causes of sudden unequal pupils

If anisocoria remains the same in both lighting conditions, and the difference between pupil sizes is no more than 2 mm, the aetiology is likely to be physiological.6The presence of ptosis and/or extraocular muscle involvement suggests a pathological process regardless of the magnitude of anisocoria. These cases may be due to brain mass lesions which cause oculomotor nerve palsy. When the issue is significant, multiple factors can cause it. Fixed, dilated pupils can be caused by several factors. . Use for phrases Both pupils may still constrict briskly to bright light, Horners syndrome with additional oculomotor nerve lesion J AAPOS. Campbell-Walsh Urology. If an underlying cause is identified, treatment is aimed at this issue. Slight differences in pupil sizes are found in up to 1 in 5 healthy people. Take these preventative measures to potentially avoid the issue: If you experience uneven eyes, talk to your doctor about possible solutions. Eye drops placed in both eyes can sometimes have unequal effects, causing uneven pupils. Here's the deal, jealous people tend to be unkind. If the larger pupil is abnormal, the difference between pupil sizes is greater in bright light. If the examiner is unsure whether the abnormal pupil is the constricted or dilated one, and if a one-sided drooping of the eyelid is present then the abnormally sized pupil can be presumed to be the one on the side of the ptosis. Symptoms that canbe associated with unequal pupils include: The pupils of the eyes normally constrict (get smaller in size) in response to light and when looking at near objects. If the patients irides are dark and the pupils are difficult to visualise, the clinician can use an ophthalmoscope to assess differences in the red reflex. Ferri's Clinical Advisor 2018. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Therefore, if anisocoria is greater in bright illumination, the underlying cause of the failure to constrict could be a tonic (Adies) pupil, an oculomotor nerve palsy or, possibly, drug-induced mydriasis.2,7 An Adies pupil is the result of disease of the ciliary ganglion and is typically characterised by light-near dissociation in which the pupil fails to constrict to light but does constrict slowly to a near target as the result of accommodation.2 The near pupillary constriction can be difficult to elicit in elderly patients in whom accommodation is reduced. The following tests might be considered: If seizures or similar issues are suspected, the doctor might order an electroencephalogram. The varied causes have implications ranging from benign to life-threatening, and a clinically guided history and examination is the first step in establishing a diagnosis. Third nerve palsy is considered a medical emergency. The pupil is the black hole in the center of the iris, the part that gives your eye its unique color. They can evaluate the issue, determine the cause, and provide treatment options that are specific to your individual case. The pupil is the black part in the center of the eye. This may be due to a brain aneurysm, and should be urgently evaluated in the emergency room. The use of eye drops is a common cause of a harmless change in pupil size. Burde RM, Savino PJ, Trobe JD. Although the pupil looks like a black circle in the center of the colored part of your eye, it is actually a hole that opens and closes to let different amounts of light through to the back of the eye, depending on your environment (e.g., sunny day or dark room). One or both of your pupils do not react to light properly. Some of the causes of uneven pupils are preventable. However, bifocals or reading glasses may be beneficial if uneven pupils cause unequal accommodation. New York: Mosby, 2002. Reaction to certain topical dilating medications (such as a pets eye drops, or anti-nausea or motion sickness patches such as scopolamine) that may accidentally get into one eye. Unequal pupils are very common and are often only a normal variation. Unequal pupils: understanding the eye's aperture. o [ pediatric abdominal pain ] Some of these are placed in the eye for the purpose of dilating (enlarging) the pupils as part of an eye examination or a surgical eye procedure. Philadelphia, PA: Elsevier; 2018:chap 20. Diagnostic tests are often needed as well. Checking the ability of each pupil to constrict in the presence of bright light and to dilate in the darkness. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Seek immediate medical attention if: You notice a sudden, unexplained change in pupil size. Qualified patients must book their procedure by 6/30/2023. In some cases, the pupil that was once larger actually goes in the opposite direction and becomes smaller than the other pupil. Practice, Formerly Australian Family Physician (AFP). A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. **, Rise in Myopia in Children During COVID-19, Scotoma (Blind Spot or Aura in Vision): Causes, Risk Factors and Treatment, Convergence Insufficiency: What Is It, Symptoms and Treatments. Doctors examine the person's pupils in light and dark rooms. But people can experience it on a regular basis too. Doctors' first goal is to determine whether the pupils have always been unequal or whether there is another cause such as a drug or disorder. 19th ed. Unequal pupils (anisocoria) has many different causes. Aetiology of a relative afferent pupillary defect, Relative afferent pupillary defect present. Accessed Oct. 30, 2017. General Mydriasis is the eyes inherent response to stimuli. When Adie syndrome is present, it usually starts by affecting one pupil. Or you might notice someone elses pupils are not the same size. Of those patients presenting with an acquired oculomotor palsy, only 6% were found to have compression from an aneurysm and, of these compressive oculomotor nerve palsies, only64% had pupil involvement.8However, all patients with a new-onset oculomotor nerve palsy should be presumed to have a posterior communicating artery aneurysm until proven otherwise, meaning they require urgent neuroimaging.2, Conversely, failure of dilation is most obvious in the dark. An ophthalmologist should be seen to rule out ocular causes of eye pain and pupil asymmetry, especially when vision loss or changes, redness or discharge from the eye(s) is present. Cluster headaches: Cluster headaches can cause a constricted pupil on one side. Importantly, anisocoria can indicate underlying disease of the eye, orbit, brain, neck or chest. Unequal pupil size; Slurred speech; Loss of movement (paralysis) on the opposite side of the body from the head injury; . Marcus Gunn pupil, also called a relative afferent pupillary defect, occurs when both pupils constrict in response to light in one eye but do not constrict in response to light in the other. Cheng KP. Philadelphia: Lippincott Williams & Wilkins, 2005. You should also see a doctor if you experience other neurological symptoms in conjunction with fixed, dilated pupils, such as: Numbness or tingling in your extremities. Treatment for anisocoria itself is usually not necessary. Prasad S. A window to the brain: Neuro-ophthalmology for the primary care practitioner. Disease Anisocoria indicates unequal pupil sizes. The underlying cause of this condition ultimately determines the other symptoms that a person experiences. Doctors first ask questions about the person's symptoms and medical history, including questions about smoking. The black spot in the center of your eye is known as the pupil. In this case, a neurologist or neuro-ophthalmologist will be called and additional testing may be required. Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Wein AJ, et al., eds. Accessed Oct. 30, 2017. If you notice that your pupils are unequal in size, see a doctor right away. Physiologic anisocoria under various lighting conditions. The tonic pupil is a common cause of anisocoria, or unequal pupils. Miller NR, Newman NJ, Biousse V, Kerrison JB. You have pupils of unequal size (one pupil is larger/smaller than the other). https://nei.nih.gov. Am J Ophthalmol 1987;104(1):6973. Accessed Nov. 11, 2017. When one eye is exposed to light, the other eye also constricts. https://www.acep.org. Facial pain, headache, and emotional fluctuations are also possible with this condition. Horner syndrome is caused by interruption of the sympathetic nerves to an eye due from any cause. Unequal pupils can be caused by both neurological (brain or nerves) and ocular (eye) issues. doi: 10.2147/OPTH.S147019. Kliegman RM, et al. The condition may be caused by dilating eye drops from an eye exam, the side effects from a drug/medication or traumatic injury. The prevalence of simple anisocoria. Testing may include magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan) to provide pictures of the brain. Adie syndrome (eg lesion in the cavernous sinus), Ipsilateral red eye with pain and ciliary hyperaemia, Horners syndrome secondary to internal carotid artery dissection The pupil may also constrict inappropriately due to inflammation in the eye or painful conditions like corneal ulcers Call 911 for all medical emergencies. These effects are usually symmetrical, but they may be unequal. If the smaller pupil is abnormal, the difference is greater in the dark. Thank you, {{form.email}}, for signing up. What causes dilated pupils (dilated eyes)? The risk involved with a blown pupil is too great to go untreated. 0 Shop NowFind Eye Doctor Conditions Conditions Eye Conditions, A-Z Eye Conditions, A-Z Anisocoria: What causes unequal pupil sizes? Certain medications placed in the eyes can cause the pupils to be different sizes, but the effects should wear off, typically within a few hours. Editorial team. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Fixed, dilated pupils can be a sign of serious, life threatening conditions and should be treated as a medical emergency. This may help to alleviate light sensitivity. Caution: If you notice that your pupils suddenly become unequal in size, seek immediate medical attention as this can be a symptom of a medical condition that requires prompt treatment. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. (life-threatening emergency), Ocular contact with foreign substances by rubbing the eyes. In many cases, people do not notice that their pupils are unequal because the size difference is not significant. Accessed Oct. 30, 2017. Over time, it is possible for both of the pupils to be affected. It is also possible for the iris to experience depigmentation. These palsies can occur when pressure is put on the nerve or the nerve does not get enough read more usually require magnetic resonance imaging (MRI) or computed tomography (CT). However, exposure to certain substances can also elicit the reaction. Accessed Dec. 5, 2017. It gets larger in dim light and smaller in bright light. How older drivers can improve their driving at night. The clinician should observe the direct pupillary response in the illuminated eye and the consensual response in the fellow eye. Often, the larger pupil is unable to constrict normally. Incidence and etiologies of acquired third nerve palsy using a population-based method. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Harrison's Principles of Internal Medicine. Clinically, it is important to establish whether anisocoria is more apparent in dim or bright light to clarify if the larger pupil or smaller pupil is the abnormal one. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. is also a founding member of Hi-Ethics. $1000 off LASIK + 0 interest if paid in full within 24 mo. The aetiology may be physiological, pathological or pharmacological. They also provide some protection from high-energy blue light and the suns ultraviolet rays. Yes, unequal pupils can often be corrected, but the purpose of treatment goes beyond correctionthe goal is to manage the underlying condition. Adult Horners syndrome: A combined clinical, pharmacological and imaging algorithm. Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes; Ringing in the ears that doesn't go away . The muscles that work your pupils can get weak and have a tough time opening them. Any injury, disease, or chemical that interferes with one or more of these functions can lead to anisocoria. 8th ed. life-threatening, including Horner's syndrome (which may be due to carotid artery dissection) and oculomotor nerve palsy (due to a brain aneurysm, uncal herniation, or head trauma). We do not control or have responsibility for the content of any third-party site. Sudden acceleration or deceleration of . If you grow up in an unequal society, your actual experience of human relationships is different. URAC's accreditation program is an independent audit to verify that A.D.A.M. Mayo Clinic, Rochester, Minn. June 14, 2017. An epidural hematoma that affects an . Horners syndrome affects the pupils ability to dilate normally in low light (within five seconds) and instead generally leads to a delayed pupil response of around 10 to 20 seconds. Walsh and Hoyts clinical neuro ophthalmology. **, Book now for $1000 off LASIK + 0 interest if paid in full within 24 mo. How to test for a relative afferent pupillary defect (RAPD). While some causes are non-life threatening and may resolve on their own, medical attention is recommended. However, the underlying disorder may need to be treated. Mokri B. Traumatic and spontaneous extracranial internal carotid artery dissections. Occasionally, the two pupils can appear unequal in size. Am J Ophthalmol Case Rep 2017;7:1113. If you have a change in pupil size, with a headache or double vision, it could be an indication of an aneurysm, which is a weak spot in the blood vessel's wall. Diagnosis of the cause of unequal pupils involves a comprehensive physical examination, including an eye examination and a neurological examination. Accessed Oct. 30, 2017. Fang C, Leavitt JA, Hodge DO, Holmes JM, Mohney BG, Chen JJ. Yes, normally, pupils constrict and dilate together simultaneously and symmetrically. However, once you step out of the dark room, your pupils will return to normal or adjust to the new level of brightness. The effects of medications or drugs on pupil size are temporary and wear off within minutes, hours, or days, depending on the drug, dose, and a persons ability to break down and remove the drug from the body. 7) They're jealous. Anisocoria is a condition in which your two pupils appear unequal in size. Yes, certain medications and recreational drugs can affect pupil size. Aneurysms and Unequal Pupil Size. Other symptoms associated with this include: Treatment for fixed, dilated pupils depends solely on the cause. In other words, mydriasis is a temporary dilation of the pupils in response to light. Background. Either the larger or the smaller pupil may be the abnormal one depending on the cause. However, anisocoria can also result from a trauma, such as a blow to the head, medication use, or an. Thus, thorough clinical evaluation is important for appropriate diagnosis and management of the underlying cause. Sometimes doctors examine an old photograph of the person (for example, on the person's driver's license) to see whether pupils were previously unequal. Pejic R, Klaric B. The aetiology underlying anisocoria may be physiological, pathological or pharmacological. Abdominal pain mimics. If these symptoms come on suddenly, seek immediate medical attention. This can make it harder for you to see at night . Usually both pupils are about the same size and respond to light equally. In some circumstances, the pupil size can indicate a severe medical emergency. In the mirror, the pupil of the eye appears as a black circle in the middle of the iris (the colored part of the eye). The link you have selected will take you to a third-party website. The pupillary light response involves both afferent (optic nerve) and efferent (oculomotor nerve and sympathetic) pathways.2 Information from the optic nerve passes to the ipsilateral pretectal nucleus and then on to the Edinger-Westphal nuclei on both sides.5 It is this bilateral innervation of the Edinger-Westphal nucleus that results in both direct and consensual responses to light shone in one eye. Causes include: The cause is disruption of the nerve fibers that read more or 3rd cranial nerve paralysis Third Cranial Nerve (Oculomotor Nerve) Palsy A palsy of the 3rd cranial nerve can impair eye movements, the response of pupils to light, or both. ACS Chem Neurosci 2018;9(2):17786. They may have a history of being rejected by others and feel that they have to compete with others in order to get what they want. Mechanical anisocoria may also develop from an ocular tumor or congenital condition that affects the structure of the iris, such as: Pharmacologic anisocoria can develop as a side effect from certain medications. When to contact a medical professional Less valid explanations include competition, grades anxiety, capitalism, and income inequality. In: Pediatric Telephone Protocols: Office Version 15th ed. Any asymmetry of the colour of the two irides (heterochromia) should be noted. You may require emergency intervention to address the cause of the eye condition. These pathways carry nerve impulses to the pupil and to the muscles that control the eye and eyelid. Causes of headache with anisocoria include Horner syndrome and trigeminal autonomic cephalgias, including cluster headache, carotid dissection wiht Horner syndrome, some oculomotor palsies (both. 1996-2023 Optometrists Network - Powered by EyeCarePro - 70 North Meadow Crescent, Thornhill ON L4J 3B1, Canada, Mayo Clinic: 9 Tips to Avoid Computer Eye Strain. Anisocoria, also called Adies tonic pupil or Adie syndrome, is described as uneven pupil size. When it occurs, a fixed dilated pupil may be present in one or both eyes. Physiologic anisocoria is pupils that are naturally different in size. Each of the ciliary ganglion has various dedicated fibers. 11th ed. A difference in pupil size between the eyes is known as anisocoria. Other important symptoms that do not involve the eyes include headache, dizziness or loss of balance, cough, chest pain, or shortness of breath. Also, the underlying disorder sometimes causes other symptoms such as eye pain and redness, loss of vision, drooping eyelid, double vision, or headache. Medicaid: Eligibility and Vision Benefits. Report any sudden vision changes immediately to a doctor. When did it start? They work much longer hoursthe most unequal countries work perhaps nine weeks longer in a year. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. It is possible to experience partial function recovery if full recovery does not occur. More often, unequal pupils are noticed only during a doctor's examination. For new uneven pupil size that is related to new double vision, eyelid droopiness or head, neck or eye pain, it is best to be evaluated in the emergency room. Pupils are the dark circles in the eyes. Horners syndrome:is usually caused by an underlying medical condition, such as a tumor, spinal cord injury, or stroke though sometimes, the cause is unknown. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Binocular read more, Loss of vision Vision Loss, Sudden Loss of vision is considered sudden if it develops within a few minutes to a couple of days. Physiological anisocoria does not cause any problems with development of vision. However, bifocals or reading glasses may be beneficial if uneven pupils cause unequal accommodation. Learn more about A.D.A.M. People with a drooping eyelid or double vision may have a serious disorder. doi: 10.1016/j.amjmed.2017.10.008. Learn what causes anisocoria and when to see an eye doctor if you have unequal pupils. More often than not, it is pointed out to the person by someone close to them. Physiological anisocoria is common: approximately 20% of normal people have different-sized pupils.24 Non-physiological anisocoria indicates disease of the sympathetic or parasympathetic pathways supplying the pupil, or a problem with the iris itself.2,5, A thorough history should include asking about the use of new medications or inadvertent ocular contact with foreign substances by rubbing the eyes. Please speak with your NVISION Eye Center for additional details. 3rd ed. This is called physiologic anisocoria and is normal. The doctor usually starts with a blood differential and a complete blood count. However, sometimes, as in Horner syndrome Horner Syndrome Horner syndrome affects one side of the face, causing the eyelid to droop, the pupil to become small (constricted), and sweating to decrease. How Healthcare Providers Test Pupil Reflexes. Schmitt BD. For example, using alcohol, marijuana, or cocaine can cause dilated pupils, and opiates can cause pupillary constriction or dilation. Yalcin S, Pampal K, Erden A, Oba S, Bilgin S. Do we really need to panic in all anisocoria cases in critical care? Accessed Nov. 20, 2017. Some research suggests that mild anisocoria affects about 20 percent of the general population. Journal of 2017;64:525. A.D.A.M. That's why you should talk to your provider as soon as you notice any changes in your eyes or vision. 2000-2023 AAV Media, LLC. Copyright 1997-2023, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited without authorization. Anisocoria may be diagnosed if one pupil is bigger or smaller than the other. Horners syndrome is a droopy eyelid, pupil constriction, decreased sweating, and possibly eye redness. This is a sign of vision problems in the eye that dont elicit pupil constriction. Babies born with different sized pupils may not have any underlying disorder. Viral infection If you have anisocoria and experience accompanying symptoms like headaches or eye pain, you should seek immediate care. Doctors examine the pupils in light and dark rooms to help determine the cause. The physical examination focuses on the head and eyes. Eye disorders that cause unequal pupils include birth defects and eye injury. Eyeglass temples: How do you know if they're the right length? Offer cannot be combined with any other discounts or special offers, previous surgery, insurance, or vision care plan savings. What do the numbers on your eyeglass frames mean? Some people are born with unequal pupils. Elsevier Point of Care. If this nerve becomes paralyzed from an aneurysm, brain hemorrhage, or tumor, the pupil will appear dilated at all times. A third nerve palsy can result in the inability to move the affected eye normally, in addition to eyelid drooping (which is often significant) on the side of the larger pupil. The precise cause of this type of anisocoria has yet to be discovered. For example, if a seizure caused uneven pupils, a treatment regimen to control seizures will likely be implemented. Many medications affect pupil size and can cause anisocoria. Accessed Nov. 11, 2017. This is referred to as anisocoria. . Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia Do you have other symptoms such as headache, nausea, vomiting, fever, or stiff neck. This is a benign condition that causes the pupils to differ in size, usually by up to one millimeter in diameter, without affecting the pupils response to light. The key difference between blown pupils and mydriasis is pretty simple: One is a natural, normal response and the other is not. A third nerve palsy can result in the inability to move the affected eye normally, in addition to eyelid drooping (which is often significant) on the side of the larger pupil. Some of the causes of anisocoria are How Long Do Pupils Remain Dilated After an Eye Exam? Petty RE, et al., eds. The response to testing each eye separately with a bright light source is then assessed. Are There Tests to Diagnose the Cause of Unequal Pupils? American College of Emergency Physicians. People with Horner syndrome Horner Syndrome Horner syndrome affects one side of the face, causing the eyelid to droop, the pupil to become small (constricted), and sweating to decrease. Your pupils tend to get smaller as you get older, too. 107-1411 Cook Street Victoria, BC V8V 0E8 Contact Information (250) 920-0755-- mi Cook St Location-- mi Douglas St Location Causes Treatment Diagnosis When to See a Healthcare Provider Pupils are the dark circles in the eyes. Fertile Land: Human settlements on large scale are at places which are more fertile and where with less efforts the agricultural yield is more. Seek prompt medical care if your child has an eye injury or experiences sudden vision changes, especially if accompanied by: See a specialist in vision problems (optometrist or ophthalmologist) if your child experiences any vision problems that impair his or her ability to read or write comfortably or participate in everyday activities. doi:10.1097/CCM.0000000000005272, Heath Jeffery RC, Young B, Swann PG, Lueck CJ. Anisocoria and poor pupil reactivity by quantitative pupillometry in patients with intracranial pathology, Unequal pupils: understanding the eye's aperture, Anisocoria secondary to antiperspirant wipes in a pediatric population: a case series, Numbness or weakness of one side of the face or body, Blurred vision or loss of vision in one or both eyes, Flomax (tamsulosin HCL) and other alpha-1 blockers used to treat enlarged prostate, Antipsychotics: Thorazine (chlorpromazine), Mellaril (thioridazine), and more. For new accounts: Purchase APR (interest rate) is 29.99%; Minimum Interest Charge is $2. What is the cause of the patient's anisocoria? Also, for unknown reasons, pupils may temporarily differ in size. Causes of unequal pupils can include: Pupil size and reactivity are controlled by coordination between vision (controlled by cranial nerve two), muscles that move the opening of the pupil, and the nerve that controls these muscles (cranial nerve three). If you have glaucoma, the doctor might recommend you undergo tonometry testing. At Another Johns Hopkins Member Hospital: Cortical Visual and Perceptual Impairments. If the smaller pupil dilates in response to instillation of. Rosen's Emergency Medicine: Concepts and Clinical Practice. In fact, it happens in about one in five people. Anisocoria is unequal pupil size. You experience trauma to one or both of your eyes. Check one or more factors on this page that apply to your child's symptom. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com.. Accessed Dec. 2, 2017. In: Liu GT, Volpe NJ, Galetta SL, eds. In some cases, this condition is only temporary. Treatment is not necessarily focused on making the pupils look equal. Contact a provider if you have persistent, unexplained, or sudden changes in pupil size. Children with third nerve palsy can develop this condition from a migraine, meningitis, or other severe infection. Background Unequal pupils (anisocoria) may be physiological, pathological or pharmacological. This is because Horner's syndrome and oculomotor nerve lesions both cause ptosis. In such people, both pupils react normally to light and darkness and there are no symptoms. On the other . Syphilis: Syphilis can cause an Argyll-Robertson pupil. For example, possible causes include: direct trauma to the eye concussion bleeding in your skull inflammation of your optic nerve brain tumor aneurysm meningitis seizure How will your doctor. It can be a natural physical trait, a temporary effect of medication, alcohol, or illicit drugs, or a sign of neurological or eye disease. Use to remove results with certain terms For example, a severe headache may indicate increased intracranial pressure, while fever and stiff neck are signs of meningitis. Doctors may then perform multiple tests to figure out the underlying cause. Review provided by VeriMed Healthcare Network. Use OR to account for alternate terms Here are some of the causes of anisocoria in cats: Diseases inside and outside the eye can lead to anisocoria in cats. But for some people, the pupils are not always the same size. Broadway DC. For additional information visit Linking to and Using Content from MedlinePlus. Other symptoms and signs can help to identify underlying medical conditions. This can then lead to aggression or even attempting to sabotage the success of others in . Treatments for Stress-Related Vision Problems. Evaluation of the causes and accuracy of pharmacologic localization in Horners syndrome. The most obvious symptom of blown pupils is having one or both pupils that appear abnormally dilated (large) and do not react to light. Serious causes of fixed, dilated pupils include: Trauma or compression of the upper brain stem and third cranial nerve, which is responsible for eye muscles and movement (oculomotor function). They examine whether the eyes move normally when the person follows a doctor's finger moving up, down, left, right, and toward the eyes. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis.

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