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Clinical Examination in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Selvakumar Ambika, Krishnakumar Padmalakshmi
Ductions are monocular eye movements. Medial movement of eye is termed as adduction, lateral is—abduction, upward—elevation/supraduction, downward-depression/infraduction. Vergences are binocular eye movements, which may be convergence or divergence. Convergence is tested by asking the patient to look at an accommodative target as it is brought closer to the nose and is associated with physiological constriction of pupils. Disorders of midbrain and Parkinson's disease can cause convergence insufficiency.
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
The ductions should be tested. Ductions are the movements of both eyes in all the directions of gaze and are tested by asking the patient to look in a direction, follow an object, or localize a sound with their eyes. How the movement is stimulated does not matter as this is a motor test, not a sensory test. Limitations of motility of any of the muscles may be noted during this examination. Testing the eyes separately can be helpful when there is misalignment present. Vergences are the result of the eyes moving in opposite directions such as convergence and divergence and are testing by having the patient look at an object moving toward them and away from them.
One or More Bulging Eyes
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Ocular motility: Should be examined, which may reveal mechanical restriction in eye movement or involvement of other cranial nerves. Examining ductions, versions, a force duction test or performing a Hess chart will help to differentiate a mechanical versus neurological cause of restriction. A formal orthoptist report should be obtained.
Measurement of ductions and fields of binocular single vision (BSV): orthoptic practice in the UK and Ireland
Published in Strabismus, 2021
Catherine Jukes, A. Bjerre, C. Codina, H. Griffiths
Eye movement limitations can indicate serious pathology, such as: brain and orbital tumors,1 Graves Orbitopathy (GO),2 orbital cellulitis,3,4 orbital fractures5 chronic progressive external ophthalmoplegia,6 and multiple sclerosis.7 It is important to accurately detect and monitor limitations as these can indicate medical conditions requiring prompt investigation and treatment. Clinically, eye movement excursions are often estimated using the grading scale method; rating movements from −4 to +4.8 This method is imprecise, lacks standardization and is prone to intra and inter–observer variation.9 Clinical methods used to quantify eye movement excursions and fields of BSV are: Goldmann perimeter,10–12 Aimark perimeter,13 Arc perimeters,14 and Octopus perimeter.15 The aforementioned machines are quite large, taking up valuable clinical space. Throughout this report the term duction will be used when referring to the extent of eye movement excursions (rather than uniocular field of fixation- which refers to the measurement in six or eight positions of gaze).
Consecutive Esotropia with and without Abduction Limitation – Risk Factors and Surgical Outcomes of Lateral Rectus Advancement
Published in Journal of Binocular Vision and Ocular Motility, 2021
Pratik Chougule, Mayank Jain, Virender Sachdeva, Ramesh Kekunnaya
All patients were divided into two groups; group-A: without abduction limitation (Figure 1); group-B with abduction limitation after initial exotropia surgery (Figure 2). All patients underwent comprehensive eye examination including cycloplegic refraction, anterior and posterior segment evaluation. Data regarding ductions and the versions of all patients were collected from the clinical records. Duction limitation was recorded based on a subjective scale of 0 to −4 with 0 indicating no limitation, and −4 indicating failure of the eye to cross the midline. Overaction of muscle was graded similarly on a scale of 0 to +4.13 Preoperatively, the amount of deviation was measured by the prism and alternate cover test for both distance and near in primary position and in all gazes to look for incomitance and/or any pattern deviation. Exotropia was subclassified as constant, intermittent, or sensory. Intermittent exotropia was further classified according to Burian’s classification.14
Abnormal Head Posture in Unilateral Superior Oblique Palsy
Published in Journal of Binocular Vision and Ocular Motility, 2021
Masoud Khorrami-Nejad, Mohamad Reza Akbari, Haleh Kangari, Alireza Akbarzadeh Baghban, Babak Masoomian, Mahsa Ranjbar-Pazooki
For the diagnosis of SOP, the angle of deviation in nine diagnostic gazes was measured by prism cover test. Also, eye movements, as well as overshoot and undershoot of extraocular muscles were tested by version and duction tests. In the next step, before performing the Bielschowsky three-step test, other clinical conditions mimicking unilateral superior oblique palsy or conditions which may have a positive Bielschowsky three-step test except for SOP were examined accurately and excluded from the study. These conditions included paresis of more than one vertical muscle, contracture of the vertical recti, previous vertical muscle surgery, dissociated vertical divergence, myasthenia gravis, skew deviation, and small nonparalytic vertical deviations associated with horizontal strabismus.12 In addition, non-paretic upshoot in adduction as a latent motility disorder, which is usually observed accompanying horizontal strabismus in children13,14 was differentiated from unilateral superior oblique palsy by the absence of history of trauma, absence of primary position hyperdeviation, a lack of subjective torsion, and by checking the chin position. Head tilt with chin up was observed in patients with non-paretic upshoot in adduction.15 Finally, through the Bielschowsky three-step test, SOP was diagnosed with hypertropia in the central gaze that increased in contralateral head tilt and on contralateral gaze.4,16