Advertisement

Anatomy and Physiology of Eye Movements

  • Kenneth W. Wright

Abstract

Within the orbit, the eye is suspended by six extraocular muscles (four rectus muscles and two oblique muscles), suspensory ligaments, and surrounding orbital fat (Fig. 8-1). A tug-of-war exists between the rectus and oblique muscles. The four rectus muscles insert anterior to the equator, and pull the eye posteriorly, while the two oblique muscles insert posterior to the equator providing anterior counterforces. Posterior orbital fat also pushes the eye forward. If rectus muscle tension increases, the eye will be pulled back causing enophthalmos and lid fissure narrowing. Simultaneous cocontraction of the horizontal rectus muscles in Duane’s syndrome, for example, can cause significant lid fissure narrowing and enophthalmos. In contrast, decreased rectus muscle tone causes proptosis and lid fissure widening. Conditions such as muscle palsies or a detached rectus muscle allow the eye to move forward and result in lid fissure widening. Rectus muscle tightening procedures such as resections tend to cause lid fissure narrowing whereas loosening procedures such as rectus recessions induce lid fissure widening. When the eye is looking straight ahead with the visual axis parallel to the sagittal plane of the head, the eye is in primary position. The vertical rectus muscles follow the orbits and diverge from the central sagittal plane of the head by 23°. Thus, the visual axis in primary position is 23° nasal to the muscle axis of the vertical rectus muscles (Fig. 8-2). This discrepancy between the vertical rectus muscle axis and the visual axis of the eye explains the secondary and tertiary functions of the vertical rectus muscles (see muscle functions, following). The term position of rest refers to the position of the eyes when all the extraocular muscles are relaxed or paralyzed. Normally, the position of rest is divergent (i.e., exotropic), with the visual axis in line with the orbital axis. The eyes of a patient under general anesthesia are usually deviated in a divergent position.

Keywords

Smooth Pursuit Rectus Muscle Extraocular Muscle Strabismus Surgery Medial Rectus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Atkinson J. Development of optokinetic nystagmus in the human infant and monkey infant: an analogue to the development in kitten. In: Freeman RD (ed) Developmental neurobi-ology of vision. New York: Plenum Press, 1979.Google Scholar
  2. 2.
    Bartini C, Horcholle-Bossavit G. Extraocular muscle afferents and visual input interactions in the superior colliculus of the cat. Prog Brain Res 1979;50:335.CrossRefGoogle Scholar
  3. 3.
    Beisner DH. Reduction of ocular torque by medial rectus recession. Arch Ophthalmol 1971;85:13.PubMedCrossRefGoogle Scholar
  4. 4.
    Bloom JN, Graviss ER, Mardelli PG. A magnetic resonance imaging study of the upshoot-downshoot phenomenon of Duane’s retraction syndrome. Am J Ophthalmol 1991;111:548–554.PubMedGoogle Scholar
  5. 5.
    Bremer DL, Rogers GL, Quick LD. Primary-position hypotropia after anterior transposition of the inferior oblique. Arch Ophthalmol 1986;104:229–232.PubMedCrossRefGoogle Scholar
  6. 6.
    Clark RA, Miller JM, Demer JL. Three-dimensional location of human rectus pulleys by path inflections in secondary gaze positions. Investig Ophthalmol Vis Sci 2000;41:3787–3797.Google Scholar
  7. 7.
    Collins CC. The human oculomotor control system. In: Lennerstrand G, Bach-y-Rita P (eds) Basic mechanism of ocular motility and their clinical implications. New York: Pergamon, 1975:145–180Google Scholar
  8. 8.
    Cynader M, Berman N, Hein A. Recovery of function in cat visual cortex following prolonged deprivation. Exp Brain Res 1975;25:139–156.Google Scholar
  9. 9.
    Daniel P. Spiral nerve endings in the extrinsic eye muscles of man. J Anat 1946;80:189.Google Scholar
  10. 10.
    Demer JL, Poulkens V, Miller JM, Micevych P. Innervation of extraocular pulley smooth muscle in monkeys and humans. Investig Ophthalmol Vis Sci 1997;38:1774–1785.Google Scholar
  11. 11.
    Demer JL, Oh SY, Poulkens V. Evidence for an active control of rectus extraocular muscle pulleys. Investig Ophthalmol Vis Sci 2000;41:1280–1290.Google Scholar
  12. 12.
    Fells P, March RJ. Anterior segment ischemia following surgery on two rectus muscles. In: Reinecke RD (ed) Strabismus: proceedings of the third meeting of the International Strabismological Association, May 10–12, 1978;Kyoto, Japan. New York: Grune & Stratton, 1978:375-380.Google Scholar
  13. 13.
    Fink WH. Surgery of the oblique muscles of the eye. St. Louis: Mosby, 1951:92-95.Google Scholar
  14. 14.
    Fishman PH, Repka MX, et al. A primate model of anterior segment ischemia after strabismus surgery. Ophthalmology 1990;97(4):456–461.PubMedGoogle Scholar
  15. 15.
    France TD, Simon JW. Anterior segment ischemia syndrome following muscle surgery. The AAPO&S experience. J Pediatr Ophthalmol Strabismus 1986;23:87–91.PubMedGoogle Scholar
  16. 16.
    Guemes A, Wright KW. Effect of graded anterior transposition of the inferior oblique muscle on versions and vertical deviation in primary position. JAAPOS 1998;201-206.Google Scholar
  17. 17.
    Hawes MJ, Dortzbach RK. The microscopic anatomy of the lower eyelid retractors. Arch Ophthalmol 1982;100(8):1313–1318.PubMedCrossRefGoogle Scholar
  18. 18.
    Hayreh SS, Scott WE. Fluorescein iris angiography. Arch Ophthalmol 1978;96:1390–1400.PubMedCrossRefGoogle Scholar
  19. 19.
    Helveston EM, Merriam WW, Ellis FD, et al. The trochlea: a study of the anatomy and physiology. Ophthalmology 1982;89:124–133.PubMedGoogle Scholar
  20. 20.
    Hiatt RL. Production of anterior segment ischemia. Trans Am Ophthalmol Soc 1977;75:87–102.PubMedGoogle Scholar
  21. 21.
    Jampel RS. The fundamental principle of the action of the oblique ocular muscles. Am J Ophthalmol 1970;69:623.PubMedGoogle Scholar
  22. 22.
    Koornneef L. Orbital septa: anatomy and function. Ophthalmology 1979;86:876–880.PubMedGoogle Scholar
  23. 23.
    Linwong M, Herman SJ. Cycloduction of the eyes with head tilt. Arch Ophthalmol 1971;85:570.PubMedCrossRefGoogle Scholar
  24. 24.
    McKeown CA, Lambert HM, et al. Preservation of the anterior ciliary vessels during extraocular muscle surgery. Ophthalmology 1989;96:498–507.PubMedGoogle Scholar
  25. 25.
    Mims JL, Wood RC. Bilateral anterior transposition of the inferior obliques. Arch Ophthalmol 1989;107:41–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Mims JL, Wood RC. Anti-elevation syndrome after bilateral anterior transposition of the inferior oblique muscles: incidence and prevention. J Am Assoc Pediatr Ophthalmol Strabismus 1999;3(6):333–336.CrossRefGoogle Scholar
  27. 27.
    Morrison JC, van Buskirk EM. Anterior collateral circulation in the primate eye. Ophthalmology 1983;90:707–715.PubMedGoogle Scholar
  28. 28.
    Oh SY, Poulkens V, Demer J. Quantitative analysis of rectus extraocular muscle layers in the monkey and humans. Inves-tig Ophthalmol Vis Sci 2001;42(1):10–17.Google Scholar
  29. 29.
    Parks MM, Bloom JN. The “slipped muscle.” In: Symposium on strabismus. Transactions of the New Orleans Academy of Ophthalmology. St. Louis: Mosby, 1978:1389–1396.Google Scholar
  30. 30.
    Parks MM. Atlas of strabismus surgery. Philadelphia: Harper & Row, 1983.Google Scholar
  31. 31.
    Parks MM. Causes of the adhesive syndrome. In: Symposium on strabismus. Transactions of the New Orleans Academy of Ophthalmology. St. Louis: Mosby, 1978:269–279.Google Scholar
  32. 32.
    Plager DA, Parks MM. Recognition and repair of the “lost” rectus muscle. Ophthalmology 1990;97:131.PubMedGoogle Scholar
  33. 33.
    Porter JD, Baker RS, Ragusa RJ, Brueckner JK. Extraocular muscles: basic and clinical aspects of structure and functions. Surv Ophthalmol 1995;39:451–484.PubMedCrossRefGoogle Scholar
  34. 34.
    Saunders RA, Sandall GS. Anterior segment ischemia syndrome following rectus muscle transposition. Am J Ophthalmol 1982;93:34–38.PubMedGoogle Scholar
  35. 35.
    Saunders RA, Phillips MS. Anterior segment ischemia after three rectus muscle surgery. Ophthalmology 1988;95:533–537.PubMedGoogle Scholar
  36. 36.
    Simon JW, Price EC, et al. Anterior segment ischemia following strabismus surgery. J Pediatr Ophthalmol Strabismus 1984;21:179–184.PubMedGoogle Scholar
  37. 37.
    Spencer RF, Porter J. Structural organization of the extraocular muscles. In: Buttner-Ennever J (ed) Neuroanatomy of the oculomotor system. Amsterdam: Elsevier, 1988:33–79.Google Scholar
  38. 38.
    Stager DR, Weakley DR, Stager D. Anterior transposition of the inferior oblique: anatomic assessment of the neurovascular bundle. Arch Ophthalmol 1992;110:360–362.PubMedCrossRefGoogle Scholar
  39. 39.
    Stager DR, Porter J, Weakley DR, Stidham DB. A comparative microscopic analysis of the capsule of the nerve to the inferior oblique muscle. Trans Am Ophthalmol Soc 1997;95:453–462.; discussion 463-465.PubMedGoogle Scholar
  40. 40.
    Swan KC. Fascia in relation to extraocular muscle surgery. Arch Ophthalmol 1970;83:134–140.PubMedCrossRefGoogle Scholar
  41. 41.
    Virdi PS, Hayreh SS. Normal fluorescein iris angiographic pattern in subhuman primates. Investig Ophthalmol Vis Sci 1983;24:790–793.Google Scholar
  42. 42.
    von Noorden GK. Anterior segment ischemia following the Jensen procedure. Arch Ophthalmol 1976;94:845–847.CrossRefGoogle Scholar
  43. 43.
    von Noorden GK. Letter to the Editor. A magnetic resonance imaging study of the upshoot downshoot phenomenon of Duane’s retraction syndrome. Am J Ophthalmol 1991;112:358–359.Google Scholar
  44. 44.
    Wilcox LM Jr, Keough EM, et al. The contribution of blood flow by the anterior ciliary arteries to the anterior segment in the primate eye. Exp Eye Res 1980;30:167–174.PubMedCrossRefGoogle Scholar
  45. 45.
    Wright KW, Lanier AB. Effect of a modified rectus tuck on anterior segment circulation in monkeys. J Pediatr Ophthalmol Strabismus 1991;28:77–81.PubMedGoogle Scholar
  46. 46.
    Wright KW, et al. Acquired inflammatory superior oblique tendon sheath syndrome: a clinicopathologic study. Arch Ophthalmol 1982;100:1752–1754.PubMedCrossRefGoogle Scholar
  47. 47.
    Wright KW. Color atlas of ophthalmic surgery: strabismus. Philadelphia: Lippincott, 1991.Google Scholar
  48. 48.
    Wright KW. Discussion of paper: Recognition and repair of the lost rectus muscle. Ophthalmology 1990;97:136.Google Scholar
  49. 49.
    Wright KW. The fat adherence syndrome and strabismus after retinal surgery. Ophthalmology 1986;93:411–415.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Kenneth W. Wright

There are no affiliations available

Personalised recommendations