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A Maneuver to Elicit Vertical Dolls' Eye Movements
724
AMERICAN JOURNAL OF OPHTHALMOLOGY
MAY, 1979
meeting was first class in every respect. The level of ophthalmology in the West ern hemisphere is rapidly rising. Oph thalmologists are making important and critical observations and the meeting re flected the remarkable technical advances of the past decade. The XIII Congress is scheduled for Feb. 21-28, 1981, in Acapulco, Mexico. F R A N K W. N E W E L L
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with l1/2-inch margins on all four sides, and limited in length to two man uscript pages. A Maneuver to Elicit Vertical Dolls' Eye Movements Editor: In certain patients, such as those with Parkinson's disease or progressive supranuclear palsy, rigidity of the neck limits the ability to demonstrate vertical dolls' eye movements. The head resists being bent forward quickly enough to bring out passive contraversive eye movements. Daroff and Troost 1 wrote that "the oculocephalic responses are brisk in the hori zontal direction, but nuchal rigidity usu ally limits vertical head movements." David, Mackey, and Smith 2 explicitly de scribed in one of their patients with pro gressive supranuclear palsy "vertical movement of the neck required effort to overcome the rigidity and caused the pa tient to complain bitterly of pain." We have had similar experiences and have found a simple maneuver to use in testing for vertical passive eye move ments. The patient lies supinely on a stretcher that has wheels. The stretcher is sharply pushed either toward the feet or
Figure. (Chu, Reingold, and Cogan). Top, While lying on a stretcher, the patient directs his eyes directly forward. Center, If the head of the stretcher is sharply pushed forward the eyes roll up. Bottom, If the foot of the stretcher is pushed back, the eyes roll down.
the head. The eyes can then be observed to move in a direction opposite to head movement (Figure). Occasionally the eye movements may be amplified by directing the patient to fixate a target flashlight or a particular spot on the ceiling. Compared to the gross body manipula tions or passive head thrusts that are ordinarily used to determine the existence of vertical dolls' eye movements, our method has the advantages of simplicity for the examiner and comfort for the pa tient. F R E D C. C H U , M.D. D O U G L A S R E I N G O L D , M.A. D A V I D G. C O G A N , M.D,
Bethesda,
Maryland
REFERENCES 1. Daroff, R.B., and Troost, B. T.: Supranuclear disorders of gaze. In Duane, T. B. (ed.): Clinical Ophthalmology, vol. 2. Hagerstown, Harper and Row, 1976, Chap. 10, p. 6. 2. David, N.J., Mackey, E. A., and Smith, J. L.: Further observations in progressive supanuclear palsy. Neurology 18:349, 1968.
AMERICAN JOURNAL OF OPHTHALMOLOGY
MAY, 1979
meeting was first class in every respect. The level of ophthalmology in the West ern hemisphere is rapidly rising. Oph thalmologists are making important and critical observations and the meeting re flected the remarkable technical advances of the past decade. The XIII Congress is scheduled for Feb. 21-28, 1981, in Acapulco, Mexico. F R A N K W. N E W E L L
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with l1/2-inch margins on all four sides, and limited in length to two man uscript pages. A Maneuver to Elicit Vertical Dolls' Eye Movements Editor: In certain patients, such as those with Parkinson's disease or progressive supranuclear palsy, rigidity of the neck limits the ability to demonstrate vertical dolls' eye movements. The head resists being bent forward quickly enough to bring out passive contraversive eye movements. Daroff and Troost 1 wrote that "the oculocephalic responses are brisk in the hori zontal direction, but nuchal rigidity usu ally limits vertical head movements." David, Mackey, and Smith 2 explicitly de scribed in one of their patients with pro gressive supranuclear palsy "vertical movement of the neck required effort to overcome the rigidity and caused the pa tient to complain bitterly of pain." We have had similar experiences and have found a simple maneuver to use in testing for vertical passive eye move ments. The patient lies supinely on a stretcher that has wheels. The stretcher is sharply pushed either toward the feet or
Figure. (Chu, Reingold, and Cogan). Top, While lying on a stretcher, the patient directs his eyes directly forward. Center, If the head of the stretcher is sharply pushed forward the eyes roll up. Bottom, If the foot of the stretcher is pushed back, the eyes roll down.
the head. The eyes can then be observed to move in a direction opposite to head movement (Figure). Occasionally the eye movements may be amplified by directing the patient to fixate a target flashlight or a particular spot on the ceiling. Compared to the gross body manipula tions or passive head thrusts that are ordinarily used to determine the existence of vertical dolls' eye movements, our method has the advantages of simplicity for the examiner and comfort for the pa tient. F R E D C. C H U , M.D. D O U G L A S R E I N G O L D , M.A. D A V I D G. C O G A N , M.D,
Bethesda,
Maryland
REFERENCES 1. Daroff, R.B., and Troost, B. T.: Supranuclear disorders of gaze. In Duane, T. B. (ed.): Clinical Ophthalmology, vol. 2. Hagerstown, Harper and Row, 1976, Chap. 10, p. 6. 2. David, N.J., Mackey, E. A., and Smith, J. L.: Further observations in progressive supanuclear palsy. Neurology 18:349, 1968.