Do You Really Need Your Oblique Muscles?

Abstract

There continues to be tenacious resistance to the notion that human extraocular muscles can primarily overact due to excessive innervation. Yet we know that while cortical centers control body movements, subcortical centers control individual muscles. In infantile strabismus, this phenomenon results from persistent activation of visuo-vestibular pathways at the subcortical level. Its resurgence in humans with defective binocular vision represents a physiologic activation rather a neurological deficit. As disconjugate binocular torsion induces a relative retinal disparity that is perceived stereoscopically, these subcortical torsional pathways are necessarily extinguished early in infancy in the service of binocular vision and stereopsis. However, they continue to function in patients with infantile strabismus.