This document summarizes ocular movements. It describes both monocular movements including elevation, depression, adduction, abduction, intorsion and extortion as well as binocular movements including version and vergence. The primary, secondary and tertiary positions of gaze are defined. The document also outlines the laws of ocular motility including Sherrington's law of reciprocal innervation, Herring's law of equal innervation, Donder's law, and Listing's law. Finally, the clinical significance of understanding ocular movements is discussed through examples such as Brown syndrome and congenital fibrosis of the extraocular muscles.

1. OCULAR MOVEMENTS
By: Denis Kamara
MURHEC - MUST

2. Overview of Ocular Movements
Monocular
 Adduction
 Abduction
 Elevation
 Depression
 Intorsion
 extortion
Binocular
 Version
 Vergence
Laws of ocular
motility
Clinical
Significance
2

4. Monocular Movements
1. Elevation
2. Depression
3. Adduction
4. Abduction
5. Intorsion
6. Extortion
4
X- axis
Z- axis
Y-
axis/AP
LISTING
PLANE

6. Monocular Movements

7. Binocular Movements
A)Version (conjugate )
 Secondary & Tertiary positions
of gaze
B)Vergences (disconjugate )
 Convergence: BE moving
nasally or inward
 Divergence: BE moving
temporally or outward
 Secondary positions of
gaze
1. Supraversion
2. Infraversion
3. Dextroversion
4. Levoversion
 Tertiary positions of
gaze
1. Dextroelevation
2. Dextrodepression
3. Levoelevation
4. Levodepression
7

8. Binocular Movements
8

9. Binocular Movement
Gazes
PRIMARY POSITION (E); SECONDARY POSITIONS (B, D, F, H); TERTIARY
POSITIONS (A, C, G, I); CARDINAL POSITIONS (A, C, D, F, G, I).

10. Gazes

11. CARDINAL POSITIONS

12. TYPES OF CONVERGENCE
A. Reflex
i. Tonic
ii. Proximal
iii. Fusional
iv. Accommodative
B. Voluntary

13. Convergence Reflex

14. Laws of Ocular Motility
1. Sherrington’s law
2. Herring’s law
3. Donder’s law
4. Listing’s law

15. Laws of Ocular Motility
1. Sherrington’s law of reciprocal
innervation
 During ocular motility increased flow of
innervation to the contracting muscle (agonist)
is accompanied by decreased flow of
innervation to the relaxing antagonist muscle
2. Herring’s law of equal innervation
 Equal and simultaneous innervation flows from
the brain to a pair of muscles which contract
simultaneously (yoke muscles) in different
binocular movements
15

16. Sherrington’s law of
reciprocal innervation

17. Herring’s law of equal
innervation

18. Laws of Ocular Motility
3.Donder’s law
 Donder stated that each position of line of sight
belongs to the definite orientation of vertical and
horizontal retinal meridian relative to the
coordinate of the space.
 Orientation of retinal meridian is always same
irrespective of the path the eye has taken to reach
that position and depends upon the amount of
elevation or depression and lateral rotation of the
globe, after returning to the initial position the
retinal meridian is oriented exactly as it was
before the movement was initiated

19. Laws of Ocular Motility
4.Listing’s law
 States that each
movement of the eye
from the primary
position to any other
position involves a
rotation around a
single axis lying in
the equatorial plane
,also called as
listing’s plane

20. Laws of Ocular Motility

21. Clinical Significance

27. Brown syndrome
mechanical restriction

28. Congenital fibrosis of the
extraocular muscles
(CFEOM) is a rare
non-progressive
Characterized by
bilateral ptosis and
restrictive external
ophthalmoplegia

29. Strabismus fixus
Very rare condition in
which both eyes are
fixed by fibrous
tightening of the
medial recti
(convergent
strabismus fixus)
Or lateral recti
(divergent strabismus
fixus )

30. Monocular elevator deficit
Tight or contracted
inferior rectus
muscle or a
hypoplastic or
ineffective superior
rectus muscle.
(A) Defective
elevation in
abduction; (b) in
upgaze; (c) and in
adduction

31. ANATOMICAL LANDMARK WHEN
PERFORMING SURGERY

32. THANKS

33. REFFERENCES
1. Wolff’s anatomy of the Eye and Orbit 8th
Edition.
2. Anatomy and Physiology of the Eye, A K
Khurana.
3. Clinical Ophthalmology, A systemic approach
by Jack. J Kanski and Brad Bowling
4. Online Articles……………….