Physical examination maneuver
Physical Exam
Extraocular Movements
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Hold your fingertip about an arm's length away from the patient and ask the patient to follow it with their eyes while keeping the head still. Move it through the six cardinal directions of gaze in an 'H' pattern, pausing at the extremes. Ask the patient to report any double vision experienced during the examination. Watch both eyes for full, smooth, conjugate movement and for any nystagmus or lag.
How to Interpret
Showing 6 of 21 findings
Hyperthyroidism
Eyelid lag
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Myasthenia Gravis
Improvement of ptosis with the ice-pack test
Rule in
Somewhat helpful
Rule out
Helpful
Evidence:Moderate
Fatigable ptosis / worsening ocular misalignment on sustained gaze
Rule in
Somewhat helpfulWide CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Orbital Fracture
Diplopia after facial trauma
Rule in
InconclusiveWide CI
Rule out
Not helpfulDerived CI
Evidence:Strong
Stroke
Conjugate gaze palsy in a patient with confirmed acute ischemic stroke
Rule in
Somewhat helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Diplopia in a patient with confirmed acute ischemic stroke
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
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Rule in:HAcromegaly, HStroke, SHCushing Syndrome +5 more
Rule out:SHAcromegaly, SHCushing Syndrome, SHStroke +5 more
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Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
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Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
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Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
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Alternate Cover Test
aka Cross-cover test, Test of skew
Rule in:VHSkew Deviation, VHVestibular Dysfunction, HStroke +1 more
Rule out:VHStroke, VHVestibular Dysfunction, HSkew Deviation +1 more
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Head Impulse Test
aka Head thrust test; Halmagyi test
Rule in:VHVestibular Dysfunction, HStroke
Rule out:VHStroke, VHVestibular Dysfunction