Extra-ocular Muscles Anatomy & Physiology

 There are Six extra ocular muscles.

 Four rectus muscles and two oblique muscles.
 Four rectus muscles are superior rectus, inferior rectus, medial rectus and lateral
rectus.
 Two oblique muscles are superior oblique and inferior oblique.

Rectus muscle:

 Origin- The four rectus muscles are originated from a common tendinous ring called
Annulus tendinous communis of Zinn, which is a fibrous ring across the supra-
orbital fissure and attach to the tubercle of the medial margin of the orbital surface of
the greater wing of the spheroid bone. Medial rectus arises from the medial part of the
ring, superior rectus from the superior part, inferior rectus from the inferior part and
lateral rectus from the lateral part by two heads in a ‘V’ form.

 Course- All the four rectus muscle run forward from their origin. The medial and
lateral rectus muscle follow the corresponding walls of the orbit. Lateral rectus
remains in contact with the orbital floor for only about half its length. Superior rectus
muscle is separated from the roof by LPS and orbital fat.
 Insertion- All four rectus muscles are inserted into the sclera at different distance
from the limbus as follows –
(According to Fuchs)
Medial rectus – 5.5 mm
Inferior rectus – 6.5mm
Lateral rectus – 6.9mm
Superior rectus – 7.7mm

The imaginary line joining the points of the insertion of all the four rectus muscle do
not form a circle, rather form a spiral called the Spiral of Tillaux.

- Expansion of the fascial sheath of the superior rectus muscle goes to blend with the
sheath of LPS muscle.
- Expansion of the fascial sheath of inferior rectus muscle goes to blend with the
inferior tursus.
- Expansion of the fascial sheath of medial rectus muscle called the medial check
ligament, which goes to the creast of the lacrimal bone.
- Expansion of the fascial sheaqth of lateral rectus muscle called the lateral check
ligament, goes to the Whitnall’s tubercle of the zygomatic bone.
Superior Oblique Muscle:

 Origin- From the body of the sphenoid bone, postero medial part of the optic foramen
by a narrow tendon, partially overlapping the origin of LPS.

 Course- Moves forward between the roof and medial of the orbit, passes to the
trochlea at the superonasal orbital rim, hook back from the trochlea become tendinous
at the distal third portion. The reflected tendon passes under the superior rectus muscle
and fans out to get inserted.

 Insertion- Inserted into the superolateral angle of the sclera. Anterior end lies 13.8
mm behind the limbus and posterior end lies 18.8 mm behind the limbus.

Inferior Oblique Muscle:

 Origin- By a rounded tendon from a shallow depression on the orbital surface of the
maxilla bone.
 Course- Passes laterally and backward, between the inferior rectus muscle and floor
of the orbit.
 Insertion- Into the inferolateral angle of the sclera of the eye ball.
Nerve supply of EOM:

LR6 SO4
Except lateral rectus muscle and superior oblique muscle all other muscles supplied by third
cranial nerve i.e oculomotor nerve.

Blood supply of EOM :

 Anterior Ciliary arteries also arises from these muscular arteries.

 There are Seven branches.
 Two for each recti expect lateral rectus which recieves only one branch.

Ophthalmic
artery

Medial Lateral
muscular Muscular
artery artery

MR,IR,IO LR,SR,SO,LPS
Muscle Primary Secondary action Tertiary action
action

MR Adduction - -

LR Abduction - -

SR Elevation Intortion Adduction

IR Depression Extortion Adduction

SO Intortion Depression Abduction

IO Extortion Elevation Abduction

Physiology of ocular motility:

Positions of gaze –

 Primary position of gaze – It is the position of the two eyes, with the head erect, the
object of regard is at infinity and lies at the intersection of the sagittal plane of the
head.

 Secondary position of gaze - To achieve the gaze only either horizontal or vertical
movement occurs. Like Dextroversion, Levoversion, Supraversion, Infraversion.

 Tertiary position of gaze – To achieve the gaze position both vertical and
horizontal movement occurs. Like dextroelevation, dextrodepression,
levoelevation, levodepression.
 Cardinal position of gaze- Among the nine gazes there are six cardinal position of
gaze. This positions which allow examination of all 12 extraocular muscle. These are
dextroversion, levoversion, dextroelevation, detrodepression, levoelevation,
levodepression.
Listing’s Law :

• All achieved eye orientations can be reached by starting from one specific "primary"
reference orientation and then rotating about an axis that lies within the plane orthogonal
to the primary orientation's gaze direction (line of sight / visual axis).

• This plane is called Listing's plane.

• According to Listing cycloversion is 0.

• Adduction is movement of the eye nasally;

• Abduction is movement of the eye temporally.

• Elevation is an upward rotation of the eye;

• Depression is a downward rotation of the eye.

• Intorsion/Incycloduction is defined as a nasal

rotation of the superior portion of the vertical
corneal meridian.

• Extorsion/Excycloduction is a temporal rotation

of the superior portion of the vertical corneal
meridian

1. Versions

a) Dextroversion
b) Levoversion
c) Supraversion
d) Infraversion
e) Dextroelevation
f) Dextrodepression
g) Levoelevation
h) Levodepression
i) Dextrocycloversion
j) Levocycloversion
2. Vergence
a) Convergence
b) Divergence
c) Vertical vergence
d) Cyclovergence

Version : versions are conjugate, synchronous(simultaneous) symmetric movements of

both eyes in the same direction.
 Vergence : vergence are disjugate asynchronous and symmetric movement of the two
eyes in opposite direction.

- Depending on the direction of movement vergence are of two types

Convergence: It is simultaneous and synchronous inward rotation of both eyes

which results from co-contraction of the two medial rectus muscle.

Divergence: It is simultaneous , synchronous outward rotation of the both eyes

results from co-contraction of the two lateral rectus muscle.

Terminologies used for EOM :

Agonist

• Any particular EOM producing specific ocular movement.

• Ex. Right LR for right eye abduction

Synergists

• Muscles of the same eye that move the eye in the same direction.

• Ex. Right SR and right IO for right eye elevation

Antagonists

• A pair of muscles in the same eye that move the eye in opposite

directions

• Ex. right LR and right MR.

Yoke Muscles ( Contralateral Synergists)

• Pair of muscles, one in each eye , that produce conjugate ocular

movements

• Ex. right LR and left MR in dextroversion

Contralateral antagonist

• Pair of muscles having opposite action( one from each eye).

• Example RLR and LLR.

LAWS OF MUSCLE :
Factors involved in mechanics of action of EOM :
1.Cross sectional area of the muscle (Muscles exert force in proportion to their cross

sectional area)

2.Length of the muscle

3.Distance between the anatomic and physiologic insertion is called the arc of contact. (The
power of the muscle is proportionate to its length and arc of contact)

4. Muscle Plane- The plane Passing through the mid point of the origin of muscle,
anatomical insertion, physiological insertion and centre of rotation of the globe.

5. Muscle axis of rotation – Perpendicular to the muscle plane , erected in the centre of
rotation.

Concept of action of EOM:

• Superior rectus and inferior rectus are having common muscle plane.
• Superior oblique and inferior oblique also having same muscle plane.
 SR and IR makes an angle of 23 degree ( according to AAO) with the visual line at
primary position.
 SO and IO makes an angle 51 degree (according to AAO) with the visual line at
primary position.

• When the globe is abducted to 23°, the visual and orbital axis coincide. In this position
superior rectus acts as a pure elevator. And inferior rectus acts as a pure depressor.

• If the globe were adducted to 67° the angle between the visual and orbital axis would
be 90° In this position SR would act as a pure intorter. And IR would act as a pure
extorter.
• When the globe is adducted to 51 ͦ, the visual axis coincides with the line of pull of the
muscle, the SO acts as a depressor and IO acts as Elevator.
• When the globe is abducted to 39 ,ͦ the visual axis and the SO makes an angle of 90 ͦ,
the SO causes only intorsion and IO causes only extortion.