Next spread each eye open with your thumb and index finger. Ask the patient to look to each side and downward to expose the entire bulbar surface. Note any discoloration, redness, discharge, or lesions. Note any deformity of the iris or lesion cornea. Extraocular Muscles Corneal Reflections Shine a light from directly in front of the patient.
Asymmetry suggests extraocular muscle pathology.
Extraocular Movement Stand or sit 3 to 6 feet in front of the patient. Ask the patient to follow your finger with their eyes without moving their head. Check convergence by moving your finger toward the bridge of the patient's nose. Ophthalmoscopic Exam Darken the room as much as possible. Adjust the aperture to a plain white circle.