Abnormal Eye Movements

Initial Assessment of the Eye Eye Movements Abnormal Eye Movements

Here is a summary of the findings and causes of abnormal eye movements. In each image, the right eye is always the abnormal one.

III nerve (oculomotor) palsy

Description: affected eye lies ‘down and out’ with a dilated pupil
Common causes: aneurysm, trauma, microvasculopathy, e.g. diabetes, atherosclerosis

Fig.12 image via Shutterstock

IV nerve (trochlear) palsy

Description: affected eye elevated on forward gaze, accentuated on head tilting to affected side
Common causes: trauma, microvasculopathy

Fig.13 image via Shutterstock

VI nerve (abducens) palsy

Description: affected eye adducted at rest and no movement on lateral gaze
Common causes: space occupying lesion, trauma, aneurysm

Fig.14 image via Shutterstock

Internuclear ophthalmoplegia

Description: one or both eyes fail to adduct
Common cause: multiple sclerosis (lesion in medial longitudinal fasciculus)