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 (Ficks

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 oclock on the
superior limbus
Intorsion (incyclorotation) rotation nasally

Extorsion (excyclorotation) rotation of the 12 oclock 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.

Insertion1.
2.
3.

Upper lamina-Anterior surface of

superior tarsus and
skin of upper eyelid.

superior tarsus.
fornix

Middle lamina-superior margin of

Lower lamina-Superior conjunctival

. NERVE SUPPLYUpper 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 sclerocorneal 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.
ACTIONSPrimary 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.
ACTIONPrimary 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.
ACTIONPrimary abductor of eye.

SPIRAL OF TILLAUX
7.7mm

5.5mm

6.9mm
6.5mm

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.