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This section gives a neurological examination approach to the eye movements. More details are given with each problem.
Assessment of the function of the extrinsic muscles of the eye begins with the question, 'Do you have any double vision?'
The patient is then asked to fixate on an object - fingers, a red pin - held about half a metre from the face. Keeping their head steady, the patient is then asked to follow the object as it is moved laterally left and right and horizontally up and down, to the limits of eye movement in an H pattern, with both eyes. The patient should be asked to say if the object appears double at any time, and if so, whether the images are side-by-side, or on top of one another.
The manoeuvre is repeated holding the object steady for a few seconds close to - but not at - each extreme of gaze in the horizontal plane. Nystagmus will be elicited by this test and it should be sustained more than a few beats. Note that most people demonstrate physiological nystagmus at the extremes of gaze.
If myasthenia is suspected then ask the patient to look at your finger whilst at the top of the 'H' and keep it in that position for a half minute to test for ocular muscle weakness and ptosis.