FIGURE 1.

Serial Hess charts of Patient 1 demonstrating the progressively worsening esotropia. March 2002: At initial presentation, a small esodeviation was found in primary position with small bilateral under-action of lateral recti, without over-action of medial recti. Additionally, there was no over-action of superior obliques nor inferior obliques; therefore, no A or V pattern was seen. June 2004: There was an increase in the esodeviation and the under-action of the lateral recti. No A or V pattern was seen. January 2006 and November 2006: There was an increase in the esodeviation and lateral recti under-actions. There was also a small right over left deviation.