Test for double vision with each eye occluded. If diplopia persists it is uniocular. If, however, double vision disappears when either eye is covered, there is a defect of one of the muscles moving the eyeball. Determine whether diplopia occurs in any particular direction of gaze. It is most marked when moved in the direction of action of the weak muscle. Ask patient to follow your finger, red pin or penlight with both eyes and move it in an H pattern.
• 3rd nerve—eye turned out: divergent squint
• 6th nerve—failure to abduct: convergent squint
See Figure 29.1 .
superior rectus inferior rectus
Li ferioi oöhque superior rectus
Fig. 29.1 Direction of movement of the right eye indicating the responsible extra-ocular muscles and cranial nerves (3 = oculomotor, 4 = trochlear, 6 = abducens)
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