CASE 6C

A 9 year old male patient enters your office. History is positive for eye strain when looking up at the chalkboard. Patient also gets HA after 10 minutes of reading

Retinoscopy	O.D.: +0.25 DS O.S.: +Plano -0.25 X 180
Acuities	20/20 O.D. / O.S. Near and Distance
Cover test (entering)	R hyperphoria 5D D/N; no resistance to occlusion with either eye
Cover Test (9 gaze positions)	Significant increase in L HYPOTROPIA on right gaze; vertical component most extreme when O.S. is adducted and elevated (15D); patient reluctant to maintain fixation in superior gaze
EOM	Appearance of increased left hypotropia on adducting eye O.S. (* see movie #5); duction tests reveal difficulty elevating/adducting O.S.; no nystagmus noted

1. Any additional tests/observations?

EOM testing
Other

2. Diagnosis?

3. What are some conditions that mimmic this Dx?

4. What is the most likely etiology of this Dx, if congenital?

5. How would this patient perform on a forced duction test?

6. How should you educate the mother? How do you guide her towards or away from the surgical alternative?