Clinical hints for your approach for examining ocular motility

Clinical hints for your approach for examining ocular motility

Note VA with/without correction

Observe
• head posture
• Face turn
• head tilt
• chin up/ down

Hirschberg test for manifest deviation 

Cover/uncover + alternate cover test for manifest or latent deviation.

Examine ductions and versions
9 cardinal positions of gaze
Ask patient to follow target (usually a pen-torch)

Perform cover test in each position
Ask patient to report any diplopia in 1ry position or during test

Any abnormality
• Under/overaction
• Paresis/restriction
• alphabet patterns
• Lid/head movements

Examine horizontal and vertical saccades 
• Normal/slow
• Ask patient to look rapidly between targets hypo/hypermetric positioned at 30° on either side of the midline

Examine convergence
• Normal/reduced
• Assess to both an accommodative and non-accommodative target

Examine horizontal/vertical doll’s head 
• Normal/absent movements

Examine horizontal/vertical optokinetic (OKN)
• Normal/absent
• convergence retraction nystagmus
• Slowly rotate an OKN drum in horizontal and
vertical direction

Quantitative assessment of the ocular deviation (such as the prism cover test and krimsky test)

Consider: caloric tests
• useful in patients with decreased consciousness.
•Ideally position the patient, with the head inclined backwards at 60°.
• Water placed in either ear causes nystagmus, with fast phase (cold—opposite, warm—same (COWS)

Clinical hints for your approach for examining ocular motility powerpoint presentations:

Diseases of ocular motility with an emphasis on squint

1.  Disorders of Ocular Motility Prithwiraj Maiti Admin, Pgblaster India. R.G.Kar. Medical College Kolkata. India. Email: prithwiraj2009@yahoo.In Prithwiraj Maiti
2.  Table Of Contents • For the purpose of ease, we will divide the lecture into 7 parts: • Part 1: Anatomy and action of extraocular muscles. • Part 2: Normal physiological regulatory mechanisms of eye movements. • Part 3: Apparent and latent strabismus. • Part 4: Comitant strabismus. • Part 5: Incomitant strabismus. • Part 6: Diagnostic approach in a suspected case of squint. • Part 7: Management of squint.
3. Part 1 Anatomy and action of extraocular muscles
4.  Anatomy of the Extraocular Muscles • There are 6 extraocular muscles: 4 of them are recti muscles and 2 of them are oblique muscles. • The primary action of recti muscles is to rotate the eyeball in 4 directions: up, down, out, in. • The primary action of oblique muscles is to rotate the globe (intorsion and extorsion).

Anatomy of extraocular muscles and ocular motility

Occular motility

Clinical hints for your approach for examining ocular motility Videos:

Ocular Motility Examination / www.hawal-eg.com – YouTube

Ocular motility exam – YouTube

Testing the Extraocular Muscles – YouTube

Clinical hints for your approach for examining ocular motility