Oculomotor Lecture

Oculomotor Lecture
Presentation lecture from:Mary Warren, Uni. of Alabama at Birmingham

Evaluation Purpose

* Determine if an oculomotor impairment exists and interferes with occupational performance
o Not to diagnose the impairment
* Evaluation should be a simple screening using a “look and listen” approach
o Look at the deviations in oculomotor control
o Listen to patient complaints regarding occupational performance

Begin Evaluation by Listening

* Obtain visual history
o Congenital childhood strabismus
+ Did pt have eye surgery, patching as a child?
+ Did anyone ever tell the patient h/she had a lazy eye?
o If patient had a head injury
+ Was there any trauma to the eye or orbit?

* What are the patient’s functional complaints?
o Print blurs when reading
o Unable to keep objects in focus
o Balance difficulty
o Past pointing/reaching
o Eye fatigue/eye pain/headache with sustained focus
o Difficulty maintaining concentration on activities requiring sustained focus
+ Reading or computer work
o Nausea/blurring vision with head movement
o Blurring of vision when changing focal distances

Assessment of Diplopia

* Subjective complaints of diplopia
o Lateral or vertical splitting of images
o Present at near distances or far distances
o Present intermittently or constantly
o Direction of affected gaze
+ Primary gaze
+ Right or left gaze
+ All gaze directions
o Minimize or exacerbated by head position
o Accompanied by blurring vision when head movement

* Objective observations
o Disappears when one eye is closed
+ Indicates oculomotor impairment
o Remains with closing of one eye
+ Indicates some other cause such as retinal injury
o Area of fusion
+ All persons have some area where they can see a single image known as the fusion zone
+ Distance from face
+ Ability to maintain fusion within the zone
o Neck range of motion
+ Horizontal and vertical

General Appearance of Eyes and Head

* Have pt focus on a distant, visible target and compare appearance of the eyes
o Symmetry of pupil size
o Symmetry and function of eyelids
o Presence of nystagmus
* Does patient assume a deviated head position?
* Observe symmetry of corneal reflections in primary gaze

Corneal Reflections

* Spot of light reflected off the cornea of the eyes.
* Observation of corneal reflections is one of the simplest ways to assess ocular alignment.

* When eyes are aligned the reflections should match in location (note: some persons have slightly unequal reflections due to corneal imperfections).
* Known as Hirschberg test

Corneal Reflections Test

* Test materials
o Recording form
o Penlight
o Distant interesting target large enough to be seen easily at 6 plus feet
* Environment
o Well lighted room; ensure light source is not shining directly into the patient’s eyes. Room illumination can be decreased if corneal reflections are difficult to see.

* Procedure:
o Patient should have glasses on if worn
o Instruct the patient to focus on the target held at eye level
o Hold the penlight centered in front of the patient’s face approximately 12 inches from the tip of the nose; hold the penlight vertically so the light is directed upward and not shining into the patient’s eyes

Observe the cornea reflection in each eye
as the patient fixates

Examples of Corneal Reflections
Esotropia: reflection is on the outer rim of the cornea

Corneal Reflections Test
Assessment of Eye Movements
Smooth Pursuits
Recording
Example
Convergence
Recording
Eye Movements
Diplopia Testing
Cover Uncover Test
Outward movement: esotropia
Inward movement: exotropia
Downward movement: hypertropia
Upward movement: hypotropia
Alternate Cover Test
Diplopia Tests
Evaluating the Low Functioning Patient
Treatment
Performance Areas Affected by Oculomotor Dysfunction
Considerations in Treatment
OT Treatment Approach
Management Techniques
Occlusion
Prisms
Occlusion
Complete Occlusion
Partial Occlusion
Both Types of Occlusion
Prism
Restoration Techniques
Eye exercises
Surgical intervention

Oculomotor Lecture.ppt