The lecture has been given on Apr. 11th, 2011 by Dr. Tara.

2. Anatomy of the eye muscles The extraocular muscles rotate the eyes about three axes to produce vertical (elevation and depression), horizontal (adduction and abduction), and rotational (intorsion and extorsion) movement. The horizontal recti produce purely horizontal movements; the vertical recti and the obliques have vertical, rotational, and horizontal actions. Their principal effect depends upon the horizontal position of the eye in the orbit, and therefore varies with gaze position.

9. All four recti and superior oblique have their origin at the apex of the orbit, while inferior oblique has its origin at the nasal end of the anterior orbital floor. The recti insert anterior to the equator, at 7.5 mm (superior), 7.0 mm (lateral), 6.5 mm (inferior), and 5.5 mm (medial) behind the limbus.

10. The obliques insert behind the equator; the insertion of the superior oblique tendon lies along the lateral border of superior rectus, having been reflected through the pulley of the trochlea at the anterior nasal orbital roof, and the insertion of inferior oblique lies external to the macula. The superior oblique tendon passes beneath the superior rectus, and the inferior oblique passes beneath the inferior rectus.

12. Horizontal movements (adduction and abduction) are produced by contractions of medial rectus (MR) and lateral rectus (LR) muscles

13. Nerve supply of EOM Superior oblique by 4th cranial nerve (trochlear N.) Lateral rectus by 6th cranial nerve (abducent N. ) Others by 3rd cranial nerve (oculomotor N.) (LR6SO4)3 Eye movements Horizontal ductions The horizontal recti are mainly responsible for adduction and abduction. vertical ductions The vertical recti act as pure elevators and depressors in abduction. Torsion The superior rectus and superior oblique act as intortors, and the inferior rectus and inferior oblique act as extortors.

14. Disorders of ocular motility The direction of the visual axis of each eye towards a fixation point is co-ordinated by the action of the extraocular muscles. Strabismus (squint): is a failure of the co-ordination of binocular alignment. It leads inevitably to loss of binocular single vision. Fusion of the two images is replaced either by diplopia or suppression of one image. Strabismus may be caused by orbit, muscle, motor nerve, or brainstem pathology. Primary position Gaze straight ahead, with the visual axes parallel.

17. Heterotropia Manifest deviation i.e. failure of the visual axes to meet at the fixation point. Manifest covergent squint is described as esotropia, and manifest divergent squint as exotropia. Vertical squint is hypertropia and hypotropia. Incomitant(Paralytic) Variable angle of squint, according to gaze direction, paralytic squint is incomitant. Concomitant(Non-paralytic) Constant angle of deviation irrespective of the direction of gaze (non-paralytic). Heterophoria Latent deviation, i.e. failure of the visual axes to meet at the fixation point when they are dissociated e.g. by monocular occlusion. Latent convergent and divergent squint are, respectively, esophoria and exophoria.

18. Assessment of ocular motility disorder The extraocular muscle or muscles whose underaction, overaction, or restriction has led to ocular motor imbalance. The binocular sensory status, including any compensation which occurred (suppression or abnormal retinal correspondence). Muscle imbalance Weakness of any of the 12 EOM causes diplopia which is maximal in the field of action of that muscle. Two muscles are active in any cardinal position; the paretic muscle is identified by finding the position in which diplopia is maximal. Binocular vision: describes the quality of simultaneous perception by the two eyes of an object in visual space.

22. Pseudosquint(apparent squint). Epicanthal folds

27. Paralytic (non commitant, incomitant)squint; or strabismus Abducent nerve palsy.

31. Esotropia congenital AGE OF ONSET AT BIRTH OR SHORTLY AFTER

34. CORRECTION OF ACCOMODATIVE SQUINT BY GLASSES & TREATMENT OF AMBLIOPIA BY PATCHING SO BOTH EYE NOW HAVE GOOG VISUAL ACUITY AND NORMAL ALIGNED

38. 1-Childhood-Onset Exotropia

42. EXODEVEATION (EXOTROPIA) ALTERNATING WHEN FIXATE WITH THE RIGHT EYE THE LEFT DEVIATED & VISE VERSA, BOTH EYES NOT COOPERATE TOGETHER TO FORM SINGLE IMAGE(NO BINOCULAR SINGLE VISION-BSV)

44. EXODEVEATION (EXOTROPIA )SENSORY DEPRIVATION=POOR SEEING EYE

47. Complication of strabismus is Amblyopia Treatment of amblyopic eye. (lazy eye) Patching of normal eye

48. Causes of acquired ocular motility disorder Neurogenic (ocular motor nerve lesion): Vascular (diabetes or hypertention). Demyelinating (multiple sclerosis). Inflammatory Compressive (aneurysm or tumour) Trauma or surgery . Myogenic Myasthenia gravis Ocular myopathy Restriction Dysthyroid ophthalmopathy Trauma Inflammation Orbital Orbital mass restricting eye movement