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Sideslip of the Medial Rectus Muscle during Vertical Eye Rotation

¹From the The Smith-Kettlewell Eye Research Institute, San Francisco, California; the ²Department of Neurology, Seoul National University, Seoul, South Korea; and the ³Bay Imaging Consultants, Berkeley, California.

PURPOSE. The kinematics of eye rotation is not entirely elucidated despite two centuries of fascination with the deceptively simple yet geometrically complex nature of the movement. Recently, the traditional view that oculorotatory muscles except the superior oblique muscle exert straight pull on the globe has been challenged by the claim that the muscles also go through a connective tissue pulley-like structure that holds them steady during eye rotation. Although earlier studies failed to observe sideslippage at the posterior part of muscles, a finding supportive of the pulley hypothesis, the conclusions should not be taken as conclusive given short-comings in the techniques used in the studies.

METHODS. The authors developed a novel method of image analysis to improve spatial resolution and applied the method for investigating the medial rectus muscle, the entire length of which can easily be identified in magnetic resonance images.

RESULTS. Contrary to previous reports, vertical sideslippage was observed at the posterior part of the muscle during vertical eye rotation between two tertiary eye positions. Furthermore, the sideslip varied as a function of horizontal eye position, in accordance with the half-angle rule of Listing’s law.

CONCLUSIONS. These findings are more consistent with the traditional view of the restrained shortest-path model than with the pulley model and have further implications for basic and clinical understanding of ocular kinematics.