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Figure 1.
Figure 2.
Figure 3.
Figure 4 .
Write down the answers
In the Figures 1-4
1. Which eye is abnormal ?
2. What is t...
EXTRAOCULAR MUSCLES
Extraocular muscles
4 Recti and 2 Obliques
Superior rectus Superior oblique
Inferior rectus Inferior oblique
Medial rectus...
LEVATOR PALPEBRAE SUPERIORIS
Origin:
Undersurface of lesser wing of
sphenoid above optic canal
Insertion:
 Skin of upper...
LEVATOR PALPEBRAE SUPERIORIS
Nerve supply and Actions
Paralysis - PTOSIS
Oculomotor nerve, Sympathetics
Elevates upper lid
Equator
Optical axis/Axis of Gaze – direction of
sight .Primary position of eye
Axis of movements
Axis of muscles
Movements
Abduction
Elevation
Depression
Adduction Intorsion
Extorsion
Elevation & Depression – Around the transverse axis...
And the RULE is…..(for recti and oblique)
Any muscle inserting
medial to vertical axis – Adduction
lateral to vertical axi...
ORIGIN OF THE 4 RECTI MUSCLE
Common tendinous ring
(Annulus of Zinn)
•Lateral rectus by 2
heads
–Extra head from
adjoining...
COURSE OF THE 4 RECTI
Muscular cone
Corresponding
wall of orbit
Rectus muscle length – 40mm
Innervated from intraconal
sid...
INSERTION OF THE 4 RECTI
The line connecting the insertion of the
recti in series is spiral & is known as spiral
line of T...
AXES OF THE RECTI MUSCLE
Medial and lateral recti in same
horizontal plane
Superior and inferior recti in same
oblique p...
Action of the RECTI
• Medial & lateral recti lie in the same horizontal plane
Around a vertical axis
Medial rectus - adduc...
• Superior rectus
 Around the transverse axis – rotates the
eyeball upwards – Elevation (PRIMARY
ACTION)
 Around the ver...
Only in the Abducted position of the eyeball the visual axis coincides with
the axis of superior and inferior recti
In abd...
Superior Oblique muscle
Body of sphenoid above and medial
to optic canal
Winds around trochlea at
superomedial part of o...
Origin from orbital surface of
maxilla
Passes backward and laterally
below inferior rectus
Insertion behind equator
par...
Axis of the Oblique Muscles
The obliques lie in
the same oblique
plane 51⁰medial to
optical axis
In the adducted eye
axe...
• Superior oblique
 Around the anteroposterior axis –
Intorsion(primary action)
 Around the vertical axis Abduction
 Ar...
Only in the Adducted position of the eyeball the visual axis coincides with the axis of
superior and inferior oblique
In A...
Superior division of oculomotor:- levator palpebrae superioris, superior rectus
Inferior division of oculomotor:- medial r...
Blood supply
Ophthalmic artery
Extraocular Muscles
 Allow accurate positioning of visual axis
 Determine the spatial relationship
between the two eyes
...
Fascial expansions of Extraocular muscles
RECTI -Adduct
OBLIQUES – Abduct
SUPERIORS – Intort
INFERIORS -Extort
Clinical Testing
Ptosis
Eyeball turned down and out
Ocular movements restricted
Pupil fixed and dilated
Loss of accomodation
OCCULOMOT...
ABDUCENS PALSY – Internal squint
The right eye unable to abduct
External squint- Medial rectus paralysis
The right eye una...
TROCHLEAR NERVE PALSY
 Affected eye rotated up and in.
 Attempts to compensate lead to the patient tilting their head to...
ABDUCENS PALSY
Third nerve palsy results in an inability to move
the eye normally in all directions. Injury to the
third nerve can occur ...
Movements
Elevation
Depression
Adduction
Abduction
Intortion extortion
phthalmoplegia, also called extraocular muscle palsy, paralysis of the
extraocular muscles that control the movements of t...
The optical axis of the eye (the line from the
center of the cornea to the fovea) points
straight ahead during straight-ah...
The pulling direction of the obliques is not
aligned with either the optical axis or the
orbital axis, and their actions c...
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
Extra ocular muscles ppt
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Extraocular muscle- lecture ppt

Extra ocular muscles ppt

  1. 1. Figure 1. Figure 2. Figure 3. Figure 4 . Write down the answers In the Figures 1-4 1. Which eye is abnormal ? 2. What is the abnormality ? 3. Name the cranial nerve involved. 4. Name the muscles supplied by that cranial nerve
  2. 2. EXTRAOCULAR MUSCLES
  3. 3. Extraocular muscles 4 Recti and 2 Obliques Superior rectus Superior oblique Inferior rectus Inferior oblique Medial rectus Lateral rectus Levator palpebrae superioris
  4. 4. LEVATOR PALPEBRAE SUPERIORIS Origin: Undersurface of lesser wing of sphenoid above optic canal Insertion:  Skin of upper eyelids Anterior surface of superior tarsus Muller`s muscle/Superior tarsal muscle Superior conjunctival fornix
  5. 5. LEVATOR PALPEBRAE SUPERIORIS Nerve supply and Actions Paralysis - PTOSIS Oculomotor nerve, Sympathetics Elevates upper lid
  6. 6. Equator Optical axis/Axis of Gaze – direction of sight .Primary position of eye Axis of movements Axis of muscles
  7. 7. Movements Abduction Elevation Depression Adduction Intorsion Extorsion Elevation & Depression – Around the transverse axis Adduction & Abduction – Around the vertical axis Intortion & Extortion – Around the anteroposterior axis
  8. 8. And the RULE is…..(for recti and oblique) Any muscle inserting medial to vertical axis – Adduction lateral to vertical axis - Abduction superior to AP axis – Intorsion inferior to AP axis – Extorsion For muscle inserting in front of equator i.e RECTI above transverse axis – Elevation below transverse axis - Depression
  9. 9. ORIGIN OF THE 4 RECTI MUSCLE Common tendinous ring (Annulus of Zinn) •Lateral rectus by 2 heads –Extra head from adjoining greater wing of sphenoid LEFT EYE
  10. 10. COURSE OF THE 4 RECTI Muscular cone Corresponding wall of orbit Rectus muscle length – 40mm Innervated from intraconal side of the muscle belly at the junction of anterior 2/3 and posterior 1/3 of the muscle
  11. 11. INSERTION OF THE 4 RECTI The line connecting the insertion of the recti in series is spiral & is known as spiral line of Tillaux Pierce Tenon’scapsule Sclera in front of the equator Medial rectus is susceptible to injury during anterior segment procedures
  12. 12. AXES OF THE RECTI MUSCLE Medial and lateral recti in same horizontal plane Superior and inferior recti in same oblique plane, 25⁰lateral to optical axis In the abducted eye the axes coincide
  13. 13. Action of the RECTI • Medial & lateral recti lie in the same horizontal plane Around a vertical axis Medial rectus - adduction Lateral rectus - abduction
  14. 14. • Superior rectus  Around the transverse axis – rotates the eyeball upwards – Elevation (PRIMARY ACTION)  Around the vertical axis - Adduction  Around the anteroposterior axis - Intortion • Inferior rectus  Around the transverse axis – rotates the eyeball downwards – Depression (PRIMARY ACTION)  Around the vertical axis – Adduction  Around the anteroposterior axis - Extortion
  15. 15. Only in the Abducted position of the eyeball the visual axis coincides with the axis of superior and inferior recti In abducted eye Superior rectus – Elevation only Inferior rectus - Depression only
  16. 16. Superior Oblique muscle Body of sphenoid above and medial to optic canal Winds around trochlea at superomedial part of orbit (functional origin) Insertion behind the equator Postero‐superior quadrant Only eye muscle innervated on the outer surface of muscle belly. Retrobulbar anaesthetic block
  17. 17. Origin from orbital surface of maxilla Passes backward and laterally below inferior rectus Insertion behind equator parallel to superior oblique Postero‐superior quadrant Inferior Oblique Muscle The oblique muscles always course below the corresponding vertical rectus muscle
  18. 18. Axis of the Oblique Muscles The obliques lie in the same oblique plane 51⁰medial to optical axis In the adducted eye axes coincide with the optical axis
  19. 19. • Superior oblique  Around the anteroposterior axis – Intorsion(primary action)  Around the vertical axis Abduction  Around the transverse eaxis – Depression • Inferior oblique  Extortion(primary action)  Abduction  Elevation
  20. 20. Only in the Adducted position of the eyeball the visual axis coincides with the axis of superior and inferior oblique In Adducted eye Superior oblique – Depression only Inferior oblique – Elevation only
  21. 21. Superior division of oculomotor:- levator palpebrae superioris, superior rectus Inferior division of oculomotor:- medial rectus, inferior oblique, inferior rectus Trochlear nerve - superior oblique Abducent nerve - lateral rectus Nerve Supply of Extraocular Muscles
  22. 22. Blood supply Ophthalmic artery
  23. 23. Extraocular Muscles  Allow accurate positioning of visual axis  Determine the spatial relationship between the two eyes  Responsible for binocular vision  Have the smallest motor unit among skeletal muscles – ratio of nerve fibre to muscle fibre is 1:2(whereas 1:25 in other skeletal muscles)  -Yoke Muscles: a muscle of one eye is paired with another muscle of the fellow eye to produce a cardinal gaze -Example: Right LR & Left MR while looking towards right side  They develop from ? Preotic/preoccipital somitomeres
  24. 24. Fascial expansions of Extraocular muscles
  25. 25. RECTI -Adduct OBLIQUES – Abduct SUPERIORS – Intort INFERIORS -Extort
  26. 26. Clinical Testing
  27. 27. Ptosis Eyeball turned down and out Ocular movements restricted Pupil fixed and dilated Loss of accomodation OCCULOMOTOR NERVE PALSY
  28. 28. ABDUCENS PALSY – Internal squint The right eye unable to abduct External squint- Medial rectus paralysis The right eye unable to adduct OPTHALMOPLEGIA / EXTRAOCULAR MUSCLE PALSY Injury to III, IV, VI cranial nerve Muscle paralysis Unilateral paralysis produces Strabismus /Squint, Diplopia TROCHLEAR NERVE PALSY Eyeball turned upwards and inwards
  29. 29. TROCHLEAR NERVE PALSY  Affected eye rotated up and in.  Attempts to compensate lead to the patient tilting their head to the contralateral side.
  30. 30. ABDUCENS PALSY
  31. 31. Third nerve palsy results in an inability to move the eye normally in all directions. Injury to the third nerve can occur anywhere along its path, from where it originates within the brain to where it innervates the muscles that move the eyeball. Third nerve palsy prevents the proper functioning of the medial, superior, and inferior recti, and inferior oblique muscles. As a result, the eye cannot move up, down, or in. When at rest, the eye tends to look down and to the side, due to an inequality of muscle functioning. The muscle responsible for keeping the upper eyelid open (levator palpebrae superioris) is also affected, resulting in a drooping upper eyelid (ptosis
  32. 32. Movements Elevation Depression Adduction Abduction Intortion extortion
  33. 33. phthalmoplegia, also called extraocular muscle palsy, paralysis of the extraocular muscles that control the movements of the eye. Ophthalmoplegia usually involves the third (oculomotor), fourth (trochlear), or sixth (abducens)cranial nerves. Double vision is the characteristic symptom in all three cases
  34. 34. The optical axis of the eye (the line from the center of the cornea to the fovea) points straight ahead during straight-ahead gaze, but the axis of the orbit points about 23 degrees laterally. The superior and inferior recti originate from the back of the orbit, and so their direction of pulling is not parallel to the optical axis. As a result, although the superior rectus primarily elevates the eye, it also has smaller adducting and intorting effects. (Similarly, although not indicated in the Þgure, the inferior rectus primarily depresses but also adducts and extorts a little.)
  35. 35. The pulling direction of the obliques is not aligned with either the optical axis or the orbital axis, and their actions change with the direction of gaze. The superior oblique inserts in the posterior half of the eye and pulls diagonally forward. A, As a result, during straight-ahead gaze, although it primarily intorts the eye, it also pulls the back of the eye a little bit medially and upward (i.e., abducts and depresses a little). B, During adduction, the direction of pull is more nearly in line with the optical axis, and the same muscle depresses more and intorts less. C, During abduction, the direction of pull can wind up perpendicular to the optical axis, and the action becomes purely intorsion. (Similarly, although not indicated in the Þgure, the inferior oblique primarily extorts when the eye is abducted, but it also elevates and abducts in other directions of gaze.)
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Extraocular muscle- lecture ppt

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