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Parks 3 Step Test

The document outlines Park's 3-step test, a method used to diagnose superior oblique palsies by assessing eye deviation in different gazes and head tilts. It details the three steps involved: identifying the hypertropic eye, determining the deviation in gaze, and performing the head tilt test to implicate specific eye muscles. Learning outcomes include understanding the indications, procedure, and interpretation of results for the test.

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Abubaker Siddique
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378 views16 pages

Parks 3 Step Test

The document outlines Park's 3-step test, a method used to diagnose superior oblique palsies by assessing eye deviation in different gazes and head tilts. It details the three steps involved: identifying the hypertropic eye, determining the deviation in gaze, and performing the head tilt test to implicate specific eye muscles. Learning outcomes include understanding the indications, procedure, and interpretation of results for the test.

Uploaded by

Abubaker Siddique
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Park’s 3-step test

Learning Objectives
Students will learn about
 How to perform 3-step test
 Assessing angle of deviation in different
gazes & head tilts
Park’s 3-step test
Contents

 Park’s 3-step test


 Indications for the test
 Steps of 3-step test
Park’s Three – Step Test
Three – Step Test
 Superior oblique palsies are often
diagnosed using the three-step test.
 There are eight cyclovertically acting
muscles; four work as depressor of the
eye and four work as elevators of the
eye.
 Four in each eye.
Step-1

 Determine which eye is hypertropic by


using the cover test.
Step-1 narrows the number of possibly
under acting muscles from eight to four
e.g. R hypertropic. This means that either the
depressors of the R eye are weakened (RIR,RSO) or
the elevators of the L eye are weakened (LIO,LIR).
Draw an oval around them
R Hypertropia
Elevators of L eye

RSR RIO LIO LSR

RSO

LIR
RIR RSO LSO

Depressors of R eye
Step-2

 Determine whether the vertical deviation


is greater in R gaze or in L gaze.
 e.g. in L gaze. This implicates one of the four vertical
acting muscles used in left gaze, the two possible
muscles at this point are either both intortors or both
extortors. Draw an oval around the four vertically acting
muscles that are used in L gaze. It may be either the
RSO or LSR. These are the only muscles circles twice.
R Hypertropia

RIO LSR
RSR LIO

RSO

RIR RSO LSO LIR


RSO

Left Gaze
Step-3
 This step is also known as Bielschowsky head
tilting test, it involves tilting the head to the Right
then to the Left.
 Head tilt to the Right stimulate intorsion of the R
eye (RSR,RSO) and extorsion of the L eye
(LIR,LIO) and vice versa.
 e.g. in the same case suppose that the vertical deviation
is quite larger to the R tilt and absent to L tilt. This
implicates the four muscles that act vertically in the R tilt
position. Draw an oval around these muscles. Note that
the RSO is the only muscles that is surrounded by three
ovals.
RIO LSR
LIO
LIO
RSR

RSO

RIR RSO LSO LIR


RSO

Tilt to R side Left Gaze


RSO Palsy
Learning Outcomes

Students have learnt

Indications for 3-step step


Procedure to perform 3-step test
Interpret the results
References

 Clinical Orthoptics by Fiona J. Rowe


 Diagnosis & Management of ocular
motility disorders

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