Bitesize Orthoptics - Assessing ocular movements
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Assessing ocular movements is a core part of any Orthoptic assessment. It helps you to evaluate how well the eyes move together and can reveal any motility disorders, restrictions, or neurological involvement. This guide will walk you through how to perform an ocular movement examination confidently and accurately.
Before you begin
Before assessing the ocular movements, ensure you have done a vision test so you know the level of vision in each eye. You want to ensure that the patient can see the pentorch with both eyes, so that they can take up fixation with each eye.
You will need a pen torch and an occluder
Make sure the pentorch is bright enough so that you can see the corneal reflections, but not too bright that it makes the test uncomfortable for the patient
Make sure you hold the pentorch in one hand and the occluder in the other, in a way that you are comfortable with.
Explain the procedure to the patient: Something along the lines of - I will now test your ocular movements. To do this, please keep your head still and only move your eyes to follow the light.
Remember to test without glasses as the frames will get in the way of an accurate assessment
How to perform an ocular motility assessment
Begin by using your pentorch to assess the patient in primary position - note if the patient has a misalignment (eg esotropia/exotropia, and note which eye)
Perform a cover-uncover test by covering one eye and observing the movement of the uncovered eye when the patient alternates fixation.
Now move your pentorch to either dextroversion or laevoversion - make sure you reach the extreme end of the gaze. Assess for any restrictions. Also note any nystagmus that might be present (and which type if you have learnt this)
Perform a cover/uncover test to assess any underactions.
Return to the primary position.
Repeat this for all other positions of gaze, making sure to return to primary position before moving on to the next gaze.
A key thing to note is that you must be able to see the corneal reflection at the extreme point of gaze. If your light is obstructed by the patient's nose/facial features, then the patient can't see the light either and you are not testing the gaze correctly.
Record your results clearly on an ocular movements diagram, using the correct annotation for what you saw.
- is used for an underaction
+ is used for an overaction
Arrows are used for up/down shoots
Hashed lines are used for restrictions
Interpret the results, considering the coordination, smoothness, and limitations in eye movements, which may point to a specific ocular motility disorder.
Keep your eyes peeled for our upcoming guide on Ocular Motility. This guide will outline the types of ocular movements, the extra ocular muscles, assessing and performing ocular motility examination.
