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
10. 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
11. 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
12. 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
13. 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
14. 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
15. Action of the RECTI
• Medial & lateral recti lie in the same horizontal plane
Around a vertical axis
Medial rectus - adduction Lateral rectus -
abduction
16. • 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
17. 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
18. 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
19. 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
20. 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
21. • 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
22. 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
23. 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
25. 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
29. Ptosis
Eyeball turned down and out
Ocular movements restricted
Pupil fixed and dilated
Loss of accomodation
OCCULOMOTOR NERVE PALSY
30. 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
31.
32.
33.
34. TROCHLEAR NERVE PALSY
Affected eye rotated up and in.
Attempts to compensate lead to the patient tilting their head to the contralateral side.
45. 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
48. 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
49.
50.
51.
52.
53.
54. 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.)
55. 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.)
Editor's Notes
A layer of invol smooth muscle fibres arise from the aponeurosis of LPS andis attached to superior tarsal plate, innervated by sympathetics, denervation- ptosis.
Ocular rotations are for the most part under vol. control, whereas torsional movements cant be vol. initiated
When the visual axis in its primary position, directed to the horizon,
Medial rectus rotates the eye medially – adduction
Lateral rectus rotates the eye laterally – abduction
around a vertical axis.
Medial & lateral recti lie in the same horizontal plane
The eye's major blood supply comes from the ophthalmic artery. The lateral muscular branch of the ophthalmic artery supplies the lateral rectus, superior rectus, and superior oblique muscles. The medial muscular branch supplies the inferior rectus, medial rectus, and inferior oblique muscles.
Medial and lateral muscular branches of the artery give rise to 7 anterior ciliary vessels, which travel with the 4 rectus muscles to provide circulation for the anterior segment of the eye. Each rectus muscle has 2 anterior ciliary vessels, except for the lateral rectus muscle, which has 1 vessel. These vessels pass anteriorly to the episclera and supply the anterior segment of the eye, including the sclera, limbus, and conjunctiva.
The role of eye movts is to bring the image of objects of visual interest onto the fovea of the retina and to hold the image steady in order to achieve the highest level of visual acuity..several types of eye movts are required to ensure that these conditions are met. Moreover the movements of both eyes must be near perfectly matched to achieve the venefits of binocularity
In the setting of an eye movement problem, isolating which muscle or CN is the culprit can be tricky. When trying to isolate a problem, it can help to check movement in the direction in which that muscle is the primary mover. This can be assessed as follows:
Superior oblique: Depresses the eye when looking medially
Inferior oblique: Elevates the eye when looking medially
Superior rectus: Elevates the eye when looking laterally
Inferior rectus: Depresses the eye when looking laterally
Medial rectus: Adduction when pupil moving along horizontal plane
Lateral rectus: Abduction when pupil moving along horizontal plane