Cranial Nerve Examination
Prepare patient
• Introduction
• Position sitting
General Inspection
General signs:
• Scars
• Facial asymmetry
• Neurofibromas
• Skin lesions e.g. Sturge-Weber
I – Olfactory Nerve
Ask patient if any problem with sense of smell
Use standard set of bottles of non-pungent odours
II – Optic Nerve
Ask patient to wear spectacles if he
normally does
Visual acuity - one eye at a time with Snellen
chart
Visual fields – one eye at a time by
confrontation with finger moving.
Map blind spot (red pin).
Fundoscopy
• Red reflex
• Focus on eye from cornea to fundus -
Start at +20 & reduce towards 0.
Note cataracts.
• Fundi
o Note colour, vessels, exudates, haemorrhages, retinitis pigmentosa, tears
o Look at macula
o Examine optic disc – atrophy, papilloedema
III – Oculomotor Nerve, IV – Trochlear Nerve, VI – Abducens Nerve
Note any ptosis, proptosis
Pupil
• Relative sizes & shape
• Reaction to light
• Relative afferent papillary
(IIn) defect (pupil dilates with
direct light after consensual
constriction)
• Accommodation
Eye movements
• Follow pin in “H” pattern to
isolate/test individual muscles
o Ask if any double vision
Prepare patient
• Introduction
• Position sitting
General Inspection
General signs:
• Scars
• Facial asymmetry
• Neurofibromas
• Skin lesions e.g. Sturge-Weber
I – Olfactory Nerve
Ask patient if any problem with sense of smell
Use standard set of bottles of non-pungent odours
II – Optic Nerve
Ask patient to wear spectacles if he
normally does
Visual acuity - one eye at a time with Snellen
chart
Visual fields – one eye at a time by
confrontation with finger moving.
Map blind spot (red pin).
Fundoscopy
• Red reflex
• Focus on eye from cornea to fundus -
Start at +20 & reduce towards 0.
Note cataracts.
• Fundi
o Note colour, vessels, exudates, haemorrhages, retinitis pigmentosa, tears
o Look at macula
o Examine optic disc – atrophy, papilloedema
III – Oculomotor Nerve, IV – Trochlear Nerve, VI – Abducens Nerve
Note any ptosis, proptosis
Pupil
• Relative sizes & shape
• Reaction to light
• Relative afferent papillary
(IIn) defect (pupil dilates with
direct light after consensual
constriction)
• Accommodation
Eye movements
• Follow pin in “H” pattern to
isolate/test individual muscles
o Ask if any double vision
