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OPHTHALMOLOGY
1.2E STRABISMUS

OBJECTIVES
Enumerate the EOMs - O, I, A
Anatomy and physiology
Yoke
Perform an eye exam
Types of strabismus
EXTRAOCULAR MUSCLES
4 Recti muscles

Superior rectus

Inferior rectus

Medial rectus

Lateral rectus
2 Oblique muscles

Superior oblique

Inferior oblique
Levator palpebrae superioris

FICK'S AXES
X (horizontal) axis

Lies horizontally
when head is upright

Elevation /
Depression
Y (antero-posterior) axis

Torsional movements

Extorsion / Intorsion
Z (vertica axis)

Adduction / abduction

SUPERIOR RECTUS
Around the transverse
axis - rotates the eyeball
upwards - Elevation
(Primary action)

Around the vertical axis adduction

Around the
anteroposterior axis Intorion

INFERIOR OBLIQUE MUSCLE

Origin from orbital surface of maxilla
Passes backward and laterally below
inferior rectus
Insertion behind equator parallel to
superior oblique postero-superior
quadrant
The oblique muscles always course
below the corresponding vertical rectus muscle

OCULAR MOVEMENTS
MONOCULAR
BINOCULAR
1. Abduction
1. Version
2. Adduction
2. Vergence
3. Elevation
4. Depression
5. Intorsion
6. Extorsion

MUSCLES CAUSING MONOCULAR MOVEMENTS

Extra-ocular muscles can have primary, secondary, and tertiary
actions
Primary muscle action is the main and most powerful direction
in which the eye moves when the muscle is contracted
Secondary muscle action is the second direction in which the
eye moves when that muscle is contracted, but is not the main
or most important action.
Tertiary muscle action is the least powerful direction in which
the eye moves as a result of contraction of the muscle.

SUPERIOR OBLIQUE MUSCLE

Body of sphenoid above and medial to
optic canal
Winds around trochlea at superomedial
part of orbit (functional origin)
Insertion behind the equator posterosuperior quadrant
Only eye muscle innervated on the outer
surface of muscle belly.
Retrobulbar anaesthatic block

Muscle

Primary action

MR
LR
SR
IR
SO
IO

Adduction
Abduction
Elevation
Depression
Intorsion
Extorsion

INFERIOR RECTUS
Around the transverse
axis - rotates the eyeball
downwards - Depression
(Primary action)

Around the vertical axis Adduction

Around the
anteroposterior axis Extortion

Secondary
action

Tertiary action

Intorsion
Extorsion
Depression
Elevation

Adduction
Adduction
Abduction
Abduction

Sheringtons law refers to Ductions (reciprocal inervation)

Herings law refers to Versions(equal innervation to YOKE
muscles)
YOKE MUSCLES
A pair of muscles, one in each eye, which move the two eyes in
the same direction.
Example: RLR and LMR; RMR and LLR
Hering's law

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Ophthalmology

1.
2.
3.

BINOCULAR VISION
Eyes that work together
Requirements
Clear eyes
Straight eyes
Numbers 1 and 2 present in infancy

1.
2.
3.

AMBLYOPIA
FUNCTIONAL LOSS OF VISION due to:
Strabismus aka squint, tropia, ocular deviation
Anisometropia (Unequal grade of the two eyes)
Visual deprivation in infancy (ex: congenital cataract)

CLASSIFICATION OF STRABISMUS
Esotropia, Exotropia, Hypertropia
Congenital or acquired
Accommodative or non accommodative
Comitant or incomitant (non paralytic / paralytic)
Alternating or monocular

TESTS FOR OCULAR ALIGNMENT

Corneal light reflection test or Hirschberg's test
Prism test or Krimsky test

1.
2.
3.

AIMS OF TREATMENT
Good vision
Good alignment
Binocular vision if possible

1.
2.
3.

TREATMENT
Eyeglasses
Patching for amblyopia
Surgery
Most commonly recess-resect procedures

Ductions
Sherington's law of reciprocal innervation

1.2E STRABISMUS

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