← All modules
Preliminary testingOptometric Technician

Extraocular motility

Drive the patient through all nine positions of gaze, spot an underaction, and map it back to the muscle and cranial nerve behind it.

Competent means: Tests all nine positions with the head steady, identifies the restricted position, and recognizes a pupil-involving third nerve palsy as an emergency.

Three ways through this module

Same cases, three depths. Onboard once, drill whenever there's a gap in the schedule, and certify when you can hold the standard without coaching.

Onboarding

Teaches the procedure from zero, then walks every case with coaching. For a new hire's first week.

Length
~47 min
Cases
4
Pass mark
70%
Pace target
18m 0s

Loading…

Start

Drill

One case, graded immediately. Short enough to run in the gaps between patients.

Length
~8 min
Cases
1
Pass mark
80%
Pace target
4m 30s

Loading…

Start

Certification

Three cases, no coaching, no feedback until the end. This is what signs someone off.

Length
~19 min
Cases
3
Pass mark
85%
Pace target
13m 30s

Loading…

Start

Watch it done

Shown once during onboarding

Motility in nine positions

Footage not filmed yet

The whole H pattern at working speed, with a clear view of both eyes throughout. The thing video adds here is what a real underaction looks like in motion — an eye stopping short is obvious on film and almost impossible to convey in text.

Shot list

target 3m 30s

  1. 0:00Target in hand at about 40 cm, with something in frame for scale. Show the choice of target — small and high contrast, not a waving hand.
  2. 0:15Steadying the chin, and the two instructions spoken aloud: keep the head still, say if it splits in two.
  3. 0:35The full H at working pace, camera square to the face so both eyes are readable. Hold a beat at each end point — the hold is the technique.
  4. 1:35Asking about diplopia in an eccentric position, and the patient answering.
  5. 1:55A genuine abduction deficit, if a consenting patient is available: the affected eye stopping short while the other carries on. Slow motion insert, then real time.
  6. 2:30Close on lids and pupils in primary gaze — the check that turns an ordinary palsy into an urgent one.
  7. 2:55Charting the position and the grade, not just 'abnormal'.

Drop the files in public/demos/ as extraocular-motility.mp4, .webm, .jpg poster and .vtt captions, then set this module's demo.status to ready.

What this module trains

  • Instruct and steady the patient for pursuit testing
  • Cover all nine positions of gaze
  • Detect and grade an underaction
  • Map a cardinal position to its muscle and cranial nerve
  • Recognize the red flags that stop the workup

The lesson, in onboarding

~6 min of reading

Twelve muscles, three nerves, nine positions. Motility is where neurological disease most often walks into a routine lane — here's how to see it.

  1. 1Six muscles, and what each one does
  2. 2The nine positions, and which muscle each one isolates
  3. 3Three nerves, and a very uneven split
  4. 4Seeing an underaction in a real lane
  5. 5The one that stops the workup

How a case runs

  1. 1Meet your patientbriefing
  2. 2Call it before you testclinical accuracy · 5 pts
  3. 3Set up the testtechnique · 10 pts
  4. 4Instruct the patientpatient communication · 10 pts
  5. 5Know what you're watching fortechnique · 10 pts
  6. 6Run the H patterntechnique · 25 pts
  7. 7Name the muscleclinical accuracy · 10 pts
  8. 8Name the nerveclinical accuracy · 10 pts
  9. 9Chart and triageclinical accuracy · 10 pts
  10. 10Paceefficiency · 10 pts, graded on hands-on time

How it's graded

Technique45 pts
Did the test itself get done correctly?
Patient communication10 pts
Did the patient know what to do, and feel able to report the truth?
Clinical accuracy35 pts
Was the finding named, charted and localized correctly?
Efficiency10 pts
Could this be done at lane pace once technique is clean?

Loading your progress…

Case rotation

Cases are dealt at random, and a retake avoids the ones you just saw. The finding stays hidden until you have worked it out, so repeating a module is practice rather than recall.

  • Case 1 — 29Mcore
  • Case 2 — 58Fintermediate
  • Case 3 — 41Fadvanced
  • Case 4 — 63Madvanced

Want a specific case for teaching? Append &case=normal to the simulator URL.