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2009 Series : July 21, 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

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

This 12-year-old girl has a history of "downward deviation" of the left eye since early childhood. This is associated with drooping of the left upper lid. She has a slight left head tilt and slight mid-facial hypoplasia on the left. The right hyper increases with left eye fixation. The left eye has some limitation of elevation and the right eye a limitation of depression. Visual acuity is 6/6 in each eye and the refraction is +0.50 in each eye. The girl does not record stereo acuity. She denies double vision. The right hyper/left hypo measures around 45 prism diopters in all fields of gaze, but is more with right head tilt.

1. The ptosis of the left upper lid in the primary position seen in this patient is an example of:

a. myasthenia
b. pseudo ptosis
c. herniation of the levator aponeurosis
d. high insertion of the levator
e. none of the above

2. The left facial hypoplasia, left head tilt, increased right hyper in right head tilt, overaction of the right inferior oblique, and underaction of the right superior oblique all shown by this patient suggest a diagnosis of:

a. right superior oblique palsy
b. congenital origin
c. inhibitional palsy of the contralateral antagonist
d. primarily a vertical muscle palsy
e. all of the above

3. At the time of surgery it would be appropriate to:
a. do the superior oblique traction test
b. measure forced ductions especially to elevation in the left eye
c. check for the presence of the right superior oblique
d. reserve judgment on the type of surgery to be done until after evaluating the patient while asleep
e. all of the above

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