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:

https://www.slideshare.net/prithwiraj2012/diseases-of-ocular-motility-with-an-emphasis-on-squint?qid=0cdfa526-bf8f-42dd-ac28-50548aa77b47&v=&b=&from_search=1

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

https://www.slideshare.net/vvanya/anatomy-of-extraocular-muscles-and-ocular-motility

Occular motility

https://www.slideshare.net/sectionbmd/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