What is the medical term for eyes that are not intact and not following the left side during a physical examination?

Medical Documentation of Impaired Ocular Motility

The appropriate medical terminology for documenting eyes that are "not intact" and "not following to the left side" is: "impaired extraocular movements with limitation of leftward gaze" or more specifically "left gaze palsy" or "ophthalmoplegia affecting leftward gaze." 1, 2

Precise Documentation Framework

Terminology Selection Based on Clinical Findings

For complete inability to move eyes leftward:

• Document as "left gaze palsy" or "conjugate gaze palsy to the left" if both eyes fail to move together leftward 3
• Use "ophthalmoplegia" when referring to paralysis of extraocular muscles 1, 2

For partial limitation:

• Document as "ophthalmoparesis with limitation of leftward gaze" 1
• Specify which eye(s) are affected: "right eye adduction deficit" or "left eye abduction deficit" 3

For specific patterns:

• "Internuclear ophthalmoplegia (INO)" - when one eye fails to adduct (move nasally) with contralateral abducting nystagmus 4, 5
• "Sixth nerve palsy" - when one eye cannot abduct (move temporally) 6
• "Third nerve palsy" - when multiple movements are affected with or without ptosis/pupil involvement 3

Essential Documentation Components

Always document these specific findings: 3

• Pupillary status: "pupils equal and reactive" vs. "left pupil dilated and non-reactive" 3
• Ptosis presence: "complete left ptosis" vs. "no ptosis" 7
• Specific movement limitations: "inability to adduct right eye past midline" 3
• Diplopia characteristics: "binocular horizontal diplopia in left gaze" 4
• Nystagmus: "left-beating nystagmus in left gaze" 5

Critical Distinction: "Not Intact" Clarification

The phrase "eyes not intact" is ambiguous and should be replaced with specific anatomical findings: 3

• For structural abnormalities: "absent red reflex," "leukocoria," "corneal opacity" 3
• For alignment issues: "esotropia," "exotropia," "hypertropia" 3
• For movement disorders: "restricted extraocular movements," "ophthalmoplegia" 1, 2

Common Pitfalls to Avoid

Never use vague terminology like "eyes not working properly" or "eyes not intact" - these lack clinical precision and may delay appropriate workup 2

Always specify laterality and direction: Instead of "can't look left," document "bilateral limitation of leftward gaze" or "right eye adduction deficit on left gaze" 3

Distinguish between conjugate and disconjugate movements: Conjugate gaze palsy (both eyes fail together) suggests supranuclear pathology, while isolated muscle weakness suggests peripheral nerve or muscle pathology 3, 5

Recommended Documentation Format

Use this structured approach: 3

1. Alignment in primary gaze: "Orthotropic" vs. "10 prism diopter esotropia"
2. Extraocular movements: "Full in all directions" vs. "Limited abduction left eye"
3. Specific deficits: "Unable to adduct right eye past midline on left gaze"
4. Associated findings: "With left ptosis and 4mm dilated non-reactive left pupil"

Example complete documentation: "Extraocular movements reveal limitation of leftward gaze with failure of right eye adduction and left-beating nystagmus of the abducting left eye, consistent with right internuclear ophthalmoplegia. Pupils equal and reactive. No ptosis." 4, 5