1. Observe any
abnormal head posture
For example:
-
face turn (sixth nerve palsy, Duane's syndrome)
-
head tilt (fourth nerve palsy)
-
chin up (vertical muscle weakness, V and A pattern strabismus,
ptosis)
2. Light target (pen torch)
-
observe corneal reflexes in primary position
3. Look for deviation with
-
cover/uncover test in primary position for near and distance
(usually
6 m is sufficient). Use accommodative object for near
-
alternate cover test as above
-
if the patient were to wear glasses the eyes should be examined with and
without glasses
4. In vertical deviation perform
The most common cases are:
-
infantile esotropia ( observe for dissociated vertical deviation, latent
nystagmus)
-
accommodative esotropia ( lood for orthophoria with glasses)
-
fourth nerve palsy
Strabismus: Ocular motility
1. Ask if the examiner want you to begin with cover/uncover
test
2. Examine the eye movements in the nine cardinal positions
noting: restriction of
motility, nystagmus and associated
signs such as lid narrowing/widening or
ocular retraction
3. Check saccades both horizontal and vertical
4. Check accommodation
The most common cases are:
-
third nerve palsy
-
fourth nerve palsy
-
sixth nerve palsy
-
Duane's syndrome
-
Brown's syndrome
-
myasthenia gravis
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