You observe that your patient's eyes move smoothly and symmetrically in each of the six fields of gaze and converge on the held object as it moves toward the nose. There are a few beats of nystagmus on extreme lateral gaze
This observation indicates which of the following? a. early stage of paralysis of horizontal gaze
b. lesion in the brainstem or cerebellum
c. normal findings
d. weakness of the lateral rectus muscle
C
This observation indicates normal results in examining extraocular muscle movements by testing the six cardinal fields of gaze. Inability to move the eye in a given direction indicates weakness of an extraocular muscle (EOM) or dysfunction of the cranial nerve innervating it. Paralysis of horizontal gaze, the inability of both eyes to look to the contralateral side, is abnormal. This may be caused by damage to the motor areas of the cerebral cortex resulting in the loss of the ability of both eyes to look to the contralateral side. If one eye deviates down and the other eye deviates up, it is called skew deviation. A lesion in the brainstem or cerebellum on the same side as the eye that is deviated down can cause skew deviation. Weakness of the lateral rectus muscle is demonstrated by failure of the eye to move outward.
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