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Extra Ocular Motility @Farhana.Islam

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Extra Ocular Motility @Farhana.Islam

  1. 1. Farhana Adnin B.Optom,4th Batch ICO,CU Extra Ocular Muscles ORIGIN-INSERTION ACTION,NERVE SUPPLY
  2. 2. What is EOM . . . ???
  3. 3. ∗ There are 2 types of muscles ~ ∗ 4 Recti muscles ~Superior rectus (SR) ~Inferior rectus (IR) ~Medial rectus (MR) ~Lateral rectus (LR) ∗ 2 Oblique muscles ~Superior oblique (SO) ~Inferior oblique (IO) 6 muscles . . .
  4. 4. annulus of zinn Schematic diagram . . .
  5. 5. Common tendinous ring of zinn
  6. 6. Recti muscles Origin Insertion Nerve supply SR Superior part of common tendinous ring of zinn sclera through the tendon about 7.7mm posterior to limbus. 3rd nerve(oculomotor ) IR inferior part of common tendinous ring of zinn. sclera through the tendon about 6.5mm posterior to limbus. 3rd nerve (oculomotor ) LR Lateral part of common tendinous ring of zinn. sclera through the tendon about 6.9 mm posterior to limbus. 6th nerve (abducent) MR Medial part of common tendinous ring of zinn. sclera through the tendon about 5.5mm posterior to limbus. 3rd nerve (oculomotor )
  7. 7. Cont…
  8. 8. Oblique muscles Origin Insertion Nerve supply SO At the apex of the orbit From body of sphenoid Above & medial to the optic foramen By a narrow tendon. Behind the equator in the sclera 4th nerve (trochlear nerve)
  9. 9. Oblique muscles ORIGIN INSERTION NERVE SUPPLY IO Arises by a rounded tendon From a shallow depression On the orbital plate of maxilla Just lateral to the orifice of the naso lacrimal duct. Behind the equator ,in the lower & outer part of sclera,in temporal side, by a short tendon. 3rd nerve(oculomo tor nerve)
  10. 10. Nerve supply…(SO4LR6)~REST 3
  11. 11. ∗MR:Medial muscular branch of ophthalmic artery+Lacrimal artery ∗IR & IO :Medial muscular branch of ophthalmic artery + Infra orbital artery ∗LR,SR,SO: Lateral muscular branch BLOOD SUPPLY…
  12. 12. MUSCLES PRIMARY SECONDARY TERTIARY SR Elevation Intorsion Adduction IR Depression Extortion Adduction LR Abduction MR Adduction SO Intorsion Depression Abduction IO Extorsion Elevation Abduction ACTIONS . . .
  13. 13. CONT…
  14. 14. Fick’s axis ∗ Z Fick’s law : 3 axes are perpendicular to each other & intersect at the centre of rotation.
  15. 15. ∗ A hypothetical point around which the eyeball performs rotatory movements centre of rotation Centre of rotation
  16. 16. Describes 3 axes- ∗ 1) X (horizontal) axis. ∗ 2)Y (antero-posterior)axis. ∗ 3)Z (vertical) axis. Fick’s law
  17. 17. Ocular movements… ∗ Monocular movement:-Duction ∗ Binocular movement:-Version -Vergence
  18. 18. ∗1)Duction: the movement of one eye ∗ Abduction ∗ Adduction ∗ Supraduction or elevation ∗ Infraduction or depression ∗ Incycloduction or intorsion ∗ Excycloduction or extorsion Ocular movements…
  19. 19. Duction…
  20. 20. ∗ 2)Version: the movement of two eyes in the same direction 1)Dextroversion 2)Levoversion 3)Supraversion 4)Infraversion 5)Dextroelevation 6)Dextrodepression 7)Levoelevation 8)Levodepression 9)Dextrocycloversion 10)Levocycloversion Cont…
  21. 21. Version…
  22. 22. Diagnostic positions of gaze… 2 1 2 2 2 3 3 3 3
  23. 23. ∗3)Vergence: the movement of two eyes in opposite directions ∗ Convergence ∗ Divergence Cont…
  24. 24. Vergence….
  25. 25. Terminology of Ocular Motility ∗ Agonist ∗ Any particular EOM producing a specific ocular movement.e.g for abduction LR in right eye. ∗ Synergist ∗ Two muscles moving an eye in the same direction ∗ E.g– SR / IO - Synergist for elevation movement
  26. 26. ∗ Antagonist ∗ The muscles having opposite action in the same eye ∗ Example – medial and lateral rectus Cont…
  27. 27. • Yoke muscle (Contralateral synergists) a pair of muscle one in each eye which contract simultaneously during version movement • Pairs for six cardinal positions of gaze • Dextroversion – RLR- LMR • Levoversion – LLR- RMR • Dextroelevation – RSR-LIO • Levoelevation – LSR- RIO • Dextrodepression – RIR-LSO • Levodepression –LIR-RSO Cont…
  28. 28. • Contralateral Antagonist a pair of muscles, one in each eye having opposite action eg. RLR & LLR. Cont..
  29. 29. Hering’s Law An equal and simultaneous innervation flows from brain to a pair of muscle of both eyes which contracts simultaneously in different binocular movements. Laws of EOM Movements
  30. 30. Clinical Significance: 1. Secondary deviation > > Primary deviation 2. Inhibition palsy of the contralateral antagonist
  31. 31. Sherrington’s Law During eye movement an increased flow of innervations to the contracting agonist muscle is accompanied by an equal and simultaneous decreased flow of innervations to the relaxing antagonist muscle Cont…
  32. 32. ∗ 1.During dextroversion, an increased flow to the right LR & left MR is accompanied by a decreased flow to the right MR & left LR muscles. ∗ 2. Example:
  33. 33. ∗Donder's Law For each tertiary position, there is one and only one orientation of the vertical and horizontal meridians of retina. There is no rotation around the antero-posterior (Y) axis. (no torsion or twist occur). ∗ The eye reaches all tertiary position without movement around the Y axis. ∗ The eye always returns to the same orientation from which it started.
  34. 34. Cont…
  35. 35. ∗ Anatomy & Physiology of Eye by A.K.Khurana ∗ Binocular vision & Ocular motility by Gunter K.Von Noorden ∗ Internet References…
  36. 36. THANK YOU FOR YOUR ATTENTION …

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