{"id":1622,"date":"2010-12-06T12:43:36","date_gmt":"2010-12-06T12:43:36","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/examination-of-eye-movement\/"},"modified":"2023-10-11T16:31:32","modified_gmt":"2023-10-11T15:31:32","slug":"examination-of-eye-movement","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-eyes-and-vision\/the-position-of-the-eyes-and-binocular-vision\/examination-of-eye-movement\/","title":{"rendered":"Examination Of Eye Movement"},"content":{"rendered":"<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/123324427?dnt=1&amp;app_id=122963\" width=\"384\" height=\"288\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Hold the light, or toy, at a distance of at least <span style=\"color: #33cccc;\"><strong>40 cm<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Keep it at eye level, exactly in front of the child\u2019s nasal bridge.<\/span><\/li>\n<li><span style=\"color: #003366;\">Starting from this position, move over a distance of approximately 30 cm in all directions of view.<\/span><\/li>\n<li><span style=\"color: #003366;\">If needed, hold the child\u2019s head.<\/span><\/li>\n<li><span style=\"color: #003366;\">After this, repeat the examination in the horizontal directions with the right and left eye covered alternately (<em>monocular following movement<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1612\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-40.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-40.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-40-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 40<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><em><span style=\"color: #003366;\"><strong>Findings<\/strong><\/span><\/em><\/h3>\n<ul>\n<li><span style=\"color: #33cccc;\"><strong>Strabismus <\/strong><\/span>with a<span style=\"color: #33cccc;\"><strong> small squint angle<span style=\"color: #003366;\">:<\/span><\/strong><\/span> If o<span style=\"color: #003366;\">ne of the eyes makes a fixation movement during the brief covering of the other eye, there is no straight position of the eye\u00a0<em><strong>[Figure 41]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1613\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-41.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-41.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-41-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 41<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">If the reflex images are <span style=\"color: #33cccc;\"><strong>asymmetrical<\/strong><\/span>, cover the straight eye and look what the initial squint eye does <em><strong>[Figure 42]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Alternating Strabismus<span style=\"color: #003366;\">:<\/span><\/strong><\/span> If it makes a fixation movement, which remains after recovery of binocular vision <em><strong>[Figure 42a]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Amblyopia<span style=\"color: #003366;\">:<\/span><\/strong><\/span> If the initial squint eye does not make a fixation movement.\u00a0<em><strong>[Figure 42b]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1614\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-42.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-42.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-42-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 42<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><strong><span style=\"color: #33cccc;\">Exophoria\/esophoria<\/span>:<\/strong> After covering the eye for slightly longer, it makes a recovery movement to the neutral position that started from the outer or inner corner of the eye<em><strong> [Figure 43]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1615\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-43.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-43.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-43-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 43<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Rejection by the child, when covering an eye for both the position or follow movement examination, may indicate <span style=\"color: #33cccc;\"><strong>amblyopia<\/strong><\/span> of the other eye. This eye will not follow the offered fixation object or light.<\/span><\/li>\n<li><span style=\"color: #003366;\">When examining the following movements of the eye, you can check whether both eyes, the one positioned straight and the one affected by strabismus, follow the fixation object or light. Also check if the squint angle remains the same, regardless of the direction of view. If this is the case, then it is a non-paralytic squint.<\/span><\/li>\n<li><span style=\"color: #003366;\">A second diagnostic option is when the eye affected by strabismus does follow in certain directions, but not in the opposite directions. <\/span><\/li>\n<li><span style=\"color: #003366;\">In addition, the <span style=\"text-decoration: underline;\">squint angle<\/span> <span style=\"color: #33cccc;\"><strong>reduces<\/strong><\/span> when it remains at <span style=\"text-decoration: underline;\">rest<\/span> and <span style=\"color: #33cccc;\"><strong>increases<\/strong><\/span> when it looks into the <span style=\"text-decoration: underline;\">opposite direction<\/span>. In this case, it concerns a <span style=\"color: #33cccc;\"><strong>paralytic squint<\/strong><\/span>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Strabismus, Paralytic And Non-Paralytic Squint<\/strong><\/span><\/span><\/h3>\n<h3><span style=\"color: #003366;\"><em><strong>Strabismus<\/strong><\/em><\/span><\/h3>\n<p><span style=\"color: #003366;\">Strabismus is when the <span style=\"color: #33cccc;\"><strong>visual<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>anatomical axes<\/strong><\/span> of both eyes <span style=\"text-decoration: underline;\">do not<\/span> run parallel and the <span style=\"color: #33cccc;\"><strong>projection image<\/strong><\/span> is not formed in both <span style=\"color: #33cccc;\"><strong>central foveae<\/strong><\/span> during <span style=\"text-decoration: underline;\">fixation<\/span>. It is a <span style=\"color: #33cccc;\"><strong>secondary strabismus<\/strong><\/span> if an <span style=\"text-decoration: underline;\">organic cause<\/span> is the origin. In all other cases, it is a <span style=\"color: #33cccc;\"><strong>primary strabismus<\/strong><\/span>. With <span style=\"color: #33cccc;\"><strong>concomitant<\/strong><\/span> (<em>non-paralytic<\/em>) strabismus, \u201c<em>the squint exists in all directions of view<\/em>\u201d. This is in contrast to <span style=\"color: #33cccc;\"><strong>non-concomitant<\/strong><\/span> (<em>paralytic<\/em>) strabismus, where it usually only manifests itself in <span style=\"text-decoration: underline;\">one direction<\/span> and is dependent on the <span style=\"text-decoration: underline;\">position of the eyes<\/span>.<\/span><br \/>\n<span style=\"color: #003366;\">The squint may be present <span style=\"text-decoration: underline;\">constantly<\/span> (<em>atropia<\/em>) or <span style=\"text-decoration: underline;\">intermittently<\/span> (<em>aphoria<\/em>). It may be prevalent in various directions. If the eye axes in the horizontal direction are positioned away from each other, and the imaginary intersection is in the skull, we call this an <span style=\"color: #33cccc;\"><strong>exophoria<\/strong><\/span> or an <span style=\"color: #33cccc;\"><strong>exotropia<\/strong><\/span>. If they are towards each other, and the intersection falls in front of the head, this is called <span style=\"color: #33cccc;\"><strong>esophoria<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>esotropia<\/strong><\/span>. Abnormalities may also occur in a vertical direction. If one eye looks upwards, it is known as <span style=\"color: #33cccc;\"><strong>hyperphoria<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>hypertropia<\/strong><\/span>. Downwards is classed a <span style=\"color: #33cccc;\"><strong>hypophoria<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>hypotropia<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><em><strong>Paralytic Squint<\/strong><\/em><\/span><\/h3>\n<p><span style=\"color: #003366;\">The movements of the eye are produced by <span style=\"color: #33cccc;\"><span style=\"color: #003366;\">six<\/span><strong> external eye muscles<\/strong><\/span> per eye and directed by three different <span style=\"color: #33cccc;\"><strong>cranial nerves<\/strong><\/span>.<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Superior rectus muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Superior oblique muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Medial rectus muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Inferior oblique muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Inferior rectus muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Lateral rectus muscle.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">Only the <span style=\"color: #33cccc;\"><strong>lateral rectus muscle<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>medial rectus muscle<\/strong><\/span> cause a <span style=\"text-decoration: underline;\">straight singular movement<\/span> of the eye (<em>outside and inside in the horizontal plane<\/em>). The other eye muscles move the eye independently from the starting position in two directions. They <span style=\"color: #33cccc;\"><strong>roll<\/strong><\/span> the eye around the <span style=\"text-decoration: underline;\">vertical axis<\/span> and they <span style=\"color: #33cccc;\"><strong>turn<\/strong><\/span> it around the <span style=\"text-decoration: underline;\">horizontal axis<\/span>. This is the result of the attachment sites of these muscles on the eye globe. When describing their action, the neutral position of the eye is used as the starting point (<em>looking straight ahead<\/em>). In this position, the <span style=\"color: #33cccc;\"><strong>superior rectus muscle<\/strong><\/span> moves the eye <span style=\"text-decoration: underline;\">upwards<\/span> and to the <span style=\"text-decoration: underline;\">outside<\/span>. The <span style=\"color: #33cccc;\"><strong>superior oblique muscle<\/strong><\/span> causes a <span style=\"text-decoration: underline;\">downward<\/span> and <span style=\"text-decoration: underline;\">inward<\/span> movement. The <span style=\"color: #33cccc;\"><strong>inferior oblique muscle<\/strong><\/span> is used to look <span style=\"text-decoration: underline;\">upwards<\/span> and <span style=\"text-decoration: underline;\">inwards<\/span>. The <span style=\"color: #33cccc;\"><strong>inferior rectus muscle<\/strong><\/span> is used to look <span style=\"text-decoration: underline;\">downwards<\/span> and <span style=\"text-decoration: underline;\">outwards<\/span>. A glance straight upwards is achieved by the joint efforts of the inferior oblique muscle and the superior rectus muscle. A glance straight downwards is a joint effort of the inferior rectus muscle and the superior oblique muscle.<\/span><\/p>\n<p><span style=\"color: #003366;\">When we look in a certain direction with both eyes, the eye muscles cooperate two by two <em><strong>[Figure 44]<\/strong><\/em>. These muscle pairs are sometimes called <span style=\"color: #33cccc;\"><strong>zygomatic muscles<\/strong><\/span>. In order to look to the right with both eyes, the right lateral rectus muscle and the left medial rectus muscle are used. For looking to the left, the left lateral rectus muscle and the right medial rectus muscle contract. For upwards right, the right superior rectus muscle and the left inferior oblique muscle are used. For upwards left, the left superior rectus muscle and the right inferior oblique muscle are used.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1616\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-44.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-44.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-44-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 44<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Both <span style=\"color: #33cccc;\"><strong>lateral rectus muscles<\/strong><\/span> are <span style=\"text-decoration: underline;\">innervated<\/span> by the <span style=\"color: #33cccc;\"><strong>abducens nerve<\/strong><\/span>. The <span style=\"color: #33cccc;\"><strong>superior oblique muscles<\/strong><\/span> are innervated by the <span style=\"color: #33cccc;\"><strong>trochlear nerve<\/strong><\/span>, whereas <span style=\"color: #33cccc;\"><strong>all other external eye muscles<\/strong><\/span> are innervated by the <span style=\"color: #33cccc;\"><strong>oculomotor nerve<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">When one of these cranial nerves no longer functions, the muscle innervated by this nerve won&#8217;t be able to contract and the eye will be pulled to the other side by its \u2018<em>counterpart<\/em>\u2019. This is the underlying cause for <span style=\"color: #33cccc;\"><strong>paralytic squint<\/strong><\/span>. The angle of the squint will increase when looking in the direction where the eye is normally moved by the paralysed muscle and decrease when looking in the opposite direction.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><em><strong>Non-Paralytic Squint<\/strong><\/em><\/span><\/h3>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Primary Non-Paralytic Squint<\/strong><\/span>: N<\/span><span style=\"color: #003366;\">o demonstrable cause for the squint. The eye is simply positioned incorrectly in the socket.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Secondary Non-Paralytic Squint<\/strong><\/span>: <\/span><span style=\"color: #003366;\">There is a <span style=\"text-decoration: underline;\">demonstrable<\/span> cause for the squint. <\/span><\/p>\n<p><span style=\"color: #003366;\">To understand the most common causes for the development of this squint, we will first cover the development of vision in a child.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The diameter of a newborn&#8217;s eye is only <span style=\"text-decoration: underline;\">three-quarters<\/span> that of an adult eye. The growth will take place in the posterior part of the eye. The anterior structures, in which most of the <span style=\"color: #33cccc;\"><strong>refractory media<\/strong><\/span> are located, barely increase in dimension. To be <span style=\"color: #33cccc;\"><strong>emmetropic<\/strong><\/span> in adulthood, one would have to be <span style=\"color: #33cccc;\"><strong>hypermetropic<\/strong><\/span> as a baby, infant and toddler. It is estimated that a newborn\u2019s vision is 5\/100 and that of a 3-year-old child 5\/7.5 to 5\/5. This is achieved despite hypermetropia of 1 to 2 diopter.<\/span><\/p>\n<p><span style=\"color: #003366;\">Through accommodation, the refractive capacity can be increased. However, the accommodating eye makes a simultaneous convergence movement. The degree of convergence is closely linked to the degree of dioptric increase of the refraction. For example, an emmetropic eye will have to accommodate 4 dioptrics to focus on an object that is 25 cm away from the eye. This accommodation is accompanied by a convergence of 14 degrees. Fixation at 33 cm will give an accommodation of 3 diopter and a convergence of 11 degrees. A hypermetropic eye of 1 diopter will have to accommodate 4 diopter to focus on an object that is 33 cm away from the eye. This is a convergence of 14 degrees<em><strong> [Figure 45]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1617\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-45.jpg\" alt=\"\" width=\"250\" height=\"358\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-45.jpg 250w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-45-209x300.jpg 209w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><strong><span style=\"width: 250px; display: block;\">Figure 45<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">When a child is not hypermetropic in both eyes (<em>3 diopter in one eye and 2 diopter in the other<\/em>); the more hypermetropic eye will have to <span style=\"color: #33cccc;\"><strong>accommodate<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>converge<\/strong><\/span> more. When examining the position of the eye using a fixation light, <span style=\"color: #33cccc;\"><strong>asymmetric reflex images<\/strong><\/span> are observed. This is known as an <span style=\"color: #33cccc;\"><strong>accommodative strabismus<\/strong><\/span>. This will eventually cause suppression of the worse eye and lead to <span style=\"color: #33cccc;\"><strong>suppression amblyopia<\/strong><\/span>. A second cause of secondary strabismus is a <span style=\"color: #33cccc;\"><strong>congenital cataract<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Background Information On Amblyopia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Animals that <span style=\"text-decoration: underline;\">prey<\/span>, oversee <span style=\"color: #33cccc;\"><strong>two adjacent areas<\/strong><\/span> with their right and left eye, through which <span style=\"text-decoration: underline;\">different observations<\/span> are registered <em><strong>[Figure 46]<\/strong><\/em>. At the <span style=\"text-decoration: underline;\">cortical level<\/span>, this does not cause any problems. There is no visual conflict and this is known as <span style=\"color: #33cccc;\"><strong>simultaneous vision<\/strong><\/span>. If we compare the skull of a prey animal with those of hunters, primates and humans; the deviating position of the eye socket is noticeable (<em>lateral in the first group versus frontal in the latter groups<\/em>). Because of this, the anatomical axes of both eyes run virtually parallel. Due to the limited distance between both eyes, they end up in almost the same location.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1618\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-46.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-46.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-46-300x225.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 46<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">In the first 5 to 6 months of life, each eye looks independently, just as in prey. Because both eyes and the corresponding visual cortex develop independently of each other, this does not cause any problems at the cortical level. Therefore, humans see simultaneously at this stage of life.<\/span><\/p>\n<p><span style=\"color: #003366;\">In the healthy eye, the pupil, lens and central fovae lie on the axis of the eye and both eyes form an image of the same fixation point, albeit from a somewhat different angle: <span style=\"color: #33cccc;\"><strong>the retinal disparity<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">As the cortical visual centres <span style=\"text-decoration: underline;\">mature<\/span>, the possibility develops for both images to merge into one. This is known as <span style=\"color: #33cccc;\"><strong>sensory fusion<\/strong><\/span>. The same phenomenon occurs with images that originate from the <span style=\"color: #33cccc;\"><strong>peripheral retina<\/strong><\/span>. The sensory fusion is maintained by the motor fusion, the capacity to position the eyes in such a manner that both look to the same fixation point. As soon as development has reached this stage, <span style=\"color: #33cccc;\"><strong>binocular single vision<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>stereopsis<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>depth perception<\/strong><\/span> is possible. This normally happens in the fifth or sixth month of life.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Retinal Correspondence<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">If, in a hypothetical experiment, a two-eyed being were to turn into a one-eyed being, both eyes would move medially until they merge, and the <span style=\"color: #33cccc;\"><strong>central fovae<\/strong><\/span> of both eyes would converge. The <span style=\"color: #33cccc;\"><strong>nasal peripheral retina<\/strong><\/span> of the right eye would <span style=\"text-decoration: underline;\">overlap<\/span> with the <span style=\"color: #33cccc;\"><strong>temporal<\/strong><\/span> of the left eye and vice versa. In other words, images that are projected as nasal in the left eye are projected as temporal in the right eye. In the one-eyed being, the eye ends up in the same spot. This is referred to as the <span style=\"color: #33cccc;\"><strong>normal retinal correspondence<\/strong><\/span> <em><strong>[Figure 47]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1619\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-47.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-47.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-47-300x225.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 47<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Diplopia<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">When we hold two fingers at <span style=\"text-decoration: underline;\">different distances<\/span>, in the middle of our eyes, and <span style=\"text-decoration: underline;\">fixate<\/span> on the <span style=\"color: #33cccc;\"><strong>nearest finger<\/strong><\/span>, we will see the <span style=\"color: #33cccc;\"><strong>furthest finger<\/strong><\/span> <span style=\"text-decoration: underline;\">double<\/span> in our peripheral visual field. Because of convergence during fixation on the nearest finger, the furthest finger projects in the nasal retina halves. Our brains interpret this information as one finger being present in the temporal visual field of each eye. This is known as <span style=\"color: #33cccc;\"><strong>diplopia<\/strong><\/span> <em><strong>[Figure 48]<\/strong><\/em>. Something similar happens when the eye sockets do not run parallel and only one of the eyes fixates on a subject. The image of the object is projected onto the <span style=\"color: #33cccc;\"><strong>macula lutea<\/strong><\/span> in the fixating eye. In the non-fixating eye, it is projected on the nasal or temporal retina half. At the cortical level, this is interpreted as if the object, for that eye, is located in the temporal or nasal visual field.\u00a0<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1620\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-48.jpg\" alt=\"\" width=\"250\" height=\"322\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-48.jpg 250w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-48-233x300.jpg 233w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><strong><span style=\"width: 250px; display: block;\">Figure 48<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Confusion<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">The world around us is full of \u2018<em>objects<\/em>\u2019. One of these objects will be projected onto the <span style=\"color: #33cccc;\"><strong>central visual field<\/strong><\/span> of the non-fixating eye. Hence, centrally, two different images are projected, that cannot be made to overlap at the cortical level. This is called <span style=\"color: #33cccc;\"><strong>confusion<\/strong><\/span> <em><strong>[Figure 49]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1621\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-49.jpg\" alt=\"\" width=\"250\" height=\"375\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-49.jpg 250w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EyeVision_ey-fig-49-200x300.jpg 200w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><strong><span style=\"width: 250px; display: block;\">Figure 49<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Adjustment Mechanisms<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">If one foveal and one peripheral projection image is formed of a fixated object, this will be perceived as a <span style=\"color: #33cccc;\"><strong>double image<\/strong><\/span>, and the images are considered to \u2018<em>interfere<\/em>\u2019 at the cerebral level. A second interfering factor is the confusion that appears because of the different foveal images. To avoid this, various adjustment mechanisms are possible. If we were to carry out the previous-mentioned one-eyed experiment with one strabismic eye and one straight eye, the fovea of the straight eye will coincide with a section of the peripheral retina of the strabismic eye. <\/span><\/p>\n<p><span style=\"color: #003366;\">A possible adjustment is that the <span style=\"color: #33cccc;\"><strong>peripheral retinal area<\/strong><\/span> (<\/span><span style=\"color: #003366;\"><em>where the image is formed<\/em>) will <span style=\"text-decoration: underline;\">cooperate<\/span> with the <span style=\"color: #33cccc;\"><strong>central fovea<\/strong><\/span>. It will take over the function of the fovea. An <span style=\"color: #33cccc;\"><strong>abnormal retinal correspondence<\/strong><\/span> will develop. This is accompanied by a complete reorganisation at the cortical level, facilitating a fusion of the projection image from the peripheral retina with the foveal image. The result is <span style=\"text-decoration: underline;\">binocular vision<\/span> of <span style=\"color: #33cccc;\"><strong>poor quality<\/strong><\/span> and an <span style=\"text-decoration: underline;\">inferior depth perception<\/span>. The earlier in life that this phenomenon takes place, the harder it is to reverse it. Because the fovea in the strabismus eye regresses to a central scotoma here, correction of the position of the eye will have to be properly considered in this situation.<\/span><\/p>\n<p><span style=\"color: #003366;\">A second adjustment mechanism is the <span style=\"color: #33cccc;\"><strong>suppression<\/strong><\/span> of the qualitatively inferior image produced by the strabismic eye (<em>it originates from the peripheral retina which is more light sensitive, but it is not as focused<\/em>). When this happens constantly in the same eye, it will not develop any further than where it was when the suppression started. As a result of this, the eye becomes more or less <span style=\"color: #33cccc;\"><strong>amblyopic<\/strong><\/span>. Because this is the result of suppression by the image produced in this eye, we call this <span style=\"color: #33cccc;\"><strong>suppression-amblyopia<\/strong><\/span>. If this happens at a very young age and is not noticed in time, the loss of vision will be markedly more severe than if this happens in a 4 to 5-year-old child (<em>due to the fact that the eye is more mature in this age group<\/em>). On the other hand, a timely detection of suppression at a very young age will mean a better prognosis than when it is diagnosed in an older child. The neurological system, and also the eye and the optic nerve, has much more plasticity and recovery potential at a young age.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Procedure Hold the light, or toy, at a distance of at least 40 cm. Keep it at eye level, exactly in front of the child\u2019s nasal bridge. Starting from this position, move over a distance of approximately 30 cm in all directions of view. If needed, hold the child\u2019s head. After this, repeat the examination [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[48],"tags":[134],"class_list":["post-1622","post","type-post","status-publish","format-standard","hentry","category-the-position-of-the-eyes-and-binocular-vision","tag-the-examination-of-the-eyes-and-vision"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Examination Of Eye Movement - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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