Duke Medical Education: Core Neuro-Ophthalmologic Exam (8 of 12): Ocular Motility



we will now assess I've movements but before we determine whether there is any dynamic abnormality the eye movements it's very important to look at the alignment of the eyes and primary gaze so what I'd like to do is ask dr. Zhao to look straight ahead and it for example dr. Sauer to tell me that she was having double vision I'd want to determine whether I could see any gross abnormality of the alignment of the eyes possibly the left eye may be sitting higher than the right or maybe the right eye is turned in and you want to be able to notate that before you begin movement of the eyes themselves very good once we've determined that then it's very important to look at the way the eyes move and we'll begin by checking smooth pursuits so what our last doctor's hour to do is to look at my finger and please dr. Zhao if you could try not to move your head because it's very important that the head be still but we're only looking at the eyes moving very good please follow my finger as I move it and as we do this we're looking to see how well her eyes move whether they move appropriately to the end gaze I'm also looking to see if I see any spontaneous nystagmus possibly or I can invoke nystagmus and I check both horizontal and vertical here I'm checking vertical eye movements and here I'm checking horizontal eye movements also you can check it all four quadrants I'm gonna have her look up and to the right and I'm gonna have her look down in to the right and in this case you may want to elevate her eyelids thank you very much dr. Zhao look straight down very good look down into your left look all the way to your left and please look all the way up into your left excellent very good once you've assessed smooth pursuits the next step is to assess saccade saccade czar fast I've movements and to do that it's very important that you give the patient a target to look at so what I'm going to ask doctors out to do is to look at my nose and when I ask you to please look at my finger once I ask you to look at my finger so look at my nose look at my finger look at my nose look at my finger I'll ask you to do this to the left and then I'm gonna ask her to do it to the right look at my nose look at my finger look at my nose look at my finger very good look at my nose I I've checked horizontal saccades I'll now check vertical sockets please look at my finger look at my nose look at my finger look at my nose look at my finger look at my nose look at my finger look at my nose very good once you've assessed the saccadic eye movements now you want to check for convergence and divergence and just to check for convergence our last dr. Zhao to look at my finger and follow my finger as I bring it towards her nose and as you can see as I bring the target closer to her her eyes are coming together ie convergence and I'm looking to make sure that both eyes converge once I've determined that they're converging very well which they are then I'll bring my finger back and at that time I'm going to be looking to make sure that the eyes diverge as well they don't diverge this could be evidence of divergence insufficiency or possibly even subtle bilateral six nerve palsy is very good thank you very much dr. Zhao

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