Ocular Motility

Superior Oblique/Trochlear Muscle

Eye Muscles
Left eye Superior Rectus Muscle

Medial Rectus Muscle

Lateral Rectus Muscle

Inferior Rectus Muscle

Inferior Oblique Muscle

Anatomy Of The EOM’s
What are the actions of
EOM surround each eye:
Medial Rectus

Adduction
Lateral Rectus

Abduction
Superior Rectus

Elevation,
Adduction,
Intorsion
Inferior Rectus

Depression,
Adduction,
Extorsion
Superior Oblique

Intorsion,
Depression,
Abduction
Inferior Oblique

Extorsion
Elevation
Abduction
Anatomy Of The EOM’s
 The two Oblique are Abductors

 The two Recti are Adductors

 The two Superiors are Intorters

 The two Inferiors are Extorters

Anatomy Of The EOM’s
Origin
A common
tendinous ring
(annulus of Zinn)
Anatomy Of The EOM’s

Blood supply

Each muscle is supplied

by two Anterior Ciliary
Arteries except the Lateral
Rectus which is only
supplied by one.
Anatomy Of The EOM’s

Nerve supply
Third: LPS, MR, IR,
SR, IO
Fourth: SO
Sixth: LR
Ocular motility

CN III CN IV

CN III CN VI

CN III CN III
Eye movement

Three directions of eye movement

 Vertically
 Upward  SR & IO
 Downward  IR & SO
 Horizontally
 Abduction  LR
 Adduction  MR
 Torsionally
 Intorsion (rotate nasally)  SO
 Extorsion (rotate temporally)  IO
Ocular motility
 Agonist Muscles: Receive
equal innervation to ensure
coordinated eye movements
 Agonist/Antagonist Pairs (within
each eye)
Receive reciprocal innervation
Strabismus refers to an eye-turn.
 normal esotropia

F F F F
Why We Treat
1- Restore Stereopsis
2- Prevent Amblyopia
3- Prevent Confusion and Diplopia
4- Appearance
Strabismus measurment
 Hirschberg Test
•Used as an initial screen for strabismus
•How it works:
•Stand several feet in front of child with penlight
shining at eyes
•Light reflection will be at the same point in each eye

Normal Exotropia
Esotropia
Cover Test
 Child fixes on target (near or far)
 Examiner covers one eye while observing the
opposite eye for movement
 No movement = normal ocular alignment
 Uncovered eye shifts to re-fixate on object = Manifest
strabismus
 Indicates that the covered eye was the fixating eye
Cover-Uncover Test
•Used to detect latent strabismus
•Child fixes on object (near or far)
•A cover is placed over one eye for a few seconds
then rapidly removed
•The eye under the cover is observed for movement
Cover – Uncover test
Orthophoria, normal
No complaints, asymptomatic
Cover – Uncover test
Esophoria, abnormal, common
Only seen when eye is covered
Often asymptomatic, no complaints
Cover – Uncover test
Exophoria, abnormal, common
Only seen when eye is covered
Often asymptomatic, no complaints.
Alternate cover test
 Remember to allow the pt time to fixate on
the target, give them a minute.
 Then quickly cover the other eye to prevent
the pt from regaining fusion.
 But do not go back and forth quickly because
the pt will not have time to refixate.
Alternate Cover test
Exotropia, intermittent
May be visible with or without
alternate cover
May have intermittent diplopia,
especially when tired or sick
Alternate Cover test
Exotropia, Constant
May be visible with or without
alternate cover
May or may not have constant
diplopia
Cover Uncover test
Left Exotropia, Constant
May be visible with or without
alternate cover
Right eye preference
Cover Uncover test
Left Exotropia, Constant
May be visible with or without
alternate cover
Right eye preference
Normal Convergence
Convergence Insufficiency
How much to operate…

Alternate Cover test with Prism

Exotropia, Constant
Use prism to quantitate the
deviation.
Change prism power until
movement is neutralized.
Use this number to plan surgery
Why We Treat
The main types of Amblyopia are:

1. Strabismic amblyopia results from abnormal

binocular interaction where there is continued
monocular suppression of the deviating eye. It is
Characterized by an impairment of vision which is
present even when the eye is forced to fixate.
 Why We Treat
2. Anisometropic amblyopia is
caused by a difference in
refractive error. It results from
abnormal binocular interaction
from the superimposition of a
focused and unfocused image or
from the superimposition of large
and small images from
aniseikonia.
3. Deprivation Amblyopia is caused
from form vision deprivation of
one eye.
Why We Treat
- Confusion and Diplopia

DEFINITIONS
1. Visual axis is a line that passes through the point of fixation and the
fovea. The normal visual axes intersect at the point of fixation.
2. Strabismus is a misalignment of the visual axes which, initially, results in
confusion and diplopia.
4. Diplopia is the simultaneous appreciation of two images of one object. it
results from a failure to maintain binocular vision.