Ocular Motility
With the patient’s head immobilized, the
examiner asks the patient to look in each of the nine diagnostic positions
of gaze: 1, straight ahead;
2, right; 3, upper right; 4, up; 5, upper left; 6, left; 7, lower left; 8,
down; and 9, lower right (Fig. 1.5). This allows the examiner to diagnose strabismus, paralysis of
ocular muscles, and gaze paresis.
Evaluating the six cardinal directions
of gaze (right, left,
upper right, lower right, upper left, lower left) is sufficient when examining
paralysis of the one of the six extraocular muscles. The motion impairment of
the eye resulting from paralysis of an ocular muscle will be most evident in
these positions. Only one of the rectus muscles is involved in each of the left
and right positions of gaze (lateral or medial rectus muscle). All other
directions of gaze involve several muscles.
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