A negative forced duction test most strongly indicates which type of issue?

• A. EOM restriction
• B. Neurogenic
• C. Mechanical entrapment
• D. Normal

Answer: (B)

When the forced duction test is negative, there is no resistance to moving the eye passively in the direction of the limitation. This means there isn’t a mechanical obstacle—such as scar tissue, entrapment, or a restrictive pulley—that would physically hinder movement. Because the eye can be moved freely, the limitation is more likely due to a problem with the muscle itself or its innervation—most commonly a neurogenic issue like a nerve palsy that weakens the muscle rather than a structural restriction. If the problem were mechanical, the test would typically be positive, showing resistance to passive movement. A negative result therefore most strongly points toward a neurogenic cause of the motility deficit.