This document discusses eye movement examination and what it can reveal about eye and brain function. It describes different types of eye movements including those that prevent double vision and those that cause double vision. It provides details on muscles involved in eye movements and tests that examine pursuit, saccadic, convergence, and doll's eye movements. The results of these tests can indicate lesions in the supranuclear, internuclear, or nuclear control of eye movements. Specific findings like skew deviation or cranial nerve palsies suggest medical conditions like diabetes or surgical issues like tumors. Internuclear opthalmoplegia often arises from multiple sclerosis while supranuclear palsy is seen in degenerative conditions.

1. Eye movement examination
Ahmed Abdul Ghany

2. Types of Eye movements

3. Control of Eye movements
 No double vision
• Supranuclear
• Internuclear
• Nuclear
 Double vision
• Nerve lesion
• Neuromuscular junction
• muscle

4. Muscles involved in Eye Movements

5. WHAT TO DO ?

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Look at the position of the head, why?
Look at the eyes for ptosis
Look at the position of the eyes in 1ry gaze.
Perform cover test: for Latent squint

7. Test Eye movement to pursuit
Hold a pen vertically about 50 cm away from
patient and ask him to follow it.

8. Test Saccadic Eye movement
Face the patient. Hold both your hands out in
front of you about 30 cm apart from side to side
and about 30 cm from the patient. Then ask the
patient to look from one hand to another.

9. Test Convergence
Ask the patient to look at the distance and then
look at your finger placed 50 cm from him.
Gradually bring the eyes in.

10. Doll’s eye maneuver
In conscious patients with limited eye
movements on command or pursuit, the test
can be done to demonstrate preserved eye
movements ( supranuclear lesions).

11. WHAT YOU FIND

14. WHAT IT MEANS

15. Skew deviation
• Eyes are aligned in different vertical planes
• Common with brainstem lesions: stroke or
demyelination

16. Single cranial nerve palsy
Medical: Diabetes,
atherosclerosis, vasculitis
and Miller-Fisher
syndrome.
Surgical: tumor, aneurysm
and trauma.

17. Nuclear lesions, lateral and vertical
gaze palsy
Arise from brainstem pathology as infarction
and multiple sclerosis.

18. Internuclear ophtalmoplegia
• A lesion to the medial longitudinal fasciculus
• Common cause: Multiple sclerosis
• Rare with vasculitis

19. Supranuclear palsy
• With preserved positional and vestibular
testing.
• Seen in degenerative conditions.