Clinical Skills questions with complete
solutions
Outline the purpose of the cover test - ANS ✔✔Objective dissociative test that defines the
presence and type of deviation
State what can be learned from the initial corneal reflections - ANS ✔✔- Temporal CR :
Convergence
- Nasal CR: Divergence
- Upward CR: Hypo-deviation
- Downward CR: Hyper-deviation
State the test distance for a near cover test - ANS ✔✔1/3 of a metre
State the test distance for a distance cover test - ANS ✔✔6 metres
Outline the method for the Cover/Uncover test - ANS ✔✔-test at 1/3 metre, cover one eye and
observe the other for any movement (Manifest)
- Repeat Cover/Uncover at 6 metres, then at 1/3 and 6 metres with an accommodating target
Outline the method for the alternate cover test - ANS ✔✔- Patient fixates on spotlight at 1/3m
- One eye is covered to ensure complete dissociation
- The movement of the uncovered eye is observed (latent)
- Repeated at 6m, then again at 1/3m and 6m with an accomodative target
, State the types of manifest deviations that can be observed - ANS ✔✔- If the eye moves
outwards to take up fixation --> esotropia
- If the eye moves inwards to take up fixation --> exotropia
- If the eye moves upwards to take up fixation -->
hypotropia
- If the eye moves downwards to take up fixation --> hypertropia
Demonstrate how a cover test should be recorded - ANS ✔✔Name of the test (CT)
Emmetropic state? : with (c) glasses (gls), (s) without glasses (gls) / contact lenses (cl)
Fixation distance: (Near: 1/3m) or (Far: 6m)
Size of deviation: sl/sm/md/mkd
Direction of deviation: Exo, Eso, Hyper, Hypo
Manifest or Latent?
If latent, record recovery
State the purpose of testing smooth pursuit - ANS ✔✔To identify any abnormalities (Under-
action, over-action, limitations, end-point nystagmus) when the eyes are made to track a
spotlight slowly
State the test distance for the 9 positions of gaze test (smooth pursuit) - ANS ✔✔50cm
Outline the method for a smooth pursuit test - ANS ✔✔- Remove the patients glasses
- Perform a near cover test.
- Move the torch into dextro or laevo version maintaining a distance of 50cm
- cover one eye to test the duction movement by moving the torch into the extreme position of
gaze- cover and repeat the duction movement
- repeat for the other side
solutions
Outline the purpose of the cover test - ANS ✔✔Objective dissociative test that defines the
presence and type of deviation
State what can be learned from the initial corneal reflections - ANS ✔✔- Temporal CR :
Convergence
- Nasal CR: Divergence
- Upward CR: Hypo-deviation
- Downward CR: Hyper-deviation
State the test distance for a near cover test - ANS ✔✔1/3 of a metre
State the test distance for a distance cover test - ANS ✔✔6 metres
Outline the method for the Cover/Uncover test - ANS ✔✔-test at 1/3 metre, cover one eye and
observe the other for any movement (Manifest)
- Repeat Cover/Uncover at 6 metres, then at 1/3 and 6 metres with an accommodating target
Outline the method for the alternate cover test - ANS ✔✔- Patient fixates on spotlight at 1/3m
- One eye is covered to ensure complete dissociation
- The movement of the uncovered eye is observed (latent)
- Repeated at 6m, then again at 1/3m and 6m with an accomodative target
, State the types of manifest deviations that can be observed - ANS ✔✔- If the eye moves
outwards to take up fixation --> esotropia
- If the eye moves inwards to take up fixation --> exotropia
- If the eye moves upwards to take up fixation -->
hypotropia
- If the eye moves downwards to take up fixation --> hypertropia
Demonstrate how a cover test should be recorded - ANS ✔✔Name of the test (CT)
Emmetropic state? : with (c) glasses (gls), (s) without glasses (gls) / contact lenses (cl)
Fixation distance: (Near: 1/3m) or (Far: 6m)
Size of deviation: sl/sm/md/mkd
Direction of deviation: Exo, Eso, Hyper, Hypo
Manifest or Latent?
If latent, record recovery
State the purpose of testing smooth pursuit - ANS ✔✔To identify any abnormalities (Under-
action, over-action, limitations, end-point nystagmus) when the eyes are made to track a
spotlight slowly
State the test distance for the 9 positions of gaze test (smooth pursuit) - ANS ✔✔50cm
Outline the method for a smooth pursuit test - ANS ✔✔- Remove the patients glasses
- Perform a near cover test.
- Move the torch into dextro or laevo version maintaining a distance of 50cm
- cover one eye to test the duction movement by moving the torch into the extreme position of
gaze- cover and repeat the duction movement
- repeat for the other side
