A3. Examination of ocular movements (cranial nerves III, IV and VI)

From greek.doctor
  • Examination of ptosis
    • Drooping eyelid is due to CN III lesion
  • Examination of diplopia
    • Ask patient whether they have diplopia (double vision)
  • Examination of eye movement
    • Instruct patient to follow your finger as you move it vertically, horizontally, and diagonally
    • Observe for paresis, irregular movement, or nystagmus
    • CN III enables elevation, intorsion, adduction extorsion, and abduction
    • CN IV enables intorsion, depression, and abduction
    • CN VI enables abduction
  • Examination of visual accommodation
    • Instruct patient to follow your finger as you move it toward the patient
    • Miosis, convergence, and accommodation should occur
  • Examination of ciliospinal reflex
    • = pupils dilate if you pinch the skin of the neck
    • Not routinely examined (may be examined in unconscious patients)
    • Absent in Horner syndrome
  • Examination of oculocephalic reflex (Doll’s eye reflex)
    • Used in unconscious patients
    • Absent in brainstem damage
    • Procedure
      • Open patient’s eyes
      • Quickly turn the head to each side
      • Observe the movement of the eyes
    • Negative (reflex is present)
      • Eyes look in the same direction even when the head is turned
      • (Eyes move in the opposite direction as the head)
    • Positive (reflex is absent)
      • Eyes remain in their fixed position, moving as the head moves