1149:. When the eye is turned out (temporally) and horizontally, the function of the lateral rectus muscle is tested. When the eye is turned in (nasally) and horizontally, the function of the medial rectus muscle is being tested. When turning the eye down and in, the inferior rectus is contracting. When turning it up and in the superior rectus is contracting. Paradoxically, turning the eye up and out uses the inferior oblique muscle, and turning it down and out uses the superior oblique. All of these six movements can be tested by drawing a large "H" in the air with a finger or other object in front of a patient's face and having them follow the tip of the finger or object with their eyes without moving their head. Having them focus on the object as it is moved in toward their face in the midline will test
1238:
723:
usually triggered by the nearness of the target object. A "see-saw" movement, namely, one eye looking up and the other down, is possible, but not voluntarily; this effect is brought on by putting a prism in front of one eye, so the relevant image is apparently displaced. To avoid double vision from non-corresponding points, the eye with the prism must move up or down, following the image passing through the prism. Likewise conjugate torsion (rolling) on the anteroposterior axis (from the front to the back) can occur naturally, such as when one tips one's head to one shoulder; the torsion, in the opposite direction, keeps the image vertical.
455:
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521:, on the upper, nasal wall of the orbit. The muscle becomes tendinous about 10mm before it passes through the pulley, turning sharply across the orbit, and inserts on the lateral, posterior part of the globe. Thus, the superior oblique travels posteriorly for the last part of its path, going over the top of the eye. Due to its unique path, the superior oblique, when activated, pulls the eye downward and laterally.
1229:
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528:, which originates at the lower front of the nasal orbital wall, passes inferiorly over the inferior rectus muscle on its path laterally and posteriorly, and inserts under the lateral rectus muscle on the lateral, posterior part of the globe. Thus, the inferior oblique pulls the eye upward and laterally.
632:
The nuclei or bodies of these nerves are found in the brain stem. The nuclei of the abducens and oculomotor nerves are connected. This is important in coordinating the motion of the lateral rectus in one eye and the medial action on the other. In one eye, in two antagonistic muscles, like the lateral
718:
Intermediate directions are controlled by simultaneous actions of multiple muscles. When one shifts the gaze horizontally, one eye will move laterally (toward the side) and the other will move medially (toward the midline). This may be neurally coordinated by the central nervous system, to make the
359:
must be precise and fast. This is seen in scenarios like reading, where the reader must shift gaze constantly. Although under voluntary control, most eye movement is accomplished without conscious effort. Precisely how the integration between voluntary and involuntary control of the eye occurs is a
722:
There are two main kinds of movement: conjugate movement (the eyes move in the same direction) and disjunctive (opposite directions). The former is typical when shifting gaze right or left, the latter is convergence of the two eyes on a near object. Disjunction can be performed voluntarily, but is
509:
Medial and lateral are relative terms. Medial indicates near the midline, and lateral describes a position away from the midline. Thus, the medial rectus is the muscle closest to the nose. The superior and inferior recti do not pull straight back on the eye, because both muscles also pull slightly
446:
1100:). Lesions may also lead to inability to open the eye due to paralysis of the levator palpebrae muscle. Individuals suffering from a lesion to the oculomotor nerve may compensate by tilting their heads to alleviate symptoms due to paralysis of one or more of the eye muscles it controls.
709:
controlled by the abducens nerve (VI). This means the ability of the eye to look down and inwards is controlled by the trochlear nerve (IV), the ability to look outwards is controlled by the abducens nerve (VI), and all other movements are controlled by the oculomotor nerve (III).
1103:
Damage to the trochlear nerve (IV) can also cause double vision with the eye adducted and elevated. 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.
680:
The vestibulo-ocular reflex. A rotation of the head is detected, which triggers an inhibitory signal to the extraocular muscles on one side and an excitatory signal to the muscles on the other side. The result is a compensatory movement of the
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To evaluate for weakness or imbalance of the muscles, a penlight is shone directly on the corneas. Expected normal results of the corneal light reflex is when the penlight's reflection is located in the centre of both corneas, equally.
552:. Each rectus muscle receives blood from two anterior ciliary arteries, except for the lateral rectus muscle, which receives blood from only one. The exact number and arrangement of these ciliary arteries may vary. Branches of the
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medially. This posterior medial angle causes the eye to roll with contraction of either the superior rectus muscle or the inferior rectus muscle. The extent of rolling in the recti is less than the oblique, and opposite from it.
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Below is a table of each extraocular muscle and their innervation, origins and insertions, and the primary actions of the muscles (the secondary and tertiary actions are also included, where applicable).
653:. There are three centers of growth that are important in the development of the eye, and each is associated with a nerve. Hence the subsequent nerve supply (innervation) of the eye muscles is from three
436:
375:, and this can be a voluntary or involuntary action. The other six extraocular muscles are involved in movements of the eye; these are the four recti (straight) muscles, and two oblique muscles.
40:
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muscle originates at the back of the orbit (a little closer to the medial rectus, though medial to it), getting rounder as it courses forward to a rigid, cartilaginous pulley, called the
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506:: the four recti muscles. The four recti muscles attach directly to the front half of the eye (anterior to the eye's equator), and are named after their straight paths.
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The oculomotor (III), troclear (IV) and abducens (VI) nerves supply the muscle of the eye. Damage will affect the movement of the eye in various ways, shown here.
657:. The development of the extraocular muscles is dependent on the normal development of the eye socket, while the formation of the ligament is fully independent.
633:
and medial recti, contraction of one leads to inhibition of the other. Muscles show small degrees of activity even when resting, keeping the muscles taut. This "
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440:
234:
445:
719:
eyes move together and almost involuntarily. This is a key factor in the study of strabismus, namely, the inability of the eyes to be directed to one point.
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Damage to the abducens nerve (VI) can also result in double vision. This is due to impairment in the lateral rectus muscle, supplied by the abducens nerve.
431:
457:
450:
449:
1180:
466:
1204:
486:
in the orbit. The extraocular muscle pulley system is fundamental to the movement of the eye muscles, in particular also to ensure conformity to
467:
453:
1276:
1081:) because the movements of the eyes are not synchronized. Abnormalities of visual movement may also be seen on examination, such as jittering (
210:
451:
452:
742:
that stabilizes gaze when the head is moved. The reflex involves compensatory eye movements driven by inhibitory and excitatory signals.
1145:
The initial clinical examination of the extraoccular eye muscles is done by examining the movement of the globe of the eye through the
1907:
726:
The muscles show little inertia - a shutdown of one muscle is not due to checking of the antagonist, so the motion is not ballistic.
1543:
Demer JL (March 2004). "Pivotal role of orbital connective tissues in binocular alignment and strabismus: the
Friedenwald lecture".
448:
441:
490:. Certain diseases of the pulleys (heterotopy, instability, and hindrance of the pulleys) cause particular patterns of incomitant
1692:
Talley, Nicholas J.; O'Connor, Simon (2018). "Chapter 32. The neurological examination: general signs and the cranial nerves".
482:
The movements of the extraocular muscles take place under the influence of a system of extraocular muscle pulleys, soft tissue
2224:
1846:
1788:
1758:
97:
77:
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2033:
981:
896:
855:
787:
458:
368:
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399:. The recti muscles are all of almost equal length of around 40 mm but the lengths of their associated tendons differ.
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Damage to the oculomotor nerve (III) can cause double vision and inability to coordinate the movements of both eyes (
2181:
1443:"Normal Anatomy and Anomalies of the Rectus Extraocular Muscles in Human: A Review of the Recent Data and Findings"
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301:. The actions of the six muscles responsible for eye movement depend on the position of the eye at the time of
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17:
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2008:
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345:
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Lewis SL, Heitkemper MM, Dirkson SR, O'Brien PG, Bucher L, Barry MA, Goldsworthy S, Goodridge D (2010).
1168:
502:
Four of the extraocular muscles have their origin in the back of the orbit in a fibrous ring called the
2229:
1243:
Schematic demonstrating the actions and cranial nerve innervation (in subscript) of extraocular muscles
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Dissection showing origins of right ocular muscles, and nerves entering by the superior orbital fissure
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are shown in this image of the left eye (lateral view). Click on the structures for more information.
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544:, a main branch of the ophthalmic artery. Additional branches of the ophthalmic artery include the
317:
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2015:
2003:
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Demer JL (April 2002). "The orbital pulley system: a revolution in concepts of orbital anatomy".
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Animations of extraocular cranial nerve and muscle function and damage (University of
Liverpool)
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Kels, Barry D.; Grzybowski, Andrzej; Grant-Kels, Jane M. (March 2015). "Human ocular anatomy".
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1993:
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Westheimer G, McKee SP (July 1975). "Visual acuity in the presence of retinal-image motion".
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The four recti muscles are named according to their relative positions of attachment – the
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540:. This is done either directly or indirectly, as in the lateral rectus muscle, via the
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Figure showing the mode of innervation of the Recti medialis and lateralis of the eye
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and other animals. Six of the extraocular muscles, the four recti muscles, and the
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1331:"Extrinsic eye muscle definition and meaning | Collins English Dictionary"
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650:
637:" activity is brought on by discharges of the motor nerve to the muscle.
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may affect the movement of the eye. Damage may result in double vision (
494:. Defective pulley functions can be improved by surgical interventions.
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1885:
1089:
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701:. The oculomotor nerve controls all muscles of the eye except for the
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1833:
Eldra Pearl
Solomon; Richard R. Schmidt; Peter James Adragna (1990).
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View of the orbit from the front, with nerves and extraocular muscles
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1753:(5. ed.). Appleton and Lange: McGraw Hill. pp. 1533–1549.
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Lateral and anterior views of the extraocular muscles also showing
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plays an important role in the involuntary movement of the eye.
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The extraocular muscles are supplied mainly by branches of the
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subject of continuing research. It is known, however, that the
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106:
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is weakness or paralysis of one or more extraocular muscles.
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provides sharp vision, the eye must move to follow a target.
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144:
1296:
Shumway, Caleb L.; Motlagh, Mahsaw; Wade, Matthew (2022).
1429:
Encyclopædia
Britannica 2006 Ultimate Reference Suite DVD
556:
supply the inferior rectus and inferior oblique muscles.
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110:
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Ludwig, Parker E.; Aslam, Sanah; Czyz, Craig N. (2024).
1354:
1696:(8th ed.). Chatswood: Elsevier. pp. 500–539.
1783:. Philadelphia, Pa.: Saunders Elsevier. p. 78.
649:(part of the ligaments) and the fatty tissue of the
1834:
1691:
1295:
1628:(2nd ed., rev. and enl. ed.). London: Pion.
1298:"Anatomy, Head and Neck, Eye Extraocular Muscles"
2216:
1721:(3rd ed.). Edinburgh: Mosby. p. 1303.
705:controlled by the trochlear nerve (IV), and the
1648:
1581:Ahmed HU (2002). "A case of mistaken muscles".
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351:Since only a small part of the eye called the
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1781:Netter's head and neck anatomy for dentistry
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1877:at the University of Michigan Health System
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1277:Sherrington's law of reciprocal innervation
645:The extraocular muscles develop along with
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1894:
1427:"eye, human."Encyclopædia Britannica from
1808:. Toronto: Elsevier Canada. p. 464.
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997:(posterior, inferior, lateral surface)
956:(posterior, superior, lateral surface)
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1717:Yanoff, Myron; Duker, Jay S. (2008).
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1392:"Anatomy, Head and Neck: Eye Muscles"
1174:Nerves of the orbit. Seen from above.
371:is responsible for raising the upper
598:Levator palpebrae superioris muscle
2034:Levator palpebrae superioris muscle
139:superior and inferior orbital veins
24:
1826:
1806:Medical-Surgical Nursing in Canada
1514:10.1111/j.1749-6632.2002.tb02805.x
1369:10.1016/j.clindermatol.2014.10.006
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27:Seven extrinsic muscles of the eye
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1267:Hering's law of equal innervation
1871:- "Extraocular Muscles, Actions"
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407:The two oblique muscles are the
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1841:. Saunders College Publishing.
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2199:Suspensory ligament of eyeball
1837:Human anatomy & physiology
1624:Carpenter, Roger H.S. (1988).
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640:
169:
13:
1:
1447:BioMed Research International
1282:
912:(anterior, inferior surface)
871:(anterior, superior surface)
2225:Muscles of the head and neck
2009:Trochlea of superior oblique
1751:Principles of neural science
1545:Invest. Ophthalmol. Vis. Sci
1018:Levator palpebrae superioris
836:(anterior, lateral surface)
369:levator palpebrae superioris
331:
292:levator palpebrae superioris
7:
1248:
803:(anterior, medial surface)
660:
187:musculi externi bulbi oculi
10:
2246:
1252:
1160:
1147:six cardinal eye movements
1134:
669:
425:
314:pupillary sphincter muscle
242:Anatomical terms of muscle
2157:
2112:Accessory lacrimal glands
2087:
2044:Medial palpebral ligament
2024:
1974:
1928:
1398:. StatPearls Publishing.
1335:www.collinsdictionary.com
1304:. StatPearls Publishing.
1141:Cranial nerve examination
1092:), also eyelid drooping (
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550:anterior ciliary arteries
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135:anterior ciliary arteries
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96:
76:
64:
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37:
32:
1749:Kandel, Eric R. (2013).
1595:10.1136/bmj.324.7343.962
745:
612:Superior oblique muscle
592:Inferior oblique muscle
548:, which branch into the
322:intrinsic ocular muscles
318:pupillary dilator muscle
290:. The other muscle, the
284:inferior oblique muscles
264:extrinsic ocular muscles
2016:Inferior oblique muscle
2004:Superior oblique muscle
736:vestibulo-ocular reflex
703:superior oblique muscle
586:Inferior rectus muscle
584:Superior rectus muscle
524:The last muscle is the
413:superior oblique muscle
409:inferior oblique muscle
362:vestibulo-ocular reflex
1989:Inferior rectus muscle
1984:Superior rectus muscle
1671:10.1364/josa.65.000847
1357:Clinics in Dermatology
1272:Park's three-step test
1255:anatomical terminology
1096:) and pupil dilation (
1070:
730:Compensatory movements
682:
626:Lateral rectus muscle
498:Origins and insertions
475:
397:inferior rectus muscle
385:superior rectus muscle
348:
1994:Lateral rectus muscle
1779:Norton, Neil (2007).
1626:Movements of the eyes
1068:
1061:Clinical significance
904:Common tendinous ring
863:Common tendinous ring
828:Common tendinous ring
795:Common tendinous ring
714:Movement coordination
707:lateral rectus muscle
679:
589:Medial rectus muscle
504:common tendinous ring
470:
389:lateral rectus muscle
342:common tendinous ring
339:
320:sometimes are called
83:Common tendinous ring
49:lateral rectus muscle
1999:Medial rectus muscle
1694:Clinical examination
1557:10.1167/iovs.03-0464
1494:Ann. N. Y. Acad. Sci
1460:10.1155/2019/8909162
393:medial rectus muscle
53:medial rectus muscle
2097:Lacrimal canaliculi
1875:Atlas image: eye_13
1663:1975JOSA...65..847W
1506:2002NYASA.956...17D
1441:Haładaj, R (2019).
1222:Extraocular muscles
554:infraorbital artery
472:Extraocular muscles
326:intraocular muscles
288:movement of the eye
260:extraocular muscles
131:infraorbital artery
33:Extraocular muscles
2089:Lacrimal apparatus
1551:(3): 729–38, 728.
1253:This article uses
1117:is a condition of
1071:
683:
651:eye socket (orbit)
476:
349:
303:muscle contraction
2230:Human eye anatomy
2212:
2211:
2182:Plica semilunaris
2149:Nasolacrimal duct
2102:Lacrimal caruncle
2069:Palpebral fissure
1848:978-0-03-011914-9
1790:978-1-929007-88-2
1760:978-0-07-139011-8
1058:
1057:
984:(inferior branch)
982:Oculomotor nerve
899:(inferior branch)
897:Oculomotor nerve
858:(superior branch)
856:Oculomotor nerve
790:(inferior branch)
788:Oculomotor nerve
774:Secondary action
630:
629:
575:Oculomotor nerve
538:ophthalmic artery
480:
479:
268:extrinsic muscles
256:
255:
251:
123:Ophthalmic artery
16:(Redirected from
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2139:Lacrimal punctum
2134:Lacrimal papilla
2122:Ciaccio's glands
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1125:Ophthalmoparesis
1023:Oculomotor nerve
977:Inferior oblique
933:Superior oblique
777:Tertiary action
754:
753:
697:(VI) coordinate
687:oculomotor nerve
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608:
603:Trochlear nerve
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546:ciliary arteries
526:inferior oblique
515:superior oblique
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266:, are the seven
248:edit on Wikidata
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2054:Meibomian gland
2049:Epicanthic fold
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1262:ALS#Late stages
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1137:Eye examination
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1119:diminshed sight
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938:Trochlear nerve
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892:Inferior rectus
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851:Superior rectus
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771:Primary action
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691:trochlear nerve
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647:Tenon's capsule
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617:Abducens nerve
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542:lacrimal artery
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403:Oblique muscles
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127:lacrimal artery
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2107:Lacrimal gland
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1996:
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1986:
1980:
1978:
1972:
1971:
1969:
1968:
1963:
1958:
1953:
1948:
1946:Maxillary bone
1943:
1941:Zygomatic bone
1938:
1932:
1930:
1926:
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1913:
1912:
1905:
1898:
1890:
1884:
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1857:External links
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1113:also known as
1075:cranial nerves
1073:Damage to the
1062:
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823:Abducens nerve
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670:Main article:
667:
664:
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2129:Lacrimal lake
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2079:Gland of Zeis
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1966:Lacrimal bone
1964:
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783:Medial rectus
781:
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776:
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764:
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516:
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489:
488:Listing's law
485:
473:
429:
424:
419:Pulley system
416:
414:
410:
400:
398:
394:
390:
386:
379:Recti muscles
376:
374:
370:
365:
363:
358:
357:Eye movements
354:
347:
343:
338:
329:
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315:
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136:
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115:
112:
108:
104:
101:
99:
95:
92:
91:sphenoid bone
88:
84:
81:
79:
75:
72:
71:Visual system
69:
67:
63:
58:
54:
50:
46:
41:
36:
31:
19:
18:Recti muscles
2144:Lacrimal sac
1975:
1956:Ethmoid bone
1936:Frontal bone
1862:
1836:
1805:
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1687:
1654:
1651:J Opt Soc Am
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1500:(1): 17–32.
1497:
1493:
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1350:
1338:. Retrieved
1334:
1325:
1313:. Retrieved
1301:
1291:
1155:
1150:
1146:
1144:
1123:
1121:in one eye.
1114:
1109:
1106:
1102:
1087:
1072:
1048:upper eyelid
1045:
1044:/retraction
1033:Tarsal plate
749:
733:
725:
721:
717:
699:eye movement
684:
672:Eye movement
666:Eye movement
644:
631:
591:
588:
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560:Nerve supply
535:
532:Blood supply
525:
523:
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512:
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481:
471:
406:
382:
366:
350:
307:
263:
259:
257:
211:A04.1.01.001
186:
103:Tarsal plate
2177:Conjunctiva
1453:: 8909162.
1151:convergence
1131:Examination
761:Innervation
641:Development
344:origin and
294:, controls
176:Identifiers
2219:Categories
2194:Periorbita
1396:StatPearls
1315:12 January
1302:StatPearls
1283:References
1135:See also:
1090:strabismus
965:Depression
916:Depression
768:Insertion
492:strabismus
286:, control
150:Oculomotor
1869:eMedicine
1864:neuro/637
1603:0959-8138
1111:Amblyopia
1098:mydriasis
1083:nystagmus
1042:Elevation
1035:of upper
1011:Abduction
1006:Elevation
970:Abduction
926:Adduction
885:Adduction
875:Elevation
840:Abduction
807:Adduction
693:(IV) and
332:Structure
299:elevation
170:See table
154:trochlear
105:of upper
98:Insertion
87:maxillary
1611:71166629
1565:14985282
1530:28173133
1522:11960790
1479:31976329
1404:29262013
1377:25704934
1310:30137849
1249:See also
1115:lazy eye
1079:diplopia
948:Trochlea
946:via the
661:Function
519:trochlea
411:and the
346:trochlea
280:superior
47:showing
45:MRI scan
2170:Unibrow
2165:Eyebrow
2074:Canthus
2064:Eyelash
1976:Muscles
1920:of the
1679:1142031
1659:Bibcode
1502:Bibcode
1470:6954479
1161:Gallery
1046:of the
765:Origin
757:Muscle
689:(III),
570:Muscle
484:pulleys
270:of the
199:D009801
165:Actions
60:Details
2039:Tarsus
2026:Eyelid
1845:
1812:
1787:
1757:
1725:
1700:
1677:
1632:
1609:
1601:
1563:
1528:
1520:
1477:
1467:
1402:
1375:
1308:
1094:ptosis
1037:eyelid
740:reflex
579:N. III
395:, and
373:eyelid
296:eyelid
276:humans
118:Artery
107:eyelid
78:Origin
66:System
2158:Other
1929:Bones
1918:orbit
1607:S2CID
1526:S2CID
1340:7 May
746:Table
738:is a
681:eyes.
635:tonic
621:N. VI
607:N. IV
353:fovea
262:, or
246:[
235:49033
182:Latin
145:Nerve
1916:The
1843:ISBN
1810:ISBN
1785:ISBN
1755:ISBN
1723:ISBN
1698:ISBN
1675:PMID
1630:ISBN
1599:ISSN
1561:PMID
1518:PMID
1475:PMID
1451:2019
1431:2009
1400:PMID
1373:PMID
1342:2021
1317:2022
1306:PMID
1139:and
734:The
685:The
513:The
367:The
316:and
308:The
282:and
258:The
223:2041
206:TA98
194:MeSH
156:and
89:and
51:and
1922:eye
1867:at
1667:doi
1591:doi
1587:324
1583:BMJ
1553:doi
1510:doi
1498:956
1465:PMC
1455:doi
1365:doi
1085:).
994:Eye
953:Eye
909:Eye
868:Eye
833:Eye
800:Eye
324:or
274:in
272:eye
230:FMA
218:TA2
111:eye
2221::
1769:^
1737:^
1673:.
1665:.
1655:65
1653:.
1605:.
1597:.
1585:.
1573:^
1559:.
1549:45
1547:.
1524:.
1516:.
1508:.
1496:.
1473:.
1463:.
1449:.
1445:.
1412:^
1394:.
1371:.
1361:33
1359:.
1333:.
1300:.
623:)
609:)
581:)
415:.
391:,
387:,
328:.
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152:,
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109:,
85:,
1909:e
1902:t
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1669::
1661::
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1593::
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1512::
1504::
1481:.
1457::
1406:.
1379:.
1367::
1344:.
1319:.
1257:.
619:(
605:(
577:(
250:]
20:)
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