extra ocular muscle test examples
hess eom movements
There is a multitude of information that can be derived from this patient interactive test and should be
done whenever there is any reported discomfort which is not evident in the refraction results. Subtle  
movements are seldom detected during cover test and are usually in the primary position of gaze.
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HESS EOM - EXAMPLES - INTERPRETATION - EXPLANATION   PAGE 2/2

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Explanation / Interpretation of HESS Test results

HESS EOM Test

Example I

Enrichment:
Fully interpreting the results of the test is beyond the bounds of this manual, and the  practitioner is
encouraged to read up on some of the more complex conditions and binocular anomalies that can be
identified from the plots.

Explanation

Left Field
Right Field
► Affected Extra Ocular Muscle
► Right Field Plot deviation
► Right Field Table deviation
Explanation:
In other words the RIO 'can not turn IN' enough hence the Outward / Exo state, as well as 'can not turn UP' enough
hence the Low / hypo state. Herrings Law confirms these findings as it is noted that contra-lateral synergist,
the Left Superior Rectus ( LSR ) is overacting by 4.9 Exo and 3.8 Hyper.
Tip:
By measuring this patient over time, one can determine if the paresis is recent or long standing.
One can cross reference this finding by conducting the Park's 3-Step Test to isolate the paretic muscle.

Example I, where Herrings Law applies

: Right Inferior Oblique ( RIO )  
: Position 1 is plotted ‘short’   
: 5.0 Exo, 5.0 hypo
Example II
Example II, where Herrings Law applies
Left Field
Right Field
Explanation
►  Affected Extra Ocular Muscle
►  Left Field Plot deviation
►  Left Field Table deviation
Explanation:
In other words the Left eye 'can not turn OUT' enough hence the Inward / Eso state as well as
'can not turn UP' fully hence the Low / hypo state as well as. Again in line with Herring's Law,
the right eye is overacting in upward gaze. This is a classic blowout fracture pattern where the
upward movement of the left eye is obstructed by possibly the Inferior Rectus of that eye is
being trapped in the fracture of the left orbital floor.
Tip:
Apart from the obvious case history report, one would also be able to see a trauma induced
movement restriction by a ‘sudden’ stop in movement of that eye in upward gaze, whereas with a paresis,  
the reduction in movement will appear much slower and almost lethargic.





























































































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