Articles Tagged with trigeminal injury

Trauma to the Ocular Motor System

eye

I’m Ed Smith, a Sacramento Eye Injury Attorney. Virtually any form of eye trauma can follow a head injury.  Some ocular motor conditions are more common in trauma and various types of injury may be more likely to produce specific types of ophthalmoplegia. This article looks at trauma to the oculomotor system, beginning with the extraocular muscles, followed by a discussion of how injury affects each ocular motor nerve, and the pupillary, trigeminal, and facial nerves.

Eye Examination in the Injured Patient

Taking a history of patients with ophthalmoplegia secondary to injury should include determining the types of forces involved.  For example, in a patient with a fourth nerve palsy, the likely site of the primary impact is the region of the opposite forehead.  Fractures, especially of the base of the skull or the periorbital areas, should be identified.  Shock, coma, or other cause of hypoxia, and the use of narcotic, paralytic, or anti-seizure medications should be noted.  It is also important to determine if there have been visual, ocular motor, or neurological problems before the current injury.

On examination, the following observations are important especially in the presence of a complicated ocular motor problem:

  • Random eye movements
  • Fixation of the eyes
  • Lid function
  • Alignment of the eyes
  • Convergence of the gaze
  • Pursuit (smoothness at various velocities)
  • Vestibular reflexes
  • Response to forced eyelid closure
  • Optokinetics
  • Caloric testing
  • Forced duction testing

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