( 3 )
Eyes move smoothly and bilaterally in six cardinal fields of gaze.
Test:Accommodation and Convergence
First, hold a pencil approximately 18” ( 45 cm ) in front of your patient’s nose. Then, ask her to watch the pencil as you move it.Instruct him or her to keep his / her head and eyes stationarythroughout the examination. Then, slowly move the pencil towardthe bridge of his / her nose. If everything’s OK, both your patient’seyes will converge on the pencil at the same level and distance. Atthat point, expect his / her pupils to constrict and remainconstricted. When the pencil’s 2” to 3” ( 5 to 7.6 cm.) from the bridge of his / her nose, your patient should be able to comfortablyhold her gaze. Document all findings in your nurse’s notes.
Both eyes converge on pencil at same level and distance. Patientmaintains gaze on pencil when it’s held 2” to 3” ( 5 to 7.6 cm.)from the bridge of his / her nose. When your patient’s eyesconverge, both of her pupils constrict and remain constricted.
Abnormal findings in Oculomotor ( III ) nerve damage:
Lid ptosis, with inability to completely open eye; eyeball deviatedoutward and slightly downward; pupil dilated and unreactive tolight; nystagmus, and accommodation power lost.
Abnormal findings in Trochlear ( IV ) nerve damage:
Inability to turn eye downward or outward.
Abnormal findings in Abducens ( VI ) nerve damage:
Eyeball deviated inward, diplopia, paralysis of lateral gaze.
Possible causes of abnormalities:
Trauma, multiple sclerosis, tumor or aneurysm at base of skull,increased intracranial pressure, botulism, or lead poisoning.4)
Trigeminal ( V )
Chewing movements by innervation of masseter, temporal, and pterygoid muscles; corneal and sneezing reflexes; and sensationsof face, scalp, and teeth.
Test:Masseter muscle strength
Instruct your patient to clench her teeth tightly. As he or she does,locate and palpate the masseter muscle bulges at his / her right andleft jaw joints. Compare them.