Strabismus: Cover / Uncover test
            1. Observe any abnormal head posture
                For example:
              • face turn (sixth nerve palsy, Duane's syndrome)
              • head tilt (fourth nerve palsy)
              • chin up (vertical muscle weakness, V and A pattern strabismus, ptosis)
            2. Light target (pen torch)
              • observe corneal reflexes in primary position
            3. Look for deviation with
              • cover/uncover test in primary position for near and distance (usually 

                • 6 m is sufficient). Use accommodative object for near
              • alternate cover test as above
              • if the patient were to wear glasses the eyes should be examined with and without glasses
            4. In vertical deviation perform
              • three step test


            The most common cases are:

              • infantile esotropia ( observe for dissociated vertical deviation, latent nystagmus)
              • accommodative esotropia ( lood for orthophoria with glasses)
              • fourth nerve palsy
            Strabismus: Ocular motility

            1. Ask if the examiner want you to begin with cover/uncover test

            2. Examine the eye movements in the nine cardinal positions noting: restriction of 
                motility, nystagmus and associated signs such as lid narrowing/widening or 
                ocular retraction

            3. Check saccades both horizontal and vertical

            4. Check accommodation
             

            The most common cases are:

              •     third nerve palsy
              •     fourth nerve palsy
              •     sixth nerve palsy
              •     Duane's syndrome
              •     Brown's syndrome
              •     myasthenia gravis
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