Cranial nerves tests

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Visual acuity

Patient sits 6m from chart
Keep any eyewear on
Ask to cover one eye with one hand
Ask patient to read lowest line they can read fully
6/12 where 6 is distance from chart (m) and 12 is the lowest line they can read
Repeat for both eyes

Color vision

Ishihara plates

Blind spot

Sit 1m from patient
Ask to patient to cover one eye
Cover that same eye with yourself
Bring red pin medially to laterally
Ask patient to say when red pin is not visible

Move pin up and down to map out blindspot

No need to repeat for both eyes

Visual fields

Sit 1m from patient
Ask to remove any eyewear
ask them to cover one eye
Cover your corresponding eye
Explain the test
Bring finger from down and up in an X pattern

Stop when the patient can see the finger
Repeat for both eyes and from both sides

Pupil reflex (Direct)

Ask patient to remove eyewear
Shine a torch indirectly at an eye to note constriction of pupil

Pupil reflex (indirect + swinging test)

Ask patient to remove eyewear
Shine a torch at one eye and observe the other
Swing torch from one eye to another to check for afferent pupillary defect

Accomodation

Ask patient to remove eyewear
Bring a red pin close to their face (30cm)
Ask to focus on a point far away, then ask them to focus on the red pin
Note for pupil constriction and eye movements

Eye movements

Ask patient to remove eyewear
Move a pin in an H pattern in front of their face (30cm)
Check for double vision and nystagmus (at extreme gazes)

whispering

Whisper a number and a letter to a patient, while standing behind them (1m away)

Rinne’s test

Strike tuning fork and place it on mastoid process
When patient no longer hears fork from bone, bring it in front of ear
Patient should be able to hear

Weber’s test

Strike a tuning fork and place it on the forehead
Ask if the sound is heard equally on both sides or deviates to one ear