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2009 Series -  August 25, 2009 Lecture 19 of 52  NEXT»

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This 12-year-old girl has had three prior surgeries for an original diagnosis of left superior oblique palsy. Her slight facial asymmetry with a fuller face on the right helps confirm the original diagnosis. She is presented by her parents who are concerned that she frequently tilts her head to the right. She has a small right hypertropia. Otherwise ductions and versions are not remarkable. Visual acuity is 6/9 in each eye. A moderate myopia with astigmatism is fully corrected with her glasses. The right head tilt is always present when the left eye is covered (fixing with the right eye), never seen when fixing with the right eye covered (fixing with the left eye), and present about half of the time with both eyes open and uncovered. The patient denies diplopia.

1. The abnormality is most likely:

a. in the right eye
b. in the left eye
c. in both eyes
d. There is no way of knowing.
e. none of the above

2. This head tilt could be caused by:

a. excyclodeviation of the right eye
b. incyclodeviation of the right eye
c. incycloduction of both eyes
d. incycloduction of the left eye
e. (a) and (d)

3. Treatment for this could be:
a. nasal shift of the left inferior rectus
b. nasal shift of the right inferior rectus
c. nasal shift of the right superior rectus
d. left superior oblique tenectomy
e. none of the above

For answers to the above, click here on or after September 1, 2009.

 

 


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