{"id":3000,"date":"2024-08-13T10:38:18","date_gmt":"2024-08-13T14:38:18","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/?post_type=chapter&#038;p=3000"},"modified":"2025-01-03T15:19:42","modified_gmt":"2025-01-03T20:19:42","slug":"extraocular-eye-movement","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/extraocular-eye-movement\/","title":{"raw":"Extraocular Eye Movement","rendered":"Extraocular Eye Movement"},"content":{"raw":"<span style=\"color: #000000\">The extraocular eye movement is innervated by:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">CN III (oculomotor).<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">IV (trochlear).<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">VI (abducens) <\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">See <strong>Figure 21<\/strong> and <strong>Figure 22<\/strong>.<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves.jpg\" alt=\"\" width=\"848\" height=\"361\" class=\"wp-image-3157 aligncenter\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 21:<\/strong> Extraocular movement via cranial nerves. (Illustrator Arina Bogdan)<\/span>\r\n\r\n&nbsp;\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.-.png\" alt=\"\" width=\"819\" height=\"347\" class=\"wp-image-3159 aligncenter\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 22:<\/strong> Extraocular muscles.<\/span>\r\n<span style=\"text-align: initial;font-size: 1em;color: #000000\">(J. Gordon Betts, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix. (2022). <\/span><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/11-3-axial-muscles-of-the-head-neck-and-back\" style=\"text-align: initial;font-size: 1em\" target=\"_blank\" rel=\"noopener\">The Muscular System<\/a><span style=\"text-align: initial;font-size: 1em;color: #000000\">. In <a href=\"https:\/\/openstax.org\/details\/books\/anatomy-and-physiology-2e\" target=\"_blank\" rel=\"noopener\">anatomy and physiology 2e<\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. <span style=\"color: #000000\">OpenStax. <\/span><\/span><a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" style=\"text-align: initial;font-size: 1em\" target=\"_blank\" rel=\"noopener\">CC BY 4.0 license<\/a><span style=\"text-align: initial;font-size: 1em;color: #000000\">).<\/span>\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Extraocular eye movement<\/strong> can be assessed using the <strong>diagnostic positions test<\/strong>. Use the following steps:<\/span>\r\n<ol>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Sit or stand about 3\u20134 feet (about two arms-lengths) away from the client, at the same level.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Ask the client to focus on your nose.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, the client\u2019s gaze is midline.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings include deviation of one of the eyes or both: deviation may involve the eye moving inward, outward, up, or down.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Place your index finger straight out in front of you and ask the client to focus on your finger. Instruct the client to keep their head still as they follow your finger with their eyes through the six cardinal positions of gaze; see <strong>Figure 23<\/strong>). Positions include: diagonally in superior field, laterally at eye level, and diagonally in the inferior field. Move your finger into each of these positions by fully extending your arm: move back to centre each time you move to one of these positions and complete these movements on both sides. Hold your finger in each of these six positions for about two seconds. If the client moves their head, remind them to keep their head still and only follow your finger with their eyes. Ask the client if they experience any double vision. See <strong>Video 8.<\/strong><\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, eye movement is smooth, [pb_glossary id=\"2413\"]conjugate[\/pb_glossary], with no [pb_glossary id=\"2415\"]nystagmus[\/pb_glossary], and no double vision.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might include [pb_glossary id=\"3471\"]disconjugate movement[\/pb_glossary], nystagmus, and double vision. Report any abnormal findings to the physician or nurse practitioner for further evaluation.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cSmooth, conjugate movement with no double vision.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cDisconjugate eye movement, nystagmus of left eye with extreme lateral gaze, and double vision noted by client.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<span style=\"color: #000000\"><img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-300x169.jpg\" alt=\"\" width=\"836\" height=\"471\" class=\"alignnone wp-image-2285\" \/><\/span>\r\n\r\n<span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 23:<\/strong><span style=\"text-align: initial;font-size: 1em\"> Six diagnostic positions for testing.<\/span><\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/5dm2wDre--c[\/embed]\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Video 8:<\/strong><span style=\"text-align: initial;font-size: 1em\"> Extraocular eye movement test. [0.45 seconds].<\/span><\/span>","rendered":"<p><span style=\"color: #000000\">The extraocular eye movement is innervated by:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">CN III (oculomotor).<\/span><\/li>\n<li><span style=\"color: #000000\">IV (trochlear).<\/span><\/li>\n<li><span style=\"color: #000000\">VI (abducens) <\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">See <strong>Figure 21<\/strong> and <strong>Figure 22<\/strong>.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves.jpg\" alt=\"\" width=\"848\" height=\"361\" class=\"wp-image-3157 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves.jpg 512w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves-300x128.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves-65x28.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves-225x96.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-movement-via-cranial-nerves-350x149.jpg 350w\" sizes=\"auto, (max-width: 848px) 100vw, 848px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 21:<\/strong> Extraocular movement via cranial nerves. (Illustrator Arina Bogdan)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.-.png\" alt=\"\" width=\"819\" height=\"347\" class=\"wp-image-3159 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.-.png 512w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.--300x127.png 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.--65x28.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.--225x95.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Extraocular-muscles.--350x148.png 350w\" sizes=\"auto, (max-width: 819px) 100vw, 819px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 22:<\/strong> Extraocular muscles.<\/span><br \/>\n<span style=\"text-align: initial;font-size: 1em;color: #000000\">(J. Gordon Betts, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix. (2022). <\/span><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/11-3-axial-muscles-of-the-head-neck-and-back\" style=\"text-align: initial;font-size: 1em\" target=\"_blank\" rel=\"noopener\">The Muscular System<\/a><span style=\"text-align: initial;font-size: 1em;color: #000000\">. In <a href=\"https:\/\/openstax.org\/details\/books\/anatomy-and-physiology-2e\" target=\"_blank\" rel=\"noopener\">anatomy and physiology 2e<\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. <span style=\"color: #000000\">OpenStax. <\/span><\/span><a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" style=\"text-align: initial;font-size: 1em\" target=\"_blank\" rel=\"noopener\">CC BY 4.0 license<\/a><span style=\"text-align: initial;font-size: 1em;color: #000000\">).<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Extraocular eye movement<\/strong> can be assessed using the <strong>diagnostic positions test<\/strong>. Use the following steps:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Sit or stand about 3\u20134 feet (about two arms-lengths) away from the client, at the same level.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Ask the client to focus on your nose.<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, the client\u2019s gaze is midline.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings include deviation of one of the eyes or both: deviation may involve the eye moving inward, outward, up, or down.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Place your index finger straight out in front of you and ask the client to focus on your finger. Instruct the client to keep their head still as they follow your finger with their eyes through the six cardinal positions of gaze; see <strong>Figure 23<\/strong>). Positions include: diagonally in superior field, laterally at eye level, and diagonally in the inferior field. Move your finger into each of these positions by fully extending your arm: move back to centre each time you move to one of these positions and complete these movements on both sides. Hold your finger in each of these six positions for about two seconds. If the client moves their head, remind them to keep their head still and only follow your finger with their eyes. Ask the client if they experience any double vision. See <strong>Video 8.<\/strong><\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, eye movement is smooth, <button class=\"glossary-term\" aria-describedby=\"3000-2413\">conjugate<\/button>, with no <button class=\"glossary-term\" aria-describedby=\"3000-2415\">nystagmus<\/button>, and no double vision.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might include <button class=\"glossary-term\" aria-describedby=\"3000-3471\">disconjugate movement<\/button>, nystagmus, and double vision. Report any abnormal findings to the physician or nurse practitioner for further evaluation.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cSmooth, conjugate movement with no double vision.\u201d<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cDisconjugate eye movement, nystagmus of left eye with extreme lateral gaze, and double vision noted by client.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><span style=\"color: #000000\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-300x169.jpg\" alt=\"\" width=\"836\" height=\"471\" class=\"alignnone wp-image-2285\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-300x169.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-1024x576.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-768x432.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-65x37.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-225x127.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing-350x197.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Six-diagnostic-positions-for-testing.jpg 1440w\" sizes=\"auto, (max-width: 836px) 100vw, 836px\" \/><\/span><\/p>\n<p><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 23:<\/strong><span style=\"text-align: initial;font-size: 1em\"> Six diagnostic positions for testing.<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Extraocular Eye Movement\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/5dm2wDre--c?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Video 8:<\/strong><span style=\"text-align: initial;font-size: 1em\"> Extraocular eye movement test. [0.45 seconds].<\/span><\/span><\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"3000-2413\" hidden><p>refers to eyes moving together (in unison).<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"3000-2415\" hidden><p>is repetitive, involuntary eye movement in which the eye looks like it is quivering and can move up-down, side-to-side or in a circular motion.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"3000-3471\" hidden><p>refers to when eyes do not move together (in unison), but rather one eye moves in a different direction than the other eye.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":9,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3000","chapter","type-chapter","status-publish","hentry"],"part":1653,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/3000","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":23,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/3000\/revisions"}],"predecessor-version":[{"id":3681,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/3000\/revisions\/3681"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1653"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/3000\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=3000"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=3000"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=3000"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=3000"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}