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326 PHYSICAL EXAMINATION
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UNIT 2
INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS
Assessing the consumer for the following health-related activities can assist in identifying the
need for education about these factors. This information provides a bridge between the health
maintenance activities and eye functions.
Diet Vitamin deciencies may affect vision; uncontrolled glucose levels in
consumers with diabetes can increase risk of diabetic neuropathy
Use of safety devices Safety glasses, goggles or face shields for sports, job, or home projects;
sunglasses in bright ultraviolet light
Health check-ups Eye examination, intraocular pressure check, knowing family history to
enable close monitoring of early signs and symptoms of family-related risk
Tobacco use Smoking is associated with age-related macular degeneration
PLANNING FOR PHYSICAL EXAMINATION
The planning phase refers to evaluating subjective data to narrow the focus on
physical examination, determining what objective data needs to be gathered, as well
as considering the environment and equipment that will be required.
At this time, you will identify which of the four diagnostic techniques you will
need to implement the physical examination, and how you will sequence these.
Forthe physical examination of the eyes you will include inspection and palpation.
Objective data is:
> collected during the physical examination of the consumer
> usually collected after subjective data
> information that is measured or observed by the clinician as opposed to being
reported by the consumer
> vital to the overall health assessment, to enable you to make clinical decisions
that are representative of the whole.
Environment
Assessment of the eyes needs to be done in a suitable environment that can provide
control of light levels, and often somewhere for the consumer to sit to increase his
or her ability to be still during the examination.
Equipment
> Penlight
> Nonsterile gloves
> Snellen chart
> Snellen E chart
> Rosenbaum near vision pocket screening card
> Vision occluder
> Cotton-tipped applicator.
IMPLEMENTATION: CONDUCTING
THE PHYSICAL EXAMINATION
Implementation of the physical examination requires you to consider your scope of
practice as well. In this section, depending on your context, you may be performing
foundation assessment with aspects of advanced assessment if you are practising in
a specialised area.
EYES 327
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Assessment of the eyes should be carried out in an orderly fashion, moving from
the extraocular structures to the intraocular structures. The eye assessment usually
includes testing of associated cranial nerves and can be performed in the following
1. Determination of visual acuity
2. Determination of visual fields
3. Assessment of the external eye and lacrimal apparatus
4. Evaluation of extraocular muscle function
EXAMINATION IN BRIEF: EYES
Examination of visual acuity
Inspection
> Distance vision
> Near vision
> Colour vision
Examination of visual elds
Examination of external eye and lacrimal
apparatus
Inspection
> Eyelids, eyebrows and eyelashes
> Lacrimal apparatus
Palpation
> Lacrimal apparatus
CHAPTER 10
Examination of extraocular muscle function
Inspection
> Corneal light reex
> Cover/uncover test
> Cardinal elds of gaze
Examination of anterior segment structures
Inspection
> Conjunctiva
> Sclera
> Cornea
> Anterior chamber
> Iris
> Pupil
> Lens
General approach to examination of the eyes
1. Greet the consumer and explain the techniques that you will be using.
2. Use a quiet room that will be free from interruptions.
3. Ensure that the light in the room provides sufficient brightness to allow
adequate observation of the consumer.
4. Place the consumer in an upright sitting position on the examination table.
5. Visualise the underlying structures during the assessment process to allow
adequate description of findings.
6. Always compare the two eyes.
7. Use a systematic approach that is followed consistently each time the
assessment is performed.
Examination of visual acuity
The examination of visual acuity (cranial nerve II) is a simple, non-invasive procedure
that is carried out with the use of a Snellen chart and an occluder to cover the
consumer’s eye. The
visual acuity numbers at the end of each line of letters (
indicate the degree of visual acuity when the consumer is able to read that line of letters
at a distance of 6 metres. For instance, a consumer who has a visual acuity of 6/24 can
read at 6 metres what a consumer with 6/6 vision is able to read at 24 metres.
It is sometimes difficult to have a space of 6 metres available for the placement
of the chart, but the distance can be simulated with the use of mirrors if necessary.
For all vision screening, the chart should be illuminated with a diffuse light
source to prevent spotlighting or glare. Otherwise 3-metre Snellen charts are also
available. Please note that for the purposes of this examination you are testing for
concerns and changes, not whether the person needs vision correction, as is done in
ophthalmology clinics.
Snellen chart contains letters of various sizes with standardised
Figure 10.4A). The numbers
Advanced Assessment
328 PHYSICAL EXAMINATION
A. Snellen vision chart
B. Assist the patient in occluding the eye
C. Assessing distance vision
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UNIT 2
FIGURE 10.4 Visual acuity testing
Inspection
Distance vision
E
1. Ask the consumer to stand or sit facing the Snellen chart at a distance
of 6 metres.
2. If the consumer normally wears glasses, ask that they be removed. Contact
lenses may be left in the eyes, but you must note that vision is corrected
when documenting the results of the vision test. If possible, also note the
strength of the contact lenses that the consumer is wearing.
3. Instruct the consumer to cover the left eye with the occluder (Figure 10.4B)
and to read as many lines on the chart as possible.
4. Note the number at the end of the last line the consumer was able to read
(Figure 10.4C).
5. If the consumer is unable to read the letters at the top of the chart, move the
consumer closer to the chart. Note the distance at which the consumer is
able to read the top line.
6. Repeat the test, occluding the right eye.
7. Repeat the test for the right eye with the left eye occluded.
8. If the consumer normally wears glasses, the test should be repeated
withthe consumer wearing the glasses, and this should be so noted
(corrected or uncorrected).
The consumer who has a visual acuity of 6/6 is considered to have normal
N
visualacuity. This means that the consumer is able to read the line indicated
at6metres in both eyes.
A
The consumer is unable to read the chart with an uncorrected visual acuity of
6/9 in one eye, vision in the two eyes is different by two lines or more, or acuity
is absent.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
EYES 329
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PUTTING IT IN CONTEXT
Visual impairment access to services: nursing roles extended
Ophthalmology services are the most accessed allied health services in the community
with 5.1% of the population accessing this specialist care (AIHW, 2022). However, during
lockdowns in the recent pandemic, usual screening and management of chronic conditions was difcult to maintain (AIHW, 2022). This was especially an issue for those living
in vulnerable environments such as rural and remote areas, aged care or assisted living
environments. However, an increase in telehealth services to combat access to services
during the pandemic has seen a sharp increase in alternate options for people to access
care. This is also true in relation to vision and eye health.
A number of studies have recently been published testing the effectiveness of using
telehealth or other alternate models to support access to screening and specialist intervention,
with nurses taking a lead role. For example, nurses in one study were on site, completing
complex eye health assessment (such as visual acuity, autorefraction, keratometry, and intraocular pressure measurements), to provide data to the ophthalmologists during telehealth
specialist ophthalmology care (Pagano et al., 2021). In another study, an Australian nursing
student-led clinic, supported by a nurse practitioner onsite, screened 741 primary school
children in a remote community for hearing and vision function. This service was found to have
a signicant positive impact for the children, with improved school performance after treatment.
Almost 30% of children screened had a vision, hearing (or both) issue and were referred on and
treated (Tolchard & Stuhlmiller, 2018). The ndings from these studies indicate that with further
education and training in ophthalmology assessment techniques, nurses can help extend the
reach of specialist eye care into areas that routinely are underserviced.
Consider your assessment skills and what skills you may need to expand on if you were
part of one of the above programs. You might like to nd out what alternate models of
access to specialist eye care are available or supported in your local area.
CHAPTER 10
The consumer may have a refractive error related to a difference in the refractive
P
power of the cornea.
normal eye. In
Figure 10.5A illustrates how light rays focus on the retina in a
myopia (near-sightedness), the axial length of the globe is
longer than normal, resulting in the image not being focused directly on the
retina; this condition can be changed with corrective lenses (see
Figure 10.5B). If
the consumer is amblyopic, no corrective lenses will improve vision.
Amblyopia is the permanent loss of visual acuity resulting from strabismus
that was not corrected in early childhood, or certain medical conditions
(alcoholism, uraemia, diabetes mellitus).
The consumer may have corneal opacities that are congenital, due to lesions that
P
have scarred the cornea (e.g. herpes simplex), from trauma, or from degeneration
and dystrophies.
Visual acuity can be decreased because of opacities of the lens caused by senile or
P
traumatic cataracts.
Systemic autoimmune diseases such as inflammatory bowel disease, arthritis or
P
other collagen vascular diseases can be associated with inflammation of the iris
(iritis), which will affect visual acuity. Iritis can also be idiopathic.
Inflammation of the retina caused by toxoplasmosis or by the presence of blood
P
in the vitreous humour following haemorrhage can be responsible for decreased
visual acuity.
Systemic diseases, such as hypertension or diabetes mellitus, and trauma may
P
damage the choroid and retina, causing decreased visual acuity.
Visual acuity can be impaired by pathology affecting the optic nerve, such as
P
multiple sclerosis, tumours or abscesses of the nerve itself, optic atrophy,
papilloedema resulting from increased intracranial pressure, optic neuritis, or
neovascularisation of the optic nerve.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
330 PHYSICAL EXAMINATION
A. Normal eye
Light rays focus on the retina.
B. Myopia (nearsightedness)
Light rays focus in front
of the retina.
C. Hyperopia (farsightedness)
Light rays focus behind
the retina.
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UNIT 2
Near vision
E
1. Use a pocket Snellen chart, Rosenbaum card (see Figure 10.6), or any printed
material written at an appropriate reading level.
2. If the pocket vision card is available, have the consumer sit comfortably and
hold the card 35cm from the face without moving it.
3. Ask the consumer to read the smallest line possible (if other printed material
is used, you will only be able to gain a general understanding of the
consumer’s near vision).
Until the consumer is in their late 30s to late 40s, reading is generally possible at
N
a distance of 35cm.
A
A consumer in this age range who cannot read at 35cm is considered
presbyopic. Younger persons may have difficulty seeing up close because they
have
hyperopia, or farsightedness (Figure 10.5C).
The normal ageing process causes the lens to harden (nuclear sclerosis),
P
decreasing its ability to change shape and therefore focus on near objects.
Colour vision
E
Colour vision is usually tested in young children. If there is suspicion that the
consumer has a colour vision deficit, have the consumer identify the primary
colours on the Snellen chart or colours in the examining room. More specific
testing is conducted by optometrists and ophthalmologists.
The consumer should be able to identify colours correctly.
N
A
The colour vision defect is designated as red/green, blue/yellow, or complete
when the consumer sees only shades of grey.
Defects in colour vision can result from diseases of the optic nerve, macular
P
degeneration, pathology of the fovea centralis, nutritional deficiency, or may be
hereditary.
FIGURE 10.5 Eye refraction
FIGURE 10.6 Near vision testing with the
Rosenbaum pocket vision screener
Examination of visual elds
The confrontation technique is used to test visual fields of each eye (CN II). The
visual field of each eye is divided into quadrants, and a stimulus is presented in
eachquadrant.
E
1. Sit or stand approximately 60–90cm away from and opposite the consumer,
with your eyes at the same level as the consumer’s (see
2. Have the consumer cover their right eye with the right hand or an occluder.
3. Cover your left eye in the same manner.
4. Have the consumer look at your uncovered eye with his or her uncovered eye.
5. Hold your free hand at arm’s length equidistant from you and the consumer
and move it or a held object, such as a pen, into your and the consumer’s
field of vision from nasal, temporal, superior, inferior and oblique angles.
6. Ask the consumer to say ‘now’ when your hand is seen moving into the
fieldof vision. Use your own visual fields as the control for comparison
tothe consumer’s.
7. Repeat the procedure for the other eye.
The consumer is able to see the stimulus at about 90° temporally, 60° nasally,
N
50° superiorly and 70° inferiorly (
A
If the consumer is unable to identify movement that you perceive, a defect in
Figure 10.7B).
the visual field is presumed. The portion of the visual field loss should be noted
and the consumer referred to an optometrist or ophthalmologist.
Defects in the consumer’s visual field can be associated with tumours, strokes or
P
neurological diseases such as glaucoma or retinal detachment.
Figure 10.7A).
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
EYES 331
A. The nurse and patient should be
approximately at an eye-to-eye level
B. Visual fields range
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Examination of external eye and lacrimal apparatus
The assessment of the external eye includes the eyelids and the lacrimal apparatus.
Pathology of the eyelids is among the most common eye complaints of consumers
seeing a healthcare provider.
Inspection
Eyelids, eyebrows and eyelashes
E
1. Ask the consumer to sit facing you.
2. Observe the consumer’s eyelids for drooping, infection, tumours or other
abnormalities.
3. Note the distribution and symmetry of the eyelashes and eyebrows and any
lesions.
4. Instruct the consumer to focus on an object or a finger held about 25–30cm
away and slightly above eye level.
5. Move the object or finger slowly downwards and observe for a white space of
sclera between the upper lid and the limbus.
6. Observe the blinking of the eyes.
7. Ask the consumer to open the eyelids as wide as possible without touching
them with their fingers.
The eyelids should appear symmetrical with no drooping, infections or tumours
N
of the lids. Eyelids of Asians normally slant upwards. When the eyes are focused
in a normal frontal gaze, the lids should cover the upper portion of the iris. The
consumer can raise both eyelids symmetrically (CN III). Slight ptosis, or
drooping of the lid, can be normal. When the eye is closed, no portion of the
cornea should be exposed. Normal lid margins are smooth, with the lashes
evenly distributed and sweeping upwards from the upper lids and downwards
from the lower lids. Eyebrows are present bilaterally and are symmetrical and
without lesions or scaling.
A
The consumer has either unilateral or bilateral, constant or intermittent ptosis of
the lid (
Figure 10.8). If part of the pupil is occluded, there may be wrinkling of the
forehead above the affected eye in an attempt to compensate by using the
frontalis muscle to lift the lid.
Ptosis can be either congenital or acquired. In congenital ptosis, there is failure
P
of the levator muscle to develop. This condition may be associated with
pathology of the superior rectus muscle as well. If the ptosis is acquired, it is
related to one of three factors:
1. Mechanical: heavy lids from lesions, adipose tissue, swelling or oedema
2. Myogenic: muscular diseases such as myasthenia gravis or multiple sclerosis
3. Neurogenic: paralysis from damage or interruption of the neural pathways
such as cranial nerve III palsy
A
An area of white sclera appears between the upper lid and the limbus, widening
as the object is moved downwards.
This condition is called lid lag and may indicate the presence of thyrotoxicosis
P
or increased circulating levels of free thyroxine or triiodothyronine.
A
The consumer is unable to bring about complete lid closure. This is generally a
unilateral condition.
This condition is referred to as lagophthalmos and can be associated with
P
Bell’s palsy, stroke, trauma or ectropion (everted right eyelid) (Figure 10.9).
A
The turning inwards, or inversion, of the lower lid is referred to as entropion
and can cause severe discomfort to the consumer as the eyelashes abrade the
cornea (trichiasis) (Figure 10.10). If left untreated, it can cause inflammation,
corneal scarring and eventual ulceration.
FIGURE 10.7 Testing visual elds by
confrontation
FIGURE 10.8 Ptosis
SCIEN CE PHOTO L IBRARY/ DR P MARA ZZI
FIGURE 10.9 Ectropion right lower eyelid
COUR TESY OF MA RY A. HITC HO
50° superior
90° temporal
70°
inferior
60° nasal
CHAPTER 10
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
332 PHYSICAL EXAMINATION
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UNIT 2
Entropion is caused by spasms or advancing age (senile). In senile entropion,
P
there is a loss of muscle tone, which causes the lid to fold inwards.
A
The turning outwards, or eversion, of the lower lid is referred to as ectropion and
may be unilateral or bilateral. With ectropion, the lower lids appear to be
sagging outwards.
The normal ageing process can cause the muscles to lose their tone and relax, or
P
they may be affected by Bell’s palsy.
A
The consumer exhibits excessive blinking that may or may not be accompanied
by increased tearing and pain.
The causes of excessive blinking can be voluntary or involuntary:
P
FIGURE 10.10 Entropion
1. Voluntary: irritation to the cornea or the conjunctiva, or stress and anxiety
(usually disappears when stimulus is removed)
2. Involuntary: tonic spasms of the orbicularis oculi muscle called
blepharospasm; often seen in elderly individuals as well as in consumers with
CN VII lesions, irritation of the eye, fatigue and stress
A
The lids are black and blue, bluish, yellow or red, depending on race and skin
colour.
Colour changes in the lids can result from the following:
P
1. Redness: generalised redness is nonspecific; however, redness in the nasal
half of the lid may indicate frontal sinusitis. Redness adjacent to the lower
lid can indicate disease of the lacrimal sac or nasolacrimal duct, such as
dacryocystitis; and redness in the temporal portion of the lid can result from
dacryoadenitis, an inflammation of the lacrimal gland.
2. Bluish: cyanosis can result from orbital vein thrombosis, orbital tumours, or
aneurysms in the orbit.
3. Black and blue: ecchymosis is caused by bleeding into the surrounding tissues
following trauma (black eye).
A
Swelling or oedema is noted in the eyelid.
Swelling or oedema may be noted in nonocular conditions such as inflammation
P
associated with allergies, herpes simplex virus, systemic diseases, medications
that contribute to swelling from fluid overload, trichinosis, early myxoedema,
thyrotoxicosis and contact dermatitis.
A
There is an acute localised inflammation, tenderness and redness, with the
consumer complaining of pain in the infected area. This is called a hordeolum.
Staphylococcus is generally the infecting organism that causes a hordeolum.
P
There are two types of hordeolum:
1. Internal: affects the meibomian glands, is usually large, may point to the skin
or conjunctival side of the lid
2. External: often called a ‘stye’, an infection of a sebaceous gland, usually
points to the skin side of the lid, extending to the lid margin
Infections of the glands of the eyelid can be caused by improper removal
of make-up, dry eyes or seborrhoea. There may be some connection between a
hordeolum and increased handling of the lids in activities such as inserting and
removing contact lenses.
A
There is a chronic inflammation of the meibomian gland in either the upper or
the lower lid. It generally forms over several weeks and, in many cases, points
towards the conjunctival side of the lid, usually not on the lid margin. There is
no redness or tenderness.
This inflammation is referred to as a chalazion and its cause is unknown.
P
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
EYES 333
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A
The lids are inflamed bilaterally and are red-rimmed, with scales clinging to both
the upper and the lower lids. The consumer complains of itching and burning
along the lid margins. There may also be some loss of the eyelashes.
This is blepharitis, which may be either staphylococcal or seborrhoeic. Often a
P
consumer has both types simultaneously. If the consumer has seborrhoeic
infections elsewhere (scalp or eyebrows), it is more likely that the blepharitis is
of the seborrhoeic type.
A
Raised, yellow, nonpainful plaques are present on upper and lower lids near the
inner canthus.
These lesions are xanthelasma, a form of xanthoma frequently associated with
P
hypercholesterolaemia.
A
The eyebrows have scaling areas.
This is caused by seborrhoea.
P
Lacrimal apparatus
E
1. Have the consumer sit facing you.
2. Identify the area of the lacrimal gland. Note any swelling or enlargement of
the gland or elevation of the eyelid. Note any enlargement, swelling, redness,
increased tearing or exudate in the area of the lacrimal sac at the inner
canthus.
3. Compare to the other eye in order to determine whether there is unilateral or
bilateral involvement.
There should be no enlargement, swelling or redness; no large amount of
N
exudate; and minimal tearing.
A
There is inflammation and painful swelling beside the nose and near the inner
canthus and possibly extending to the eyelid.
Dacryocystitis is caused by inflammatory or neoplastic obstruction of the
P
lacrimal duct.
CHAPTER 10
Palpation
Lacrimal apparatus
E
1. To assess the lacrimal sac for obstruction, don gloves.
2. Gently press the index finger near the inner canthus, just inside the rim of
the bony orbit of the eye.
3. Note any discharge from the punctum.
There should not be excessive tearing or discharge from the punctum.
N
A
Mucopurulent discharge is noted.
Obstruction anywhere along the system from the lacrimal sac to the point at
P
which the ducts empty below the inferior nasal turbinate can cause
mucopurulent discharge.
A
There is an overflowing of tears from the eye.
This condition is epiphora, which is caused by obstruction of the lacrimal duct.
P
Examination of extraocular muscle function
Six extraocular muscles control the movement of each eye in relation to three axes:
vertical, horizontal and oblique (see Figure 10.11). Assessing extraocular function is
carried out by observing corneal light reflex or alignment, using the cover/uncover
test, and by testing the six cardinal fields of gaze (cranial nerves III, IV and VI).
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
334 PHYSICAL EXAMINATION
Inferior obliques
Lateral rectus
Lateral rectus
Superior rectus
Superior rectus
Right eye Left eye
A. Right esotropia
B. Right exotropia
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UNIT 2
FIGURE 10.12 Strabismus
CN III
CN VI
Inferior rectus
CN III
FIGURE 10.11 Direction of movement of extraocular muscles
Superior obliques
Inspection
Corneal light reex (Hirschberg test)
E
1. Instruct the consumer to look straight ahead.
2. Focus a penlight on the corneas approximately 30cm away from the
consumer at the midline.
3. Observe the location of reflected light on the cornea.
The reflected light (light reflex) should be seen symmetrically in the centre of
N
each cornea.
A
There is a discrepancy in the placement of one of the light reflections.
Asymmetrical corneal light reflexes indicate an extraocular muscle imbalance
P
that may be related to a variety of causes, depending on the consumer’s age and
medical condition: neurological, such as myasthenia gravis, multiple sclerosis,
stroke, neuropathies of diabetes mellitus; uncorrected childhood strabismus
(misalignment); trauma; or hypertension. The condition of one eye constantly
being deviated is called
of the eye;
exotropia is an outward turning of the eye (Figure 10.12).
strabismus, or tropia: esotropia is an inward turning
CN III
Medial
recti
CN III
CN IV
CN III
CN VI
Inferior rectus
CN III
Cover/uncover test
E
1. Ask the consumer to look straight ahead and to focus on an object in
the distance.
2. Place an occluder over the left eye for several seconds and observe for
movement in the uncovered right eye.
3. As the occluder is removed, observe the covered eye for movement.
4. Repeat the procedure with the same eye, having the consumer focus on an
object held close to the eye.
5. Repeat on the other side.
If the eyes are in alignment, there will be no movement of either eye.
N
A
If the uncovered eye shifts position as the other eye is covered, or if the
covered eye shifts position as it is uncovered, a phoria, or latent misalignment
of an eye, exists.
This condition is a mild weakness elicited by the cover/uncover test and has two
P
forms: esophoria, nasal or inwards drift, and exophoria, a temporal or
outwards drift (see Figure 10.13).
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
EYES 335
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CHAPTER 10
Left covered eye is weaker.
(Left exophoria)
FIGURE 10.13 Cover/uncover test
Right uncovered eye is weaker.
(Right esophoria)
Cardinal elds of gaze (extraocular muscle movements)
E
1. Place the consumer in a sitting position facing you.
2. Place your nondominant hand just under the consumer’s chin or on top of
the consumer’s head as a reminder to hold the head still.
3. Ask the consumer to follow an object (finger, pencil or penlight) with the
eyes.
4. Move the object through the six fields of gaze (Figure 10.14) in a smooth and
steady manner, pausing at each extreme position to detect any
or involuntary movement, and returning to the centre after each field is
tested.
5. Note the consumer’s ability to move the eyes in each direction.
6. Move the object forward to about 12cm in front of the consumer’s nose at
the midline.
7. Observe for convergence of gaze.
Both eyes should move smoothly and symmetrically in each of the six fields of
N
gaze and converge on the held object as it moves towards the nose. A few beats
of nystagmus with extreme lateral gaze can be normal. A number of
abnormalities cause changes in a person’s ability to demonstrate all cardinal
fields. The most common findings are presented in the text.
A
There is a lack of symmetrical eye movement in a particular direction.
Inability to move the eye in a given direction indicates a weakness in the muscle
P
responsible for moving the eye in that direction.
A
Abnormal eye movements consist of failure of an eye to move outwards (CN VI),
inability of an eye to move downwards when deviated inwards (CN IV), or other
defects in movement (CN III).
Traumatic ophthalmoplegia may be caused by fracture of the orbit near the
P
foramen magnum, causing damage to the extraocular muscles or CN II, III, IV
and VI. Basilar skull fractures that involve the cavernous sinus may also cause
extraocular muscle palsy.
nystagmus,
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
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