anisocoria medical terminology breakdown

Central or first-order lesions are often caused by stroke, lateral medullary syndrome, neck trauma or demyelinating disease. Therefore, an oculomotor nerve palsy presents as a down and out gaze and ptosis, occasionally accompanied by mydriasis of the pupil. "Anisocoria." condition of ingrowing eyelashes, pertaining to the second or vascular coat of the eye, root-xen-foreign Cocaine prevents the reuptake of norepinephrine at the post-synaptic third-order neuron, allowing dilation of the normal pupil. Visit your healthcare provider or go to the emergency room right away if you notice any changes in your eyes or vision, including if your pupils are irregularly sized. Apoptosis (a-popt-osis): Apoptosis is the process of programmed cell death. Anisocoria is a medical term for unequal pupil size. When your pupils are excessively dilated, it's. A thorough review of medications, especially topical eye drops, may provide explanations for pharmacologic anisocoria. Most often, the diameter difference is less than 0.5 mm, but it can be up to 1 mm. Some are temporary, but some can be life-threatening. It was named in 1909 for the Austro-Hungarian neurologist and psychiatrist . It may occur after a viral infection, but usually no known cause is found. root-opt-eye Damage to the 3rd cranial nerve can result in a dilated pupil, droopy eyelid and double vision (when the 2 lid is lifted) because the eye does not move normally. If the history and physical examination lead to clinical suspicion for Argyll Robertson pupil, VDRL, and FTA-ABS tests for screening and confirmation of syphilis are recommended. When it affects only one eye, it's also called anisocoria. The size of the pupil determines how much light is let into the eye. One pupil may be bigger than normal, or one pupil may be smaller than normal, resulting in unequal pupils. condition in which the individual has difficulty seeing at night, involuntary, constant rhythmic movement of the eyeball, one who specializes in making optical products, cf-opto/o-eye Here, the abnormal pupil will be unable to constrict in the light and will appear dilated (mydriatic). vw golf door lock problems. These nerves travel along the 3rd cranial nerve, which comes from the brainstem near the back of your brain and travels forward to your eye. This study aimed to determine the level of awareness on the early diagnosis and management of Alzheimer's disease among primary care physicians and interns in Denizli, Turkey. anisocoria medical terminology breakdown. Pre means "before." Prefixes may also indicate a location, number, or time. blepharoptosis. Word Roots A root is the foundational element of any medical term. 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While some of these medications are intentionally used in the eye, sometimes these medications or chemicals are accidentally rubbed into the eye from your skin, usually by your finger. Anisocoria can occur as a result of injury (e.g. Professional Stump Grinding Prices Our research shows that the average cost to grind a stump ranges from $100 to $400 per stump with an average price per diameter of $3. how much did tony bellew make from creed / separated but living together centrelink / separated but living together centrelink Further pharmacologic work-up (see diagnostic procedures) is useful in confirming Horners and distinguishing the order of the lesion. anisocoria medical terminology breakdown. The abnormal pupil can be identified by its failure to dilate in the dark thereby appearing constricted (miotic).3, These pupils typically represent a disruption of the sympathetic nervous system (e.g. Ischemic or diabetic oculomotor nerve palsies typically spare the pupil [14]. When associated with areflexia of the knee and/or ankles, this condition is known as Holmes-Adies syndrome. Check out our other awesome clinical skills resources including: Pathological anisocoria can be identified by worsening anisocoria in either light or dark conditions. Anisocoria is sometimes the first sign people notice of a life-threatening underlying condition like a stroke or aneurysm. The use of pilocarpine, a non-selective muscarinic receptor agonist in the parasympathetic nervous system, may result in a small and poorly reactive pupil. Normally, in dim light (such as at night), the pupil dilates (opens) to let in more light to the eyes. Is a dismness of vision or the partial loss of sight in one eye, Is any error of refraction in which images do not focus properly on the retina, Is a condition in which the pupils are unequal in size, Is a condition in which the eye does not focus properly because of uneven curvatures of the cornea, Is the use of an audiometer to measure hearing acuity, Is the loss of transparency of the lens that causes a progressive loss of visual clarity, Is a nodule or cyst usually on the upper eyelid caused by obstruction in a sebaceous gland, Is an electronic device that bypasses the damaged portions of the ear and directly stimulates the audiotory nerve, Is an inflammation of the lacrimal gland caused by a bacterial viral or fungal infection, Is the eversion of the edge of the eyelid, Is the normal relationship between the refractive power of the eye and the shape of the eye that enables lights, Is the inversion of the edge of an eyelid, Is a radiographic study of the blood vessels in the retina of the eye following the intravenous injection of a fluorescein dye as a contrast medium, Is a group of diseases characterized by increased intraocular pressure that causes damage to the retina nerve fibers and the optic nerve, Is a blindness in one half of the visual field, Stye pus filled and often painful lesion on the eyelid, Is a contagious inflammation that causes painful blisters on the eardrum, Is the surgical removal of a portion of the tissue of the iris, Is the surgical removal of all or a portion of the labrinth, Is used to treat open angle glaucoma by creating openings in the trabecular mesh work to allow the fluid to drain properly, The dilation of the pupil is the opposite of miosis, Is a small surgical incision in the eardrum to relieve pressure from excess pus or fluid, Is an involuntary constant rhythmic movement of the eyeball that can be congenital or caused by a neurological injury or drug use, Holds a doctor of optometry degree and provides primary eye care, Is the ankylosis of the bones of the middle ear, Is swelling of the tissues surrounding the eye or eyes, Is the presence of what appears to be flashes or light, Is a gradual loss of sensorineural hearing that occurs as the body ages, Is the condition of common changes in the eyes that occur with aging, Is the drooping of the upper eyelid that is usually due to paralysis, Is used to reattach the detached area in a retinal detachment, Is the surgical removal of the top portion of the stapes bone and the instertion of a small prosthetic device, Is a disorder in which the eyes point in different directions or are not alignment correctly, Is the partial or complete su turning together of the upper and lower eyelids to protect the eye when the lids are paralyzed, Commonly pronounced ringing buzzing or roaring, Is the measurement of intraocular pressure, Is a sense of whirling dizziness and loss of balance, Is the removal of the vireous humor and it's replacement with a clear solution, Julie S Snyder, Linda Lilley, Shelly Collins, Sports Medicine Essentials: Core Concepts in Athletic Training and Fitness Instruction, Ch 14 Infectious Disease Prevention & Control. iridocyclitis), diseases of the iris, paralysis of the third nerve, angle-closure glaucoma, systemic diseases (e.g. "Adams and Victor's Principles of Neurology, 7th ed." Read breaking news about the neuro-ophthalmologist shortage andlearn aboutneuro-ophthalmology fellowships & theNANOS Career Center here! Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Right Adie tonic pupil. Some babies are born with anisocoria. Acad Ophthalmol Otolaryngol. inequality in size of the pupils of the eyes. Adies pupil is a benign condition typically affecting young women, possibly secondary to viral or bacterial infection affecting the ciliary ganglion. opacity of the crystalline lens or its capsule. Kaiser PK. It can cause a drooping eyelid (ptosis), irregular pupils and a lack of sweating on half your face. However, careful clinical examination is required to rule out more serious pathological causes.1. united methodist church global methodist. Underline each adverb, and draw an arrow from each adverb to the word it modifies. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . While small differences in pupil size are normal and can even come and go (physiologic anisocoria), constant and significant differences in pupil sizes may be a sign of damage to the nerves that control the pupils or to the brain. Get useful, helpful and relevant health + wellness information. systemic absorption of drugs in therapeutic and toxic doses. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. turning inward of the margin of the lower eyelid, prefix-eso-inward Causes include Horners syndrome, Argyll Robertson pupil, iritis, mechanical anisocoria, and pharmacologic anisocoria from miotics, narcotics, or insecticides. A condition in which the two pupils are not of equal size. (4) is incorrect. Anisocoria is greater in the dark due to a defect in the pupillary dilator response secondary to lesions along the sympathetic trunk. When a patient presents with anisocoria, the fear of a serious condition, such as an intracranial aneurysm, often leads clinicians to obtain numerous tests, which are not always necessary. Van der Wiel HL, Van Gijn J. Though many causes of anisocoria are benign and some people only notice some blurry vision and/or light sensitivity, it can be a sign of a serious and potentially life-threatening neurological problem. The sympathetic pathway is a three-order neuron pathway that mediates pupillary dilation. Voice box ______________________________________. The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. condition-iasis-condition What Is Anisocoria? how do i check my medicaid status in louisiana; anisocoria medical terminology breakdown The use of pilocarpine can be diagnostic in this setting. The eyes can move fully in all directions. Pt 1):525. Anisocoria is a condition characterized by unequal pupil sizes. The first-order neuron originates from the posterolateral hypothalamus and travels caudally down the brainstem to the ciliospinal center of Budge (C8-T2). Gaines LA. (2000). Modele : le chapeau allemand Major revisions are performed on a periodic basis. acetylcholine receptor in Japanese patients. "Simple, central" anisocoria. pupil: Jimson weed mydriasis. J Neuroophthalmol 2006; 26:232-233. ria an--s-kr--. J Neurol Sci 1983; 59:229-235. The effect of latanoprost 0.005% on pupillary A collection of free medical student quizzes to put your medical and surgical knowledge to the test! An eye doctor will be able to rule out any life-threatening conditions and perform a diagnosis. in antimetropia) or it may be part of a syndrome, the most common being those of Adie's and Horner's. condition in which the eye turns inward; crossed eyes, prefix-ex-out Light and near responses are intact, and the degree of anisocoria is typically equal in light and dark. Use vesic/o (bladder) to build words that mean: pertaining to the bladder and urethra _________. (1) is incorrect. Pupil may be oval-shaped or shows segmental constriction Unilateral in 80% of cases. We do not endorse non-Cleveland Clinic products or services. Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. J Emerg Med 2007; Courtesy of Dr. Valerie Biousse, M.D. Adie's pupil may involve an orbital process, while bilateral cases may indicate systemic processes [5]. Eye drops may be used to help diagnose the cause of the anisocoria. 33:21-24. Scopolamine patches, glycopyrrolate antiperspirants, nasal vasoconstrictors, herbals such as Jimson weed, blue nightshade, and Angels trumpet can dilate pupils [5][6][7][8][9][10][11]. Pupils are the black parts in the middle of the eye. How much does it cost to grind a 12 inch stump? Suffixes can modify the meaning of the word, often in very important ways. wood projects for grandkids. Learn why Cleveland Clinic Cole Eye Institute is among the worlds most advanced eye centers. Physiologic anisocoria may be intermittent, persistent, or even self-resolving. normal or perfect vision, prefix-en-in A pupil that is chemically dilated or constricted will return to normal size and function as the chemical wears off. These nerves also control the muscles that open your eyelids and activate the sweat glands on your face. Pupillary Disorders Including Anisocoria. Davis and Unbound Medicine. The pupil is the black center of your eyes that expands and contracts to help you see in different amounts of light. Compressive lesions from head trauma, intracranial aneurysms, uncal herniation, and tumors typically involve the pupil as they affect the superficial parasympathetic fibers that innervate the pupil. study and treatment of defective binocular vision resulting from defects in ocular musculature, cf-phac/o-lens Get to know the basic word parts. A collection of surgery revision notes covering key surgical topics. View All Result . Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel , Anisocoria refers to the unequal size of pupils and can be a physiological phenomenon. inflammation of the cornea, degeneration of the macular area of the retina, an area important in the visualization of fine details, mi/o-less small elementary school yearbooks california. Anisocoria is a condition in which the pupil of one eye differs in size from the pupil of the other eye. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Your healthcare provider will diagnose anisocoria by looking at your eyes and performing a physical exam to check for other symptoms. reaction of the human eye. Accidental - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Some issues like migraines or reactions to medications will resolve themselves on their own. Chapter 12 word parts & medical terms. The clinical picture of Adies tonic pupil under slit-lamp examination shows iris sector palsy and vermiform iris movement [18]. Anisocoria (anisocoria) is a condition in which one pupil is of a different size than the other pupil. Copyright 2021. In apoptosis, the damaged or diseased cell initiates self-destruction. suffix-ic-pertaining to small, hard, painless cyst of a sebaceous gland of the eyelids. cf-my/o-muscle Thompson HS. Anisocoria can occur as a result of injury (e.g. If these tests find any serious problems, your doctor will refer you to the appropriate specialists for urgent treatment. Emmetropia=emmetr-in proper measure, opia=vision condition 3. Anisocoria can be accompanied by serious symptoms. pupil: an update. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 1. Anisocoria is characterized by a difference in pupil sizes. astigmatism uneven focus, usually due to an ir- regular cornea. Prefixes Prefixes are located at the beginning of a medical term. - Onset 01:48 Lumbar punctures for VDRL, FTA-ABS, and total protein and cell count may be indicated in the evaluation of neurosyphilis. Mechanical anisocoria secondary to other ophthalmic conditions such as uveitis or acute angle glaucoma can be medically managed as indicated. Blepharochalasis= blepharo-eyelid, chalasis-relaxation 2. 64: 592. Arch Opthalmol 1960. This is followed by a series of pharmacologic tests to further determine the exact etiology [19]. Tell your healthcare provider about any changes in your eyes or vision. Hydroxyamphetamine mydriasis in Horners syndrome. anisocoria medical terminology breakdown. The exact cause is unknown, but it is thought to be due to transient asymmetric supranuclear inhibition of the Edinger-Westphal nucleus that controls the pupillary sphincter [4]. suffix-osis-condition inability to see half of the field of vision, prefix-hyper-beyond . diabetes, syphilis) or accidental drug instillation into the eye (if the drug or substance has anticholinergic properties the condition is then referred to as, We report results of cocaine testing and underlying etiologies as well as follow-up data in a cohort of patients younger than 18 years with, Alacrima is the earliest and most consistent feature and other ophthalmological findings may include optic atrophy or pallor, high astigmatism, and, The patient was investigated with head computed tomography (CT) scan because of, A previously healthy 40-year-old woman was referred to us by an ophthalmologist who noticed. The first part of deciphering a medical term is to know the different components of a term. Taber's Cyclopedic Medical Dictionary 24th Edition Online + App from F.A. The dilated The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Li Y, Jammoul A, Mente K, et Anisocoria is a common condition, defined by a difference of 0.4 mm or more between the sizes of the pupils of the eyes. Example: hypoglycemia - hypo-below normal, glyc=sugar, emia=blood condition. Medications Or Chemicals Causing Anisocoria. There are many medications or chemicals that can cause the pupil to dilate or constrict. Vasoconstrictor Agents 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid Phenylephrine Actomyosin Norepinephrine Endothelin-1 Potassium Chloride Indomethacin Acetylcholine Nitric Oxide Vasodilator Agents Enzyme Inhibitors Receptors, Adrenergic, alpha-2 Adrenergic alpha-Agonists Endothelins Myosin Type II Serotonin Hydrazines Angiotensin II Calcium . The second-order neuron connects each pretectal nucleus to bilateral Edinger-Westphal nuclei in the midbrain and allows for the consensual light reflex. Physiologic control of pupillary function is dictated by sympathetic and parasympathetic innervation to the pupillary dilator and the pupillary sphincter muscles, respectively. Suffixes. TikTok: https://www.tiktok.com/@geekymedics Expert solutions. If you have no other symptoms and your provider rules out any serious underlying conditions you probably wont need any treatment. The Edinger-Westphal nucleus then supplies parasympathetic fibers to the third cranial nerve which traverses the cavernous sinus and enters the orbit via the superior orbital fissure to synapse at the ipsilateral ciliary ganglion. Although these problems can be serious, they may improve with treatment (inflammation), without treatment (microvascular ischemia), or slowly worsen over time (tumor). Chapters: In bright light (such as sunlight), the pupil constricts to make the pupils smaller, which decreases the amount of light getting into the eye. Examples of conditions that can result in pathologic anisocoria include: Iritis. Are you in search of a Neuro-Ophthalmology fellowship? Thus, thorough clinical evaluation is important for the appropriate diagnosis and management of the underlying cause. Facebook: http://www.facebook.com/geekymedics The use of 1% hydroxyamphetamine (Paredrine) can provide localization to the defect in Horners syndrome. No Result In other cases, they may recommend treatments for your symptoms, which could involve eye drops or nothing at all. Injuries and trauma to your head, eyes or the arteries that supply blood to them. 2019 Neuro-ophthalmology Virtual Education Library: NOVEL [1]. If no constriction is observed, a higher dose of 1% pilocarpine is used. This can help them figure out which pupil is abnormal. Anisocoria is the medical term for when one of your pupils is bigger than the other. ; Combining form: a root with a vowel attached to it, most commonly the letter O.This vowel is known as the combining vowel because it combines the root with the rest of the term. Suppose this reduces the value of bbb to 55 percent of the value in Parts (a)(a)(a) and (b)(b)(b). On this Wikipedia the language links are at the top of the page across from the article title. Apraclonidine, a strong -2 and weak -1 agonist, is a more readily available alternative to cocaine. Problems affecting the muscles or nerves controlling the pupil cause abnormal pupil size. clinical features of trigemino-autonomic headaches. suffix-ptosis-prolapse, drooping. Horner Syndrome: An Abnormally Small Pupil. Causes include physical injury from ocular trauma or surgery, inflammatory conditions such as iritis or uveitis, angle closure glaucoma leading to iris occlusion of the trabecular meshwork, or intraocular tumors causing physical distortion of the iris. Autoimmune autonomic ganglionopathy is a disorder of autoantibodies that target autonomic ganglia [5][16]. Define apparent death m its significanc and give 3 examples 4. Prostaglandins, opioids, and organophosphate insecticides can constrict pupils as well [5][12][13]. It may be physiological (e.g. Anticholinergics such as atropine, homatropine, tropicamide, scopolamine, and cyclopentolate lead to mydriasis and cycloplegia by inhibiting parasympathetic M3 receptors of the pupillary sphincter and ciliary muscles. What are the medical uses of activated charcoal and explain its mechanism ----- 1. Anisocoria itself does not cause symptoms. 1977; 83: 832839. Pupils should be compared for size in light and in dark (normal size difference is less than 0.4 mm), shape, position, symmetry, and reactivity. suffix-al-pertaining to All rights reserved. Talk to your provider about what you should expect if your childs pupils are different sizes at birth. One of the pupils may be larger or smaller. suffix-opia-sight, vision I'm bad at making friends, and I don't have any close friends that I could talk to about being trans. Even if it turns out that youre having a short-term reaction, you should always take any changes in your eyes seriously and have them checked out by a provider right away. Go to the emergency room if one pupil is bigger than the other and you experience any of the following: You might have symptoms outside your eyes too, including: Depending on whats causing the anisocoria, you might have no symptoms. everyday anisocoria: Angels trumpet ocular toxicity. It gets larger in dim light and smaller in bright light. Anisocoria can also be caused by serious, life-threatening conditions, including: Your healthcare provider will classify your anisocoria as either pathological (caused by a disease) or physiological (caused by something malfunctioning inside your body). Origin of anisocoria 1900-05; aniso- + Greek kr ( ) pupil + -ia Words nearby anisocoria anisette, Anishinaabe, aniso-, anisocarpic, anisocercal, anisocoria, anisodactyl, anisodactylous, anisogamete, anisogamous, anisogamy This should include checking accommodation and pupillary light reflexes, as well as slit-lamp examination. The study included adult patients with iTBI enrolled from April 2018 to March 2021. "Angel's Trumpet (Brugmansia arborea) and mydriasis in a child - A case report", "The remarkable story behind David Bowie's most iconic feature", "Developmental inhibitory gate controls the relay of activity to the superficial layers of the visual cortex", Thygeson's superficial punctate keratopathy, Chronic progressive external ophthalmoplegia, https://en.wikipedia.org/w/index.php?title=Anisocoria&oldid=1107800370, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, A large difference in the size of the pupils following application of, Anisocoria which is worsened (greater asymmetry between the pupils) in the dark suggests the small pupil (which should dilate in dark conditions) is the abnormal pupil and suggests Horner's syndrome or mechanical anisocoria. Generally, anisocoria is caused by impaired dilation (a sympathetic response) or impaired constriction (a parasympathetic response) of pupils. CT chest for Pancoast tumour) and referral to specialist teams. My Blog anisocoria medical terminology breakdown Localization of Horners syndrome. Segmental palsy of the iris sphincter in Adies syndrome. Suffix: The ending part of a word that modifies the meaning of . Hydroxyamphetamine increases the release of noradrenaline at the synaptic cleft and requires a working postganglionic neuron to relay the action potential. Other causes include:1,3,4. Policy. instrument used to measure the strength of the muscles of the eye, root-orth-straight Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. recording of intraocular pressure used in detecting glaucoma, root-trich-hair Est en el comedor. The nerves controlling the muscles that constrict the pupil are part of the parasympathetic nervous system. carta para mi hermana embarazada ken climo injury what are the odds of getting an ultra rare lol doll The anterior chamber can be examined for signs of iritis or uveitis. Adies tonic pupil can be managed with the help of glasses to improve vision and pilocarpine to constrict the pupil. These cases may be due to brain mass lesions which cause oculomotor nerve palsy. Mechanical anisocoria is an acquired defect that results from damage to the iris or its supporting structures. Aim: Primary care will play a more significant role on the diagnosis and management of neurodegenerative diseases in near future. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Cremer SA, Thompson HS, Digre KB, Kardon RH. - Radiation 02:45 2 suffixes that have more than one meaning, HLTH 125 Ch 10 combining forms of the blood a, Cole Conlin, Elizabeth Millan, Max Ehrsam, Parthena Draggett, Betsy Kerr, Guy Spielmann, Mary Rogers, Tracy D.Terrell, Albert Valdman, Cathy Pons, Mary Ellen Scullen, Chez Nous: Branch Sur le Monde Francophone, Albert Valdman, Cathy Pons, Katherine Mueller, Mary Ellen Scullen, Paula Bouffard. Affecting up to 20% of the population, anisocoria is often entirely harmless, but can be a sign of more serious medical problems. [2] Anisocoria has various causes: [3] Physiological anisocoria: About 20% of population has a slight difference in pupil size which is known as physiological anisocoria. Use and limitations of the 1. It is crucial for providers to be aware of the diagnostic steps to narrow a differential for anisocoria, as it can be a harbinger of treatable but life-threatening conditions. Visit Us 4201 Wilson Blvd, Suite 300, Arlington, VA 22203 glentunnel to christchurch FREE QUOTE. Your pupils are the black circles in the center of your eyes. Left Horner syndrome. turing in outward of one or both eyes, disease characterized by increased intraocular pressure; occurs when the aqueous humor is blocked and drains too slowly form the anterior chamber, disrupts proper function of the optic nerve, cf-goni/o-angle The pupil may remain large or gradually shrink in size over several years. Etiology of Anisocoria The most common cause of anisocoria is Physiologic (present in about 20% of people): The difference between pupil sizes in physiologic anisocoria is typically about 1 mm. No matter whats causing your pupils to be irregularly sized, you should see your provider as soon as possible. Anisocoria which is greater in bright light suggests the larger pupil (which should constrict in bright conditions) is the abnormal pupil. This page was last edited on 31 August 2022, at 23:58. anterior chamber the front cavity between the anterior uveitis inflammation within the front aphakia absence of the lens, usually surgical. It depends on whats causing your anisocoria. No anisocoria (unequal pupil sizes) No strabismus (crossing of eyes) Assessment of CN III (oculomotor), CN IV (trochlear), CN VI (abducens): Penlight held 12-14 inches away, checking in 6 cardinal fields of gaze, patient holds head still and follows the penlight (note: No nystagmus) Patient stares off at a distant object to dilate eyes.

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