Clinical testing of eyes and eye movements

1 Pupillary light reflex. Shine a light into one eye and observe both pupils. This tests II, midbrain, III.

2 Corneal reflex tests Va, brain stem and VII.

3 Observe pupillary size: both should be equal. If not, there may be a lesion of III or midbrain.

4 Look for nystagmus. Nystagmus present on straight forward gaze is definitely abnormal. Nystagmus evident at the extremes of eye movements is only possibly abnormal.

5 Look for a squint. A lesion of the main trunk of the oculomotor, trochlear or abducens nerves will be obvious.

6 With the head stationary, the patient should be asked to follow with both eyes together an object moving not-too-quickly (e.g. the examiner's finger or a pen) as it describes a large square with both diagonals. Should any abnormality be observed, each eye may be tested more carefully. Or, if you want the easy way out, send the patient to an optician or ophthalmologist.

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