left eye and enophthalmos and left eye up shoot, and to some extent downshoot, is seen on right gaze.  Gross stereopsis is recorded in the primary position.  Refraction is OD plano +1.00 x 90 OS +.50 +1.00 x 90.  The patient and her parents object to the upshoot and downshoot of the left eye.  Her brother also has Duane syndrome. Diagnosis:   Duane syndrome, Class I

To see views enlarged click on the individual pictures...

How would you manage this case?

To see how your answer compares with some of the experts, click here.