Extraocular Muscles and Eye Movements
Chapter 4 of 5
There are 6 extraocular muscles organized in 3 pairs. One pair controls horizontal movements, one pair controls vertical movements, and one pair controls rotational movements. The extraocular muscles are the six extrinsic muscles of the human eye. They are six extraocular muscles arranged in three pairs, responsible for horizontal and vertical gaze and torsional or rotational movements.
How Are the Extraocular Muscles Controlled?
Eye movements are under central nervous system control. The third, fourth, and sixth cranial nerves are responsible for eye movements.
- The third cranial nerve (oculomotor nerve -): controls all extraocular muscles except for the superior oblique muscle controlled by the trochlear nerve (IV), and the lateral rectus muscle controlled by the abducens nerve (VI)
- The fourth cranial nerve (trochlear nerve): controls the superior oblique muscle, consequently the ability of the eye to look down and inwards
- The sixth cranial nerve (abducens nerve) controls the lateral rectus muscle and, consequently, the ability to move each eye outwards
Understanding Eye Movement
Eye movements can be affected by either a muscle mechanical limitation or an input problem from cranial nerve anomalies such as paralysis or partial paralysis. In more complex cases, the ability of the eyes to move together is typically affected from a vascular accident to a very specific area of the brain.
- Conjugate movement (the eyes move in the same direction) is typical when shifting gaze right or left
- Disjunctive (opposite directions) is convergence of the two eyes on a near object. Disjunction can be performed voluntarily, but is usually triggered by the nearness of the target object
The Movement of the Eye May Be Affected by Damage to the Cranial Nerves
- If the eyes are not capable of moving in a coordinate fashion, this can result in double vision that may or not be constant and may only be apparent in one gaze direction
- Unilateral damage to the third nerve will typically result in an eye that is down, looking outwards, with or without ptosis, and potentially associated with mydriasis (pupil dilation)
- Damage to the trochlear nerve (IV) can also affect the two most anterior external eye structures. This can lead to diplopia. In certain gaze directions, the eye may be adducted. The result will be an eye which can not move downwards properly (especially downwards when in an inward position). This is due to impairment in the superior oblique muscle
- Damage to the sixth nerve and/or the lateral rectus can also lead to double vision. A sixth nerve palsy patient typically presents with one eye turned inward
- If the anomaly is present from birth (congenital) and the eyes cannot function well together and cannot align on a target, the brain will typically choose one eye to align on the target, and the other eye will be deviated, not aligned on the target, and therefore ignored by the brain. If, during the first 7-8 years of life, an eye is not “used” by the brain, the neural connection between the eye and the brain will not develop correctly, leading to a “lazy” eye, also known as amblyopic. Amblyopia can happen for two main reasons: because an eye is deviated (strabismic amblyopia) or because an eye has a clear image and the other does not (refractive amblyopia)
- Ophthalmoparesis is weakness or paralysis of one or more extraocular muscles