Physiology of Extraocular muscles

Dr. Archana Preethi

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Extra ocular muscles

Striated,voluntary muscles. in number in each eye. greatest structural diversity. as being weak,fast,fatigue resistant. unit

Exhibit

Charecterised

sarcomere-fuctional 4/8/12

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Physiological properties

Under isometric conditions,they have short contraction(time req. to reach peak twitch force)and half relaxation(time from peak to half peak twitch
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Max.

forces obtained are just in fraction to those obtained from limb muscles. Shallow contractions Low twitch/tetanus ratio High oxygen demand 4/8/12

Physiological properties

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Differences from other skeletal muscle

Small diameter nerve and blood supply fibroelastic tissue ca+2 transients,due to abundant of both slow&fast fibers.

Rich

Enormous Faster

SR.
Presence Diff.in

kinetics of actomyosin,due to expression of EOM specific myosin.

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Types of muscle fibres

Major 4

classification types-based on speed of contraction&fatigue resistence types twitch,fatigue resistant twitch,fatigue resistant twitch,fatigable twitch,intermediate
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Slow Fast Fast Fast

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Layered organisation of E.O.M

1)ORBITAL ORBITAL Outer,adjacent 2

2)GLOBAL

to the periorbital&orbital bone types of small fibers;OSIF(80%)&OMIF(20%) either end, myomyous 4/8/12

At

Layered organisation of E.O.M

Ends

before muscle becomes tendinous&apparently acts only on EOM pulleys,positioning them for optimal kinematics. end plates are confined to middle 1/3 of muscle. 4/8/12

Motor

Layered organisation of E.O.M

GLOBAL Inner

adjacent to optic nerve

&eye
One

MIMF&3 SIMF.

Extends

to full muscle length&inserts through a well defined tendon 4/8/12 sclera to into

Motor units of EOM

Small,1:3/4 This

in small mf&1:10/more in large muscle fibers,in skeletal mf-1:125 allows precise targeting of eye movement&fine adjustment to prevent diplopia

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Innervation of EOM
As,globe

is a small fixed load compensatory stretch reflexes are not needed. SPINDLE:small,3-l0 intrafusal mf,thin capsule,no nuclear bag region,distributed in prox.&distal 1/3 of muscle. TENDON ORGAN
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AFFERENTS: 1)MUSCLE

2)GOLGI

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 3)SPIRAL 4)TEMP.

ENDING

SENSITIVE RECEPTORS

5)RECEPTORS

FOR OCULOCARDIAC&OCULORESPIRATORY REFLEXES MOTOR NEURONS:innervates slow fibers as multiple n. endings(engrappe endings),cond. Vel. 64/8/12

EFFERENTS 1)GAMMA

 2)ALPHA

MOTOR NEURONS Singly innervated twitch/fast

Innervate

mf.
Thick Cond.

myelinated Vel.-40-80m/sec

EOM-PROPRIOCEPTION Myotendinous

cylinder/palisade ending associated with particular extrafusal,multiply innervated fiber 4/8/12

Basic kinematics
POSITIONS PRIMARY

OF GAZE

: defined by scobee,with head erect,object of regard is at infinity &lies at intersection of the sagital plane of head&a horiz. Plane passing through centers of rotation of two eyeballs. : supraversion,infraversion,dextroversion, levoversion. : comb. Of 4/8/12 vertical &horiz.

SECONDARY

TERTIARY

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Center of rotation
Hypothetical Center

point around which eyeball perfoms rotatory movements. of rotation moves in a semicircle in the plane of rotation,this locus is called SPACE CENTROID. is considered as fixed point. pri. Position,C.R lies 13.5 mm behind apex,when measured on line of sight. reality,a little behind the actual 4/8/12

It In In

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Cardinal positions of gaze

Allow

ex. Of each of 12 EOM.

6,dextroversion, levoversion, Detroelevation, levoelevation, dextrodepression& levodepression.

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Ficks axes&Listings plane

3

AXES,perpendicular to each other,intersect at C.R of the eye. elevation/depresion - extorsion/intorsion

X(hori) Y(AP)

Z(vertical)-adduction/abduction X&Z

axes are in same planeLISTINGS PLANE

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Traslatory&rotatory movements
TRANSLATORY

- movements of eyeball as a whole in the orbit,with eye remaining in pri. Position of gaze. upwards/downwards,ant/post& sideways. around 3 ficks axes OF REST:exotropia of 2.25 degrees in each eye &inc. with age.
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Include

ROTATORY POSITION

Mechanics of action of EOM

1)CROSS Force

SECTIONAL AREA OF MUSCLE

is directly proportional to crossectional area have max. c.s.a recti have 75%&obliques have 50% of the size of horiz. Muscles. general,hori. Muscles MR&LR have similar size,there by balancing opposing forces. 4/8/12

Hori.recti Vertical In

Mechanics of action of EOM

2)LENGTH For

OF MUSCLE

normal amp. Of rotation(45-50 deg.each away from pri. Position)approx. 10 mm(25% of n. resting length)change is required in each direction. muscle contracts, site of insertion moves closer to the origin site. usually reduce amplitude of
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As

resection

rotation

 3)ARC Distal

OF CONTACT

portion of each EOM,lies in flush against globe for variable dist. Before it blends into sclera (ANATOMIC INSERTION) point where muscle /tendon 1st touches globe is TANGENTIAL POINT/PHYSIOLOGIC/EFFECTIVE INSERTION of muscle
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The

Tangent

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 Arc LR

of contact is the dist. On slceral circumference between T & A on sclera -15mm

MR-6 SR-8.4 IR-9 SO-5 IO-17

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 So

that TORQUE(force of rotation)remains same. of contact is zero,where T coincides with A WEAKENS ACTION DUE DEC. IN EFFECTIVE LENGTH&REDUCTION OF ARC OF CONTACT,ADVANCEMENT OF MUSCLE HAS A STRENGTHING EFFECT.
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Arc

RESCESSION

 4)MUSCLE Imaginary Angle

PLANE

plane passing through O,A ,T,C&long axis of muscle. formed by muscle plane with visual direction /line of fixation depends on position of globe. muscles MR&LR(muscle plane coincide with horiz. Plane of the globe) SR&IR(MP makes 4/8/12 an angle of 23

Paired For

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 5)MUSCLE

AXIS OF ROTATION

Perpendicular ACTIONS

to muscle plane erected in center of rotation. OF EOM : major action when eye is in pri.position. additional actions(other than pri.action) in the pri.position are called subsidary actions(sec.&ter.actions) 4/8/12

PRI.ACTION The

 HORIZANTAL Axis In

RECTI

of rotation coincides with z axis of globe. pri.position,act as purely horiz. Movers,LR-ABDUCTION&MR-ADDUCTION RECTI muscle plane,coincide with orbital axis making 23 deg.from optical axes. 4/8/12

VERTICAL

SR&IR-common

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 OBLIQUE Inserted SO

MUSCLES

behind the equator,makes 51 deg. Angle with optical axis. 51 deg.-depression 39 deg.-only intortion 51 deg.-elevation
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Adducted Abducted IO Adducted

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 AGONIST Any

particular EOM,producing specific ocular movement muscles moving eye in same direction opp.action in same eye.
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SYNERGISTS Two

ANTAGONISTS Having

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 C/L

ANTAGONISTS(ANTAGONIST OF YOKE MUSCLES) of muscles (from each eye)having opp.action eg.rt. LR&lt. LR

Pair

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LAWS OF OCULAR MOTILITY

DONDERS

LAW:states that for each tertiary position, there is one and only one orientation of the vertical and horizontal meridians of retina. This orientation depends solely upon the amount of elevation( Z-axis) and horizontal(X-axis) movement and is independent of the path by which this position was arrived. There is no rotation around the anteriopaoterior(Yaxis) i.e, no torsion or 4/8/12 occurs. twist

Listings Law
When

we have coordinate systems, one fixed (orbital ) and one movable (globe), there is an angle produced when the moved system is compared to the fixed system. Such motion can occur without any true torsional movement having actually been made across Y-axis.

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Herings law of equal innervation

Also

called HERINGS LAW OF MOTOR CORRESPONDENCE. innervation flows from brain to a pair of yoke muscles,which contract simultaneouslyin diff. binocular vision IMP. paralytic squint, of 4/8/12

Equal&simultaneous

Eg.RLR&LMR CLINICAL

SEC.DEVIATION-in

SHERRINGTONS LAW OF RECIPROCAL INNERVATION

During

ocular motility,an inc. flow of innervation to contracting agonist is associated with dec.flow of innervation to relaxing,antagonist.eg.during DV,inc flow to RLR&LMR,dec. flow to RMR&LLR. IMP. pathological states like DUANES RETRACTION SYND. & RETRACTION NYSTAGMUS,contraction of the antagonist occur instead of relaxation. 4/8/12

CLINICAL Certain

OCULAR MOVEMENTS
1)MONOOCULAR(DUCTIONS) Adduction Abduction Supraduction(sursumduction) Infraduction(deosursumduction) Incycloduction(intorsion) Excyclodction(extorsion)
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 2)BINOCULAR A.

VERSIONS

B.VERGENCES

VERSIONS

conjugate movements

Simultaneous,synchronus,symmetric

motion of both eyes in the same direction.

Voluntary/involuntary Involuntary-due

to optical,acoustic&other stimuli 4/8/12

 Dextroversion Levoversion Supraversion Infraversion Dextroelevation Dextrodepression Levoelevation Levodepression

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 Depending

on specific pattern of eye movements : rapid conjugate movements,to bring image quickly on to the fovea. random movements
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1)SACCADES

Vol./invol. Eg.:-command Vol.

refixation saccades evoked

Sensory

 Have Long Vel.

a pre programed velocity,no change occurs during movement delay of 200msec from stimulus to execution. Is 100 deg.to 700 deg./sec PURSUITS/FOLLOWING when tracking a moving object Is to match eye&target vel.
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2)SMOOTH Made Func.

 3)POSITION Help

MAINTENANCE MOVEMENTS

to maintain a specific gaze by rapid micromovements called FLICKS & slow micromovements called DRIFTS. MOVEMENTS due to vestibular system,if head is turned rt,eyes turn lt. gravity&other lin. Accelerations also influence eye position by 4/8/12

4)STABILIZATION DYNAMIC TONIC

 VERGENCES Disjugate,synchronous,symmetric

of

both eyes in opp. Dir.

Tonic May

movements,much slower than versions(80-250 deg/sec) be a vol./optomotor reflex

TYPES CONVERGENCE
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 CONVERGENCE Disjugate,where

both eyes rotate

inward
Allow

bifoveal single vision to be maintained at any fixation dist. same throughout life can be inc. by exercises OF CONVERGENCE
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Remains Power

ANGLE

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 NEAR Point

POINT OF CONVERGENCE

at which foveal lines of sight intersect,when max. convergece is attained is the closet point at which object is seen singly. closer than NPA at will,not a part of 4/8/12

It

Always TYPES

VOLUNTARY

 FUSIONAL/POSITIVE

FUSIONAL

CONVERGENCE
To

ensure similar retinal images are projected onto corresponding retinal areas retinal image disparity

Stimulus-bitemporal Optomotor

reflex-forms a kind of motor

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fusion

ACCOMODATIVE
Stimulus Part

blured retinal image

of triad synkinetic near reflex complex,other two are,accomodation&miosis by proximity of the object

PROXIMAL Induced

Stimulus

when sub. Believes he is looking at near object 4/8/12

DIVERGENCE
FUSIONAL/NEGATIVE Stimulus

FD

binasal retinal disparity reflex

Optomotor Amp. Dist End

N near-8-12 D

-4-6 D

point for near-when acc. Is relaxed to prevent retinal disparity,causing blurring of vision
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Vertical vergence
Disjugate Stimulus Amp. To

vertical moovements of 2 eyes in opp. Dir. retinal image disparity Is smaller than hori. Vergence FV is 3-8D.

correct vertical heterophoria

avg.vertical +ve

vertical divergence-when rt. Eye rotates up in relation to lt.& vice versa

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cyclovergence
Disjugate

torsional movements,where vertical meridians of 2 eyes move in opp. Dir. retinal image disparity, correct cyclophoria

Stimulus To

6-10deg. Slow

Amp. For incyclovergence&48deg. For excyclovergence ,low amp.

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Cortical centers for saccades

Frotal

oculomotor area for both hori.&vertical saccades eye field(FEF) eye field(SEF) prefrontal cortex(DLPFC)

frontal

Supplementary Dorsolateral Post. SUB

Eye field(PEF) pontine reticular

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CORTICAL : HORIZANTAL GAZE

Paramedian

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CORTICAL-FOR PURSUITS
Occipital Medial Medial FEF

oculomotor area

temp. visual area(MT) sup.temp. visual area(MST)

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THANK YOU

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