A 3-Year-Old Girl Whose Eyes Appear Misaligned

Zane D. Foster; Kimberly G. Yen, MD; Madhuri Chilakapati, MD


July 26, 2019

Case Presentation

A healthy 3-year-old girl presented to the ophthalmology clinic for evaluation of misaligned eyes.

The mother stated that she noticed the misalignment when the child looked up or to the right. When the child was looking straight ahead, no abnormality was noted.

The patient's visual acuity was 20/20 in both eyes without correction using the HOTV matching method. She also had mild hyperopia. Bilateral pupillary responses were normal. Intraocular pressure was normal by finger palpation.

On Titmus testing, the patient was able to see the fly, but zero of three animals and zero of nine circles.

On motility examination, she was orthotropic in primary gaze both at distance and near, but she had an inability to elevate the left eye when looking up and to the right (Figure). The rest of her version testing results were normal. The patient was noted to have a slight right face turn.

Results of a fundus examination were normal.

Her medical and ocular history was otherwise unremarkable.

Figure. Primary gaze is shown on the left; on the right, the patient is looking up and to the right.


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