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Limitation of Extraocular Movement



    • How to Perform

    • Ask the patient to follow your finger with their eyes, without moving their head. Move the testing finger in a modified H pattern - up and down to the left, right and centrally.
    • Causes of Limited Ocular Movement

    • Upper motor neuron lesion - trauma, tumour, ischaemia, haemorrhage, demyelination
    • Lower motor neuron lesion - oculomotor (III), trochlear (IV) or abducens (VI) nerve palsy
    • Neuromuscular disorder - myaesthenia gravis
    • Myopathy - e.g. muscular dystrophies
    • Interpretation

    • Oculomotor nerve (III) lesion - eye deviated downward and outward, with ptosis and loss of pupillary reflexes
    • Trochlear nerve (IV) lesion - eye turned upward, with vertical diplopia and inability to look down and in
    • Abducens nerve (VI) lesion - eye turned inward (strabismus), with horizontal diplopia and inability to look laterally

Muscles Involved in Eye Movement

    • Muscles Involved in Eye Movement
    • Muscles

    • Occulomotor Nerve (III)

    • Superior rectus - intorsion and elevation
    • Inferior Rectus - abduction and depression
    • Medial rectus - adduction
    • Inferior oblique - extorsion, abduction and elevation
    • Trochlear Nerve (IV)

    • Superior oblique - intorsion, abduction and depression
    • Abducens Nerve (VI)

    • Lateral rectus - abduction
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