Ocular Motility, Confrontation Fields, and Ocular Anatomy

Ocular motility should be carefully evaluated prior to surgery. In patients with asymptomatic tropia or phoria, symptoms may develop after refractive surgery if the change in refraction causes the motility status to break down. If there is a history of strabismus (see Chapter 10) or a concern about ocular alignment postoperatively, a trial with contact lenses before surgery should be considered. A sensory motor evaluation can be obtained preoperatively if strabismus is an issue. Confrontation field tests should be performed as part of the basic ophthalmic examination.

The general anatomy of the orbits should also be assessed. Patients with small palpebral fissures and/or large brows may not be ideal candidates for LASIK because there may be inadequate exposure and difficulty in achieving suction with the microkeratome or femtosecond laser suction ring.

Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.