Measurement of extraocular horizontal muscle insertion distance via anterior segment optical coherence tomography of healthy children and comparison with healthy adults

  • Osman Bulut Ocak
  • Asli İnal
  • İhsan Yilmaz
  • Ebru Demet Aygit
  • Serap Yurttaser Ocak
  • Selcen Celik
  • Muhittin Taskapili
  • Birsen Gokyigit
Original Paper



The aim of the study was to determine the corneal limbus–extraocular muscle insertion distance (LID), via anterior segment optical coherence tomography, in healthy children and healthy adults and to compare the results of the measurements of the two groups.


Muscle limbus distances were measured using AS-OCT in 60 healthy cases in two groups. Children aged 8–13 years were evaluated as group 1, and healthy adults aged 25–30 years were evaluated as group 2. Measurements of 120 horizontal muscles were taken by one doctor (OBO). The values were compared according to age and gender groups, and correlation between LID measurements and spherical equivalent. Statistical evaluation was performed using SPSS 16® for Windows with the Student’s t test and Pearson correlation coefficient test.


LID measurements for MR and for lateral rectus (LR) were 5.74 ± 0.75 and 6.74 ± 1.11 mm, in the pediatric age-group, and 5.73 ± 0.75 and 6.84 ± 1.15 mm, in the adult age-group, respectively. There was no statistically significant difference between the two groups in terms of MR distances. There was a slight increase in the adult values, for the LR distance. There was no significant difference in terms of gender. Correlation was found 0.62 for MR and 0.46 for LR between LID measurements and spherical equivalent in the pediatric age-group.


In healthy individuals, different imaging modalities can be used to measure LID, but AS-OCT can be used in pediatric age-groups as a preferred imaging method because it is easy and noninvasive.


Anterior segment optical coherence tomography Children Horizontal muscles Limbus–insertion distance 


Authors’ contributions

OBO, AI, and BG were involved in conception and design. IY, EDA, and SC collected the data. OBO, AI, SYO, and MT performed the analysis and interpretation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Lai YH, Wu WC, Wang HZ, Hsu HT (2012) Extraocular muscle insertion positions and outcomes of strabismus surgery: correlation analysis and anatomical comparison of Western and Chinese populations. Br J Ophthalmol 96:679–682CrossRefPubMedGoogle Scholar
  2. 2.
    Ozgen A, Ariyurek M (1998) Normative measurements of orbital structures using CT. AJR Am J Roentgenol 170:1093–1096CrossRefPubMedGoogle Scholar
  3. 3.
    Demer JL, Kerman BM (1994) Comparison of standardized echography with magnetic resonance imaging to measure extraocular muscle size. Am J Ophthalmol 118:351–361CrossRefPubMedGoogle Scholar
  4. 4.
    Dai S, Kraft SP, Smith DR, Buncic JR (2006) Ultrasound biomicroscopy in strabismus reoperations. J AAPOS 10:202–205CrossRefPubMedGoogle Scholar
  5. 5.
    Khan HA, Smith DR, Kraft SP (2012) Localising rectus muscle insertions using high frequency wide-field ultrasound biomicroscopy. Br J Ophthalmol 96:683–687CrossRefPubMedGoogle Scholar
  6. 6.
    Liu X, Wang F, Xiao Y, Ye X, Hou L (2011) Measurement of the limbus-insertion distance in adult strabismus patients with anterior segment optical coherence tomography. Investig Ophthalmol Vis Sci 52:8370–8373CrossRefGoogle Scholar
  7. 7.
    Park KA, Lee JY, Oh SY (2014) Reproducibility of horizontal extraocular muscle insertion distance in anterior segment optical coherence tomography and the effect of head position. J AAPOS 18:15–20CrossRefPubMedGoogle Scholar
  8. 8.
    Salcedo-Villanueva G, Paciuc-Beja M, Harasawa M, Velez-Montoya R, Olson JL, Oliver SC, Mandava N, Quiroz-Mercado H (2015) Identification and biometry of horizontal extraocular muscle tendons using optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 253:477–485CrossRefPubMedGoogle Scholar
  9. 9.
    Ngo CS, Smith D, Kraft SP (2015) The accuracy of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular rectus muscles insertions. J AAPOS 19:233–236CrossRefPubMedGoogle Scholar
  10. 10.
    Pihlblad MS, Erenler F, Sharma A, Manchandia A, Reynolds JD (2016) Anterior segment optical coherence tomography of the horizontal and vertical extraocular muscles with measurement of the insertion to limbus distance. J Pediatr Ophthalmol Strabismus 53:141–145CrossRefPubMedGoogle Scholar
  11. 11.
    Rosseto JD, Cavuoto KM, Allemann N, McKeown CA, Capó H (2017) Accuracy of optical coherence tomography measurements of rectus muscle insertions in adult patients undergoing strabismus surgery. Am J Ophthalmol 176:236–243CrossRefGoogle Scholar
  12. 12.
    Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRefPubMedGoogle Scholar
  13. 13.
    Athavale S, Kotgirwar S, Lalwani R (2015) Rectus and oblique muscles of eyeball: a morphometric study of Indian population. Anat Cell Biol 48:201–204CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Blake CR, Lai WW, Edward DP (2003) Racial and ethnic differences in ocular anatomy. Int Ophthalmol Clin 43:9–25CrossRefPubMedGoogle Scholar
  15. 15.
    Ettl A, Kramer J, Daxer A, Koornneef L (1997) High-resolution magnetic resonance imaging of the normal extraocular musculature. Eye (Lond) 11:793–797CrossRefGoogle Scholar
  16. 16.
    Solarte CE, Smith DR, Buncic JR, Tehrani NN, Kraft SP (2008) Evaluation of vertical rectus muscles using ultrasound biomicroscopy. J AAPOS 12:128–131CrossRefPubMedGoogle Scholar
  17. 17.
    Souza-Dias C, Prieto-Díaz J, Uesugui CF (1986) Topographical aspects of the insertions of the extraocular muscles. J Pediatr Ophthalmol Strabismus 23:183–189PubMedGoogle Scholar
  18. 18.
    De-Pablo-Gómez-de-Liaño L, Fernández-Vigo JI, Ventura-Abreu N, Morales-Fernández L, Fernández-Pérez C, García-Feijóo J, Gómez-de-Liaño R (2016) Spectral domain optical coherence tomography to assess the insertion of extraocular rectus muscles. J AAPOS 20:201–205CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beyoglu Eye Education and Research HospitalUniversity of Health SciencesIstanbulTurkey
  2. 2.Department of Ophtalmology, Okmeydanı Education and Research HospitalUniversity of Health SciencesOkmeydani, IstanbulTurkey

Personalised recommendations