Pupilla learning lab
3D Eye Movement Simulator
Study binocular gaze, extraocular muscle actions and coordination of eye movements.
- Free in your browser
- English & Arabic
- Education & training
Your first practice session
- Observe the two eyes in primary position.
- Move through the gaze positions and compare both eyes.
- Explain the coordinated muscle actions using the anatomy guide.
Common mistakes to avoid
- Describing one eye without the fellow eye.
- Confusing a screen direction with the patient’s right or left.
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
Understand the principles
Ocular motility and the H-test: ductions, versions and the nine positions of gaze
The H-test examines eye movements by asking the patient to follow a target in an H shape through the six cardinal positions of gaze. In each of those positions one muscle of each eye is the main mover, so an eye that lags in a position points to weakness of the muscle that works best there. Versions are movements of both eyes together, ductions are movements of one eye with the other covered, and vergences move the eyes in opposite directions. Adding straight up, straight down and primary position gives the nine positions of gaze, which also reveal A and V patterns.
Extraocular muscles: anatomy, actions and nerve supply
Six extraocular muscles move each eye: the medial, lateral, superior and inferior recti, and the superior and inferior obliques. The medial and lateral recti move the eye horizontally; the superior and inferior recti mainly elevate and depress it; the obliques mainly rotate it (torsion) and also move it vertically. The lateral rectus is supplied by the sixth cranial nerve, the superior oblique by the fourth, and all the others by the third — remembered as "LR6 SO4 R3".
Third, fourth and sixth cranial nerve palsies and the three-step test
A third nerve palsy causes ptosis and an eye that rests down and out, with limited elevation, depression and adduction, and sometimes a dilated pupil. A fourth nerve palsy weakens the superior oblique, causing a hypertropia of the affected eye that increases on gaze to the opposite side and on head tilt toward the same side, often with a compensatory head tilt away from the affected side. A sixth nerve palsy weakens the lateral rectus, causing an esotropia and limited abduction that increase on gaze toward the affected side and at distance.
Questions about this simulator
What can I practise with the 3D Eye Movement Simulator?
Study binocular gaze, extraocular muscle actions and coordination of eye movements.
Do I need to install software or create an account?
Open the simulator free in a modern browser without installation. An account enables supported saved progress and results; coverage varies by module.
Can I use a phone or tablet?
You can access it in modern phone and tablet browsers. A larger screen gives diagrams and controls more space; performance depends on the device and browser.
Does this replace clinical training or patient diagnosis?
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
References & further learning
Sources for the teaching principles. Listing a source does not imply its institution endorses or validates this simulator.