Eye movement examination

Ahmed Abdul Ghany

Types of Eye movements

Eye

convergence

Saccadic

pursuit

Vestibular positional

Control of Eye movements

No double vision• Supranuclear• Internuclear• Nuclear

Double vision• Nerve lesion• Neuromuscular junction• muscle

Muscles involved in Eye Movements

WHAT TO DO ?

• Look at the position of the head, why?• Look at the eyes for ptosis• Look at the position of the eyes in 1ry gaze.• Perform cover test: for Latent squint

Test Eye movement to pursuit

Hold a pen vertically about 50 cm away from patient and ask him to follow it.

Test Saccadic Eye movement

Face the patient. Hold both your hands out in front of you about 30 cm apart from side to side and about 30 cm from the patient. Then ask the patient to look from one hand to another.

Test Convergence

Ask the patient to look at the distance and then look at your finger placed 50 cm from him. Gradually bring the eyes in.

Doll’s eye maneuver

In conscious patients with limited eye movements on command or pursuit, the test can be done to demonstrate preserved eye movements ( supranuclear lesions).

WHAT YOU FIND

WHAT IT MEANS

Skew deviation

• Eyes are aligned in different vertical planes• Common with brainstem lesions: stroke or

demyelination

Single cranial nerve palsy

Medical: Diabetes, atherosclerosis, vasculitis and Miller-Fisher syndrome.Surgical: tumor, aneurysm and trauma.

Nuclear lesions, lateral and vertical gaze palsy

Arise from brainstem pathology as infarction and multiple sclerosis.

Internuclear ophtalmoplegia

• A lesion to the medial longitudinal fasciculus• Common cause: Multiple sclerosis• Rare with vasculitis

Supranuclear palsy

• With preserved positional and vestibular testing.

• Seen in degenerative conditions.