EXTRAOCULAR

MUSCLES

RANGEEN CHANDRAN R
 ORBITAL MUSCLES

 Extrinsic muscles of eyeball.

 Involved in movement of eyeball.
 Intrinsic muscles
 Controls shape of lens and size of pupil.
Extraocular muscles are special

 The motor units are small, with only from 5 to 18 muscle

fibers contact by each motor nerve
 Motion of an Eye

 To describe eye motions we need a set of defined axes (Fick’s

Axes - draw on board)
 X axis : nasal -> temporal
 Y axis: anterior -> posterior
 Z axis: superior -> inferior

 These axes intersect at the center of rotation - a fixed point,

defined as 13.5 mm behind cornea.
AXES OF EYEBALL AND ORBIT
Ductions (single eye movements)

 Rotation about the Z axis (Z axis runs vertically superior to

inferior)
 Medial Rotation - adduction toward midline
 Lateral Rotation - abduction away from midline

 Rotation about the X axis (X axis runs horizontally, from

nasal to temporal)
 Upward, elevation (supraduction)
 Downward, depression (infraduction)
 Torsion - cyclorotations

 Rotation about the Y axis (Y axis runs horizontally, from anterior

to posterior)
 These are described with respect to a point at 12 o‘clock on the
superior limbus
 Intorsion (incyclorotation) rotation nasally

 Extorsion (excyclorotation) rotation of the 12 o’clock position

temporally.

 Counteracting head tilt (up to 7-9°)

 Version & Vergences

 Some eye movements are paired, that is both eyes do

the same thing. . . . Versions

 Sometimes eyes move in the opposite directions

simultaneously. . . Vergences
 Vergences

 Disjunctive eye movements (opposite left- right

movments). Non-yolked motion

 Convergence (simultaneous movement nasally)

 Divergence (simultaneous temporal movement)
 Encyclovergence (intorsion)
 Excyclovergence (extorsion)
Versions (conjugate eye
movement)
 Dextroversion - rightward gaze (demo)
 Levoversion - leftward gaze
 Supraversion - elevation
 Infraversion - depression

 Also up and right, up and left

 Down and right, down and left

ALL BEHAVIOR IS THAT OF YOLKED

EYES
Extraocular muscles

 VOLUNTARY MUSCLES
 INVOLUNTARY MUSCLES
 INVOLUNTARY MUSCLES

3 muscles.
 Superior tarsal muscle.
 Inferior tarsal muscle.
 Orbitalis.
VOLUNTARY MUSCLES

7 in number
 Levator palpebrae superioris
 Superior rectus
 Inferior rectus
 Medial rectus
 Lateral rectus
 Superior oblique
 Inferior oblique
LEVATOR PALPEBRAE
SUPERIORIS

 Superior most muscle in

the orbit.
 Has voluntary and
involuntary parts.
 Origin-Inferior surface of lesser wing of sphenoid.
 Insertion-
1. Upper lamina-Anterior surface of
superior tarsus and skin of upper eyelid.
2. Middle lamina-superior margin of
superior tarsus.
3. Lower lamina-Superior conjunctival
fornix
 NERVE SUPPLY-
Upper division of occulomotor nerve.
 ACTION

 Elevation of upper eyelid.

 Ptosis

Drooping of upper eyelid.

 Complete ptosis-injury to occulomotor nerve.
 Partial ptosis-disruption of postganglionic sympathetic
fibres from superior cervical sympathetic ganglion.
 SUPERIOR RECTUS MUSCLE

 Origin-Superior part of common tendon of zinn.

 Insertion-inserted into sclera by flat tendinous
insertion(10mm broad)about 7.7 mm behind sclero-
corneal junction.
 Nerve supply-superior division of occulomotor nerve.
ANNULUS OF ZINN
 Frontal nerve runs above the superior rectus & levator.
 The nasociliary nerve and ophthalmic artery run
below.
 The tendon for insertion of the superior oblique
muscle runs below the anterior part of the superior
rectus.
 Action of Superior Rectus

 Primary action is elevation . . But since the insertion on

the globe is lateral as well as superior, contraction will
produce rotation about the vertical axis toward midline
 Thus secondary action is adduction
 Finally, because the insertion is oblique, contraction
produces torsion nasally Intorsion.
 INFERIOR RECTUS

 Origin-inferior part of common tendon of zinn

 Insertion-in the sclera 6.5 mm behind sclero corneal
junction.
 Nerve supply-inferior division occulomotor nerve.
 Fascial attachments below attached to inferior lid
coordinate depression and lid opening.
 Fascia below Inf. Rectus and Inf. Oblique contribute to
the suspensory ligament of lockwood.
 ACTIONS-
Primary depressor.
Subsidiary actions are adduction and extorsion.
 MEDIAL RECTUS

 Origin-annulus of zinn and from optic nerve sheath.

 Insertion-in sclera 5.5mm behind sclero-corneal
junction.
 Nerve supply-lower division of occulomotor nerve.
 Fascial expansion from muscle sheath forms the medial
check ligament and attach to medial wall of orbit.
 Innervation is via cranial nerve III, the oculomotor
nerve, and the specific branch runs along the inside of
the muscle cone, on the lateral surface.
 The superior oblique, ophthalmic artery and nasociliary
nerve all lie above the medial rectus.
 ACTION-
Primary adductor of the eye.
LATERAL RECTUS

 Origin-annulus of zinn.
 Insertion-in the sclera 6.9mm behind sclerocorneal
junction.
 Nerve supply-abducens nerve which enters the muscle
on the medial surface.
 The lacrimal artery and nerve run along the superior
border.
 The abducens nerve, ophthalmic artery and ciliary
ganglion lie medial to the lateral rectus and between it
and the optic nerve.
 ACTION-
Primary abductor of eye.
SPIRAL OF TILLAUX

7.7
mm

5.5
mm

6.9
mm 6.5
mm
 SUPERIOR OBLIQUE

 Longest and thinnest intraorbital muscle, the muscle

ends before the trochlea, tendon is 2.5 cm, smooth
movement through trochlea.

 Origin-body of sphenoid above and medial to optic

canal.Passes along superomedial part of orbit and ends
in a tendon.
 Insertion-Posterosuperior quadrant of sclera behind
equator of eyeball.
 Nerve supply-trochlear nerve entering it approximately
one third of the distance from the origin to the trochlea.
 ACTIONS

 Primary action-intorsion.
 Subsidiary actions-abduction and depression.
 Adducted position-depression.
INFERIOR OBLIQUE

 Origin-Anteromedial part of orbital floor lateral to

nasolacrimal groove.
 Insertion-posteroinferior surface of globe near the
macula.
 Nerve supply-inferior division of occulomotor nerve
enters the muscle laterally at the junction of the inferior
oblique and inferior rectus muscles.
 ACTIONS

 Primary action-extorsion.
 Subsidiary actions-elevations and abduction.
 Causes elevation only in adducted position of eyeball.
Origins/Insertions of Oblique
muscles
 BLOOD SUPPLY

 Ophthalmic artery.
 Medial muscular branch-inferior rectus,
inferior oblique, medial rectus
 Lateral muscular branch-superior rectus
superior oblique, lateral rectus.