Eye Movement Examination

The eye movement examination tests how well your eyes move and work together. It's essential for diagnosing the cause of double vision and identifying which muscles or nerves are affected.

What's Tested

Versions (Eye Movements Together)

• Both eyes move in same direction
• Test gaze in all nine positions
• Identify limited movements

Ductions (Single Eye Movement)

• One eye at a time
• Cover other eye
• Assess full range of motion

Alignment

• Cover/uncover test
• Prism measurements
• Assess for strabismus

Smooth Pursuit

• Follow moving target
• Assess smoothness

Saccades

• Quick jumps between targets
• Speed and accuracy

Testing Positions

Eyes tested looking:

• Straight ahead (primary position)
• Up, down
• Left, right
• Up-right, up-left
• Down-right, down-left

Identifying the Problem

Which Nerve?

• Third nerve—affects up, down, in
• Fourth nerve—affects down-in, head tilt
• Sixth nerve—can't look outward

Muscle vs Nerve

• Thyroid eye disease—muscle restriction
• Myasthenia—variable, fatigable weakness

Special Tests

Parks-Bielschowsky Three-Step Test

• For vertical double vision
• Identifies which muscle affected
• Head tilt component

Forced Ductions

• Manually move eye (with anesthesia)
• Distinguishes restriction from weakness

Head Position

• Compensatory head turn or tilt
• Minimizes double vision