Vol 126, No. 11, November 2008 Archives Clinical Challenge: You Make the Diagnosis Strabismus in an 8-Year-Old Girl REPORT OF A CASE An 8-year-old girl had exodeviation during upgaze since age 1 year. She did not have diplopia and had no history of strabismus surgery. Her motility examination is shown in Figure 1. High-resolution T1-weighted magnetic resonance imaging was performed with a 1.5-T Sigma scanner (GE Healthcare, Milwaukee, Wisconsin) (Figure 2). What is your diagnosis? Figure 1. Photographs of the 9 cardinal positions. View a larger version of Figure 1. Figure 2. Magnetic resonance images of orbits in quasi-coronal planes at approximately 10 mm posterior to the globe center in the right (A and B) and left (C and D) eyes. Bellies of the rectus are outlined in white and the optic nerve is outlined in yellow. A, Attempted supraducted abduction in the right eye. B, Central gaze in the right eye. C, Attempted supraducted abduction in the left eye. D, Central gaze in the left eye. View a larger version of Figure 2. Please e-mail your diagnosis to ophthquiz{at}ama-assn.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our Web site and will also be able to choose one of the following books published by AMA Press: Clinical Eye Atlas, Clinical Retina, or Users’ Guides to the Medical Literature. Because of the volume of responses we are able to respond to the first person with the correct answer only. For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of Archives of Ophthalmology. Congratulations to the winner of our October quiz, Gioconda Mojica, MD, PGY-II Resident, Section of Ophthalmology and Visual Science, Department of Surgery, University of Chicago, Chicago, Illinois. The correct answer to our October challenge was cavernous hemangioma of the iris. For a complete discussion of this case, see the Letters: Research Letters section in the November Archives (Shields JA, Shields CL, Eagle RC Jr. Cavernous hemangioma of the iris. Arch Ophthalmol. 2008;126[11]:1602-1603). Next month's quiz will be available on December 8, 2008, at 3 pm Central time.