Look for any obvious tropia or abnormal head posture.
If the patient wears glasses, check the lens types and the presence
of prisms
Shine a torchlight into the patient's eye from about 1/2 metres away
and observe the corneal reflexes for any tropia
Perform a cover test for near (33 cm), 6 metres and distance (most examiners
will only expect to perform for near and 6 metres).
Perform an alternate cover test for near (33 cm), 6 metres and distance.
(As in cover/uncover test, usually near and 6 metres are sufficient)
Perform the prism cover test for near (33 cm) and distance. (The prism
is placed over the eye with manifest deviation with the apex in the direction
of the deviation. Perform an alternate cover test by moving the occluder
from one eye to another. Observe the movement of the eye behind the prism
as it takes up fixation. Increase the prism strength until there is no
movement seen in the deviating eye when the other eye is covered.)
Tip 1: When testing for near, you may need the patient
to hold the fixating target to allow
you free hand to perform the prism cover test.
Tip 2: To check the accuracy of the prism dioptre increase
the prism power until the eye
movement is reversed and then reduce it until the movement stops.