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Answers: 2008 Series -  March 25, 2008 Lecture 41 of 53  NEXT»

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

This young woman patient has just walked in to your examining room.  She appears as you see in the picture with her face turned to the left but she seems to be looking at you.

1.  What might be causing this head posture?   

e -- all of the above

When a person has a head turn like this that persists when they seem to looking right at you there is likely to be a reason and any of the choices could be that reason.

2.  What simple test would yield the most results quickly with the least effort on your part?  

d -- asking the patient to look to the left

The test that would yield the most results, quicker and with the least effort, would be to simply ask the patient to look to the left.  Note in the pictures above that this shows you that there is limitation of adduction in the right eye and narrowing of the right palpebral fissure.  You will do a little more checking, but just asking her to look to her left and noting the above makes it possible to diagnose Duane syndrome, Huber class II or exotropic Duane.

3.  What would be the most likely treatment that would be recommended after the work up is completed? 

a -- extraocular muscle surgery

As you complete your testing and make a diagnosis of Duane syndrome, it will be clear that the treatment would be eye muscle surgery.  In this case a recession of the right lateral rectus with a Y split would be appropriate.


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