8. Extraocular Muscles Flashcards

1
Q

Why do we have binocular vision?

A

Allows for wider field of vision and depth perception enabling 3D vision
Visual axis of both eyes need to be aligned

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2
Q

What is diplopia?

A

Misalignment of visual axes focuses on different area of each retina
Brain unable to fuse, thus see 2 separate images
Gives double vision

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3
Q

What are the 4 recti extra ocular muscles?

A

Superior
Inferior
Medial
Lateral

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4
Q

What are the 2 oblique extra-ocular muscles?

A

Superior

Inferior

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5
Q

Where do the extra-ocular muscles insert?

A

Sclera

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6
Q

What is the origin of the extra-ocular muscles?

A

Apex of orbit
Except from inferior oblique which arises from floor of orbital cavity anteriorly
4 recti arise from common tendinous ring

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7
Q

What are the extra-ocular muscles innervated by?

A

Most innervated by CNIII, lateral rectus by CNVI and superior oblique by CNIV
(LR6SO4)

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8
Q

What do the extra ocular muscles run in line with?

A

Axis of orbit
Therefore some muscles attach at an oblique angle
Confers several actions of movement on globe (not just up and down) for some of extra ocular muscles

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9
Q

Which muscle adducts the eye?

A

Medial rectus

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10
Q

Which muscle abducts the eye?

A

Lateral rectus

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11
Q

What is the role of superior rectus muscle?

A

Elevates eyeball
Slightly adducts
Slightly intorts (internally rotates)

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12
Q

What is the role of inferior rectus muscle?

A

Depresses eyeball
Slightly adducts
Slightly extorts (externally rotates)

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13
Q

What is the role of superior oblique muscle?

A

Intorts eyeball
Depress
Slightly abducts

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14
Q

What is the role of inferior oblique muscle?

A

Extort
Elevate
Slightly abduct

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15
Q

Which extra-ocular muscles have an action in elevating the eyeball?

A

Superior rectus

Inferior oblique

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16
Q

Which extra-ocular muscles have an action in depressing the eyeball?

A

Inferior rectus

Superior oblique

17
Q

Which extra-ocular muscles are stronger elevators and depressors of the eyeball when the eye is in the adducted position?

A

Inferior oblique

Superior oblique

18
Q

Which extra-ocular muscles are stronger elevators and depressors of the eyeball when the eye is in the abducted position?

A

Superior rectus

Inferior rectus

19
Q

What happens if a muscle is weakened?

A

It’s influence (exerted by its anatomical action on the eyeball) is lost or reduced
Other muscle actions no longer antagonised - resting position of eyeball may deviate (strabismus) due to actions of remaining working muscles
Difficulties with moving eye in certain directions of gaze

20
Q

What is a strabismus?

A

Squint

21
Q

How do you test for lateral and medial rectus?

A

Straight forward as each only performs one action on the eye

Abduction (LR) and adduction (MR)

22
Q

How do you test superior an inferior rectus muscles?

A

Start with eye abducted

Elevate and depress testing for superior and inferior rectus

23
Q

How do you test for superior and inferior oblique muscles?

A

Start with eye adducted

Elevation and depression tests for superior and inferior oblique

24
Q

Why can an adult present with strabismus?

A

Pathology or disease involving number of different structures:

  • neuromuscular junctions e.g. myasthenia gravis
  • nerves supplying muscles (CNIII, IV, VI)
25
Q

How can cranial nerves be affected?

A

Vasculopathic - microvascular ischaemia, secondary to diabetes or hypertension
Physical compression - tumour or aneurysm
Raised ICP

26
Q

What causes signs of CNIII palsy?

A
Innervates all extra-ocular muscles except LR and SO
Innervates muscle of eyelid (LPS)
Innervates sphincter pupillae muscle 
Pupil spared - vasculopathic lesions
Pupil involved - compressive lesions
27
Q

What position is the eye in and why in a CNIV palsy?

A

Innervates superior oblique muscle - intorts, depresses and abducts eye
Therefore those actions are lost and eye is extorted, slightly elevated and adducted

28
Q

What are the signs and symptoms of CNIV palsy?

A

Worsening diplopia especially looking down and medially
Eye is extorted, slightly elevated, adducted
Head tilt to compensate extortion of eyeball

29
Q

What are the signs of CNVI palsy?

A

Innervates lateral rectus, so unopposed pull of medial rectus muscle, unable to abduct eye on affected side

30
Q

How can the history help give a clearer indication for more concerning underlying causes of eye problems?

A

Headache, vomiting could suggest raised ICP
Recent head injury
Presence of pupil involvement in CIII lesions and eye pain/headache