Hereafter, we outline methods of eye movement examination, the most important findings and their clinical implications for clinicians without access to a dedicated eye movement laboratory. However, the information gained from an effective examination can help the clinician discern benign from pathological disease, localise neuropathology and non-invasively monitor a variety of neurological disorders. Examination of these eye movements in children, in an outpatient setting, can present a clinical challenge. The function of eye movements is to bring visual stimuli to the fovea and hold them there, during head movements or movement of the stimuli themselves. In summary, this review will encourage clinicians to combine a structured assessment and a logical interpretation of the resulting clinical signs, in order to recognise patterns of presentation and avoid unnecessary investigations and protracted delays in diagnosis and clinical care. We also detail the more common specific clinical findings and how they should be interpreted and used to guide further management. Here, we present a review and best practice guide for a structured, methodical clinical examination of supranuclear eye movements and nystagmus in children, a guide to clinical interpretation and age-appropriate norms. As the range of underlying diagnoses for children with abnormal eye movements is broad, recognising clinical patterns and understanding their neurological basis is also imperative for ongoing management. A structured assessment is often lacking although in many cases, simple clinical observations, combined with a basic understanding of the underlying neurology, can hold the key to clinical diagnosis. Similarly, examination of supranuclear eye movements and nystagmus in children and interpretation of any resulting clinical signs can seem very complex. Abnormal eye movements in children, including nystagmus, present a significant challenge to ophthalmologists and other healthcare professionals.
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