Pediatric Oculomotor Dysfunction

Deficiencies of Saccadic Eye Movements 
Deficiencies of Smooth Pursuit Movements 
A sensorimotor anomaly of the ocular motor system where the characteristic feature is the
inability to perform accurate and effective ocular pursuits, saccades, and fixations.

Signs and Symptoms
The signs and symptoms associated with ocular motor dysfunction are related to visuallydemanding
tasks. They may include, but are not limited to, the following:

1. Loss of place and/or omission of words when reading
2. Difficulty visually tracking and/or following objects
3. Poor academic performance
4. Reduced efficiency and productivity
5. Poor attention span/easy distractibility
6. Muscular incoordination
7. Vertigo 
8. Motion Sickness

Diagnostic Factors
Ocular motor dysfunction is characterized by one or more of the following diagnostic findings:

1. Reduced accuracy of ocular pursuits and/or saccades
2. Difficulty separating head/body and eye movements
3. Difficulty sustaining adequate pursuit or saccadic eye movement under cognitive demands
4. Inability to follow targets in proper sequence
5. Need for tactile/kinesthetic reinforcement while performing ocular motor activities
6. Inability to adequately sustain fixation/erratic fixations
7. Increased time required to perform tasks dependent upon saccadic eye movements Therapeutic Considerations

A. Management
The doctor of optometry determines appropriate diagnostic and therapeutic modalities,
and frequency of evaluation and follow-up, based upon the urgency and nature of the
patient’s condition and unique needs. The management of the case and duration of
treatment would be affected by:
1. The severity of symptoms and diagnostic factors including onset and duration of the
2. Implications of patient’s general health and associated visual conditions
3. Extent of visual demands placed upon the individual
4. Patient compliance
5. Prior interventions

B. Treatment
The treatment of most ocular motor dysfunctions requires orthoptics/vision therapy.
However, the therapy regimen may be augmented by the use of therapeutic lenses or prisms. Optometric vision therapy usually incorporates the prescription of specific treatments in order to:
1. Develop accurate fixation skills
2. Develop accurate ocular pursuits and saccades
3. Integrate ocular motor skills with accurate motor response
4. Integrate ocular motor skills with other sensory skills (vestibular, kinesthetic, tactile,auditory)
5. Integrate ocular motor skills with vergence and accommodative systems
6. Integrate ocular motor skills with information processing

Duration of Treatment
The required duration of treatment is commensurate with the severity and/or complexity of the problem.
1. The most commonly encountered ocular motor dysfunction usually requires a minimum of 12 hours of office therapy in addition to therapy provided for concurrent conditions.
2. Ocular motor dysfunction complicated by accommodative-convergence disorders usually require up to an additional 16 hours of office therapy.
3. Ocular motor dysfunction complicated by associated conditions such as stroke, head trauma or other systemic conditions require substantially more office therapy.

Follow-Up Care
At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided.


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