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2009 Series : April 14, 2009

December 29, 2009  |  December 22, 2009  |  December 15, 2009  |  December 8, 2009  |  December 1, 2009  |  November 24, 2009  |  November 17, 2009  |  November 10, 2009  |  November 3, 2009  |  October 27, 2009  |  October 20, 2009  |  October 13, 2009  |  October 6, 2009  |  September 29, 2009  |  September 22, 2009  |  September 15, 2009  |  September 8, 2009  |  September 1, 2009  |  August 25, 2009  |  August 18, 2009  |  August 11, 2009  |  August 4, 2009  |  July 28, 2009  |  July 21, 2009  |  July 14, 2009  |  July 7, 2009  |  June 30, 2009  |  June 23, 2009  |  June 16, 2009  |  June 9, 2009  |  June 2, 2009  |  May 26, 2009  |  May 19, 2009  |  May 12, 2009  |  May 5, 2009  |  April 28, 2009  |  April 21, 2009  |  April 14, 2009  |  April 7, 2009  |  March 31, 2009  |  March 24, 2009  |  March 17, 2009  |  March 10, 2009  |  March 3, 2009  |  February 24, 2009  |  February 17, 2009  |  February 10, 2009  |  February 3, 2009  |  January 27, 2009  |  January 20, 2009  |  January 13, 2009  |  January 6, 2009

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This four-year-old boy presented with a chronic chin up position as shown. He is unable to elevate his eyes even to the midline and he has bilateral ptosis. When he attempts to look up, his eyes converge. He is able to look to either side reasonably well. Vision is 20/40 in either eye and his refraction is OD +1.00 +0.50 x 90 and OS +2.50 +0.50 X 90. The remainder of his eye and physical examination is unremarkable. There are no other similarly affected relatives.

1. The most likely diagnosis in this case is:

a. juvenile thyroid disease
b. myasthenia
c. bilateral superior rectus palsy
d. congenital fibrosis syndrome
e. none of the above

2. Treatment for this condition would most likely begin with:

a. bilateral inferior rectus recession
b. extraocular muscle transfer of the horizontal recti in each eye to the superior rectus
c. superior rectus recession
d. systemic steroids for a trial period of one week
e. none of the above

3. This condition is inherited as:
a. no pattern; it is always sporadic
b. X linked recessive
c. autosomal recessive
d. autosomal dominant
e. none of the above

For answers to the above, click here on or after April 28, 2009.