The lacrimal apparatus is the physiological system containing the orbital structures for tear production and drainage. It consists of: The lacrimal gland, which secretes the tears, and its excretory ducts, which convey the fluid to the surface of the human eye;it is a serous gland located in lacrimal fossa.
The lacrimal apparatus is the physiological system containing the orbital structures for tear production and drainage. It consists of: The lacrimal gland, which secretes the tears, and its excretory ducts, which convey the fluid to the surface of the human eye;it is a serous gland located in lacrimal fossa.
1. Introduction Gross anatomy Layers Blood supply, drainage and nerve supply
2. INTRODUCTION • Sclera forms posterior 5/6th of external tunic , connective tissue coat of eyeball. • it continues with duramater and cornea • Its whole surface covered by tenon’s capsule • Anteriorly covered by- bulbar conjunctiva • Inner surface lies in contact with choroid • With a potential suprachoroidal space in between
3. Equa THICKNESS OF SCLERA
4. • Thickness varies with individual, with age • Thinner- children, elder, F> M • Thickest posteriorly • Gradually becomes thinner when traced anteriorly • Thin at insertion of extraocular muscle
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
ANATOMY AND PHYSIOLOGY OF EXTRAOCULAR MUSCLES.pptANUJA DHAKAL
The presentation begins with an overview of the extraocular muscles, highlighting their crucial role in controlling eye movements and maintaining proper vision. Emphasized the significance of these muscles in daily activities and visual perception.
1. Introduction Gross anatomy Layers Blood supply, drainage and nerve supply
2. INTRODUCTION • Sclera forms posterior 5/6th of external tunic , connective tissue coat of eyeball. • it continues with duramater and cornea • Its whole surface covered by tenon’s capsule • Anteriorly covered by- bulbar conjunctiva • Inner surface lies in contact with choroid • With a potential suprachoroidal space in between
3. Equa THICKNESS OF SCLERA
4. • Thickness varies with individual, with age • Thinner- children, elder, F> M • Thickest posteriorly • Gradually becomes thinner when traced anteriorly • Thin at insertion of extraocular muscle
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
ANATOMY AND PHYSIOLOGY OF EXTRAOCULAR MUSCLES.pptANUJA DHAKAL
The presentation begins with an overview of the extraocular muscles, highlighting their crucial role in controlling eye movements and maintaining proper vision. Emphasized the significance of these muscles in daily activities and visual perception.
2. Introduction Muscles of the eye gives support and mainly involves in the movement of the eye and provides better visual system. It has two types: intraocular and extra ocular muscles 2/13/2016 2Muscles of the eye Gives astonished look Closing of the eye
3. Intraocular muscles Ciliary muscles -helps in accommodation Sphincter pupillae -constricts pupil Dilater pupillae -Dilates pupil IOM changes shape of lens and size of pupil. 2/13/2016 3Muscles of the eye
4. Extraocular muscles(EOM) EOM Oblique muscles Superior oblique Inferior oblique Recti muscles Superior rectus Inferior rectus Medial rectus Lateral rectus LPS 2/13/2016 4Muscles of the eye
5. EOM ORIGIN NERVE SUPPLY Superior rectus Annulus of zinn Occulomotor nerve Inferior rectus Annulus of zinn Occulomotor nerve Lateral rectus Annulus of zinn Abducent nerve Medial rectus Annulus of zinn Occulomotor nerve Superior oblique Annulus of zinn via trochlea Trochlear nerve Inferior oblique Maxillary bone Occulomotor nerve Levator palpebral superiosis Sphenoid bone Occulomotor nerve 2/13/2016 5Muscles of the eye
6. 2/13/2016 6Muscles of the eye
7. Blood supply Arteries: Ophthalmic artery(medial and lateral branch), Lacrimal artery,anterior ciliary arteries Veins: superior and inferior orbital veins 2/13/2016 7Muscles of the eye
8. Insertion The Recti muscles are inserted into the sclera at the different distances from the limbus forming spiral called Spiral of Tillaux 2/13/2016 8Muscles of the eye
9. Actions of Muscles of the eye Muscles of eye Functions Orbicularis oculli closes the eye LPS elevates the upper lid Superior rectus Moves up and in Inferior rectus Moves down and in Lateral rectus Abduction Medial rectus adduction Superior oblique Eye moves down and out Inferior oblique Eye moves up and out 2/13/2016 9Muscles of the eye
10. 2/13/2016 10Muscles of the eye
11. Fig: Monocular movements of the eye Muscles of the eye
12.Muscles of the eye 12 Fig: Binocular movements of the eye
13. Disorders Amblyopia- partial loss of vision in one or both eye Diplopia- perception of two images from single object Strabismus-misalignment of visual axes of two eyes. Nystagmus- involuntary movement of the eyeballMuscles of the eye
Extraocular musles(EOM) They are six in number Four recti: Superior rectus Inferior rectus Medial rectus Lateral rectus Two oblique muscles: Superior oblique Inferior oblique
3. SUPERIOR RECTUS MUSCLE . Origin Superior part of common annular tendon of Zinn Course Passes anterolaterally beneath the levator At 23 degrees with the globe ‘s AP axis Pierces Tenon s capsule Insertion into sclera by flat tendinous 10 mm broad insertion 7.7 mm behind sclero-corneal junction. 42 mm long 9 mm wide
4. Nerve supply Sup division of 3rd N Blood Supply Lateral Muscular br. of Ophthalmic A APPLIED: SR loosely bound to LPS muscle. • During SR resection- eyelid may be pulled forward narr owing palpebral fissure • In hypotropia pseudoptosis may be present Origin of SR and MR are closely attached to the dural sheat h of the optic nerve pain during upward & inward movements of the globe in RETROBULBAR NEURITIS
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
4. INTRODUCTION
• The extraocular muscles are located within the orbit,
but are extrinsic and separate from the eyeball
itself. They act to control the movements of
the eyeball and the superior eyelid.
• There are seven extraocular muscles –
1. Levator Palpebrae Superioris
2. Superior Rectus
3. Inferior Rectus
4. Medial Rectus
5. Lateral Rectus
6. Inferior Oblique
7. Superior Oblique.
5.
6. TYPES
• Functionally, they can be divided into two
groups:
1. Responsible for eye movement:
Recti Muscles
Oblique Muscles.
2. Responsible for superior eyelid Elevation:
Levator Palpebrae Superioris
7. MUSCLES OF EYE
MOVEMENT
• There are six muscles involved in the control of
the eyeball itself. They can be divided into two
groups:
• The Four Recti Muscles,
• The Two Oblique Muscles.
8. RECTI MUSCLES
• The name recti is derived from the latin for
‘straight’ – this represents the fact that the recti
muscles have direct path from origin to
attachment. This is in contrast with the oblique
eye muscles, which have an angular approach to
the eyeball.
9. RECTI MUSCLES
• There are four recti muscles;
1. Superior Rectus
2. Inferior Rectus
3. Medial Rectus
4. Lateral Rectus
10. ANNULUS OF ZINN
• The four recti muscles arise from a short funnel-shaped tendinous
ring called the annulus of Zinn. The annulus of Zinn encloses the
optic foramen and a part of the medial end of the superior orbital
fissure.
• There are 2 tendons.
• The Lower Tendon (of Zinn) is attached to the inferior root of
the lesser wing of the sphenoid between the optic foramen and the
superior orbital fissure. The lower tendon gives origin to part of the
medial and lateral recti and all of the inferior rectus.
• The Upper Tendon (of Lockwood) arises from the body of the
sphenoid, and gives origin to part of the medial and lateral recti and
all of the superior rectus muscle. The superior and medial recti
muscles are much more closely attached to the dural sheath of the
optic nerve. This fact may be responsible for the characteristic pain
which accompanies extreme eye movements in retro-bulbar
neuritis.
11. RECTUS MUSCLES : ORIGIN
• Arises from a common
tendinous ring knows as
ANNULUS OF ZINN
• Common ring of connective
tissue
• Anterior to optic foramen
• Forms a muscle cone
12.
13.
14.
15. SPIRAL OF TILLAUX
• This is the “spiral” that describes the insertion of
the rectus muscles in relation to the limbus. The
average values are medial=5.5mm, inferior=6.5,
lateral=6.9mm, and superior=7.7mm. In the OR,
however, I just remember “5,6,7,8.
19. SUPERIOR RECTUS
• Origin – The superior rectus arises from the upper
part of the annulus of Zinn above and to the lateral
side of the optic foramen and from the sheath of the
optic nerve. This origin lies below that of the levator,
and is continuous on the medial side with the medial
rectus and on the lateral with the lateral rectus.
• Insertion – inserted superiorly, in vertical
meridian 7.7 mm from limbus
• Blood supply – Superior muscular branch of
ophthalmic artery and 2 anterior ciliary a.
• Size – 41.8 mm long; tendon is 5.8 mm long and
10.6 mm wide
20.
21.
22. SUPERIOR RECTUS
• Relations– Above the superior rectus is the levator and
the frontal nerve, which separate it from the roof of the
orbit. Below is the optic nerve, but separated by orbital
fat, the ophthalmic artery, and the naso-ciliary nerve.
Farther forwards the reflected tendon of the superior
oblique passes beneath the superior rectus to reach its
insertion. Laterally, in the angle between superior and
lateral recti, are found the lacrimal artery and
nerve.Medially,the ophthalmic artery and naso-ciliary
nerve lie in the angle between the superior rectus and the
medial rectus and superior oblique muscles.
• Innervation – The superior rectus is supplied by the
superior division of the oculomotor (3rd cranial), which
enters the under-surface of the muscle at the junction of
the middle and posterior thirds.
23.
24. INFERIOR RECTUS
• It is shortest of the recti muscles.
• Origin–It arises below the optic foramen, from the
middle slip of the lower common tendon of the annulus
of Zinn at the apex of the orbit.
• Insertion– inserted inferiorly, in vertical meridian
about 6.5 mm from the limbus. The inferior rectus is also
attached to the lower lid by means of the fascial
expansion of its sheath.
• Blood supply – the inferior muscular branch of
ophthalmic artery and infraorbital artery, 2 anterior
ciliary vessels
• Size – 40 mm long; tendon is 5.5 mm long and 9.8 mm
wide
25.
26. INFERIOR RECTUS
• Relations– Inferior division of the 3rd nerve lies above
the muscle, and the optic nerve is separated by orbital
fat, and the globe of the eye. Lateral – The nerve to the
inferior oblique runs in front of the lateral border of the
inferior rectus between it and the lateral rectus. Below is
the floor of the orbit, roofing the maxillary sinus. The
muscle is in contact with the orbital process of the
palatine bone, but more anteriorly it is separated by
orbital fat from the orbital plate of the maxilla.
• Innervation– The inferior rectus is supplied by the
inferior division of the 3rd nerve, which enters it on its
upper aspect at about the junction of the middle and
posterior thirds.
27.
28. MEDIAL RECTUS
• It is largest of the ocular muscles and stronger than the
lateral.
• Origin- The medial rectus muscle, (number 2 in the picture)
arises from the annulus of Zinn. It has a wide origin to the
medial side of and below the optic foramen from both parts of
the common tendon, and from the sheath of the optic nerve.
• Insertion – The medial rectus inserts medially, in the
horizontal meridian about 5.5 mm from the limbus.
• Blood supply – The medial rectus is supplied by the inferior
muscular branch of ophthalmic artery and 2 anterior ciliary
arteries.
Size – The medial rectus muscle is 40.8 mm long; tendon is
3.7 mm long and 10.3 mm wide.
29. MEDIAL RECTUS
• Relationships– Above the medial rectus lies the
superior oblique. The ophthalmic artery and its anterior
and posterior ethmoidal branches and the posterior
ethmoidal, anterior ethmoidal and infratrochlear nerves
run between the medial rectus and superior oblique
muscles. Below the medial rectus is the orbital floor.
Medial to the rectus is orbital fat, separating it from the
orbital plate of the ethmoid (ethmoid air cells). Laterally
is the central orbital fat.
• Innervation– The inferior division of the 3rd nerve
innervates the medial rectus on its lateral surface at
about the junction of its middle and posterior thirds.
30.
31. LATERAL RECTUS
• Origin – arises from the annulus of Zinn and spans the
superior orbital.
• Insertion – inserted laterally, in horizontal meridian 6.9 mm
from the limbus
• Blood supply – the lacrimal artery (the only rectus muscle
with a single blood supply a common board question!)
• Size – 40.6 mm long; tendon is 8 mm long and 9.2 mm wide.
The lateral or external rectus arises from both the lower and
upper parts of the common tendon from those portions which
bridge the superior orbital (sphenoidal) fissure.The origin is
said to assume form of the letter U placed so that the opening
faces the optic foramen, the limbs of the U being referred to as
the upper and lower heads of the muscle.
32. LATERAL RECTUS
• Relations– The structures which go through the two
heads of the lateral rectus, within the cone of muscles or
within the annulus of Zinn, have been referred to as the
oculomotor foramen. These structures from above
downwards are the upper division of the 3rd nerve, the
naso-ciliary, and a branch from the sympathetic, then
the lower division of the 3rd, then the 6th, and then
sometimes the ophthalmic vein or veins. The 6th nerve is
actually passing from being below the lower division of
the 3rd to lie lateral and in between the two divisions.
• Innervation– The 6th nerve (abducens) enters it on its
medial aspect, just behind its middle.
33.
34. OBLIQUE MUSCLES
• There are two oblique muscles:
1. Superior Oblique
2. Inferior Oblique
• Unlike the recti group of muscles, they do not
originate from the common tendinous ring.
• From their origin, the oblique muscles take
an angular approach to the eyeball (in contrast
to the straight approach of the recti muscles).
They attach to the posterior surface of the sclera.
35.
36.
37. SUPERIOR OBLIQUE
• It is longest and thinnest eye muscle.
• Origin – arises above and medial to the optic foramen by a
narrow tendon which partially overlaps the origin of the
levator.
• Insertion – inserted to trochlea at orbital rim, on the medial
wall of the antero-superior-medial orbit on the frontal bone.
The muscle stops just before the trochlea and then proceeds
as tendon under superior rectus posterior to insert on the
temporal aspect of the eye behind the equator.
• Blood supply – the superior muscular branch of ophthalmic
artery supply blood
• Size – 40 mm long; tendon is 20 mm long and 10.8 mm wide.
38. SUPERIOR OBLIQUE
• Trochlea- The trochlea consists of a U-shaped piece of fibro-
cartilage. The cartilage merges imperceptibly above with
fibrous tissue, and is attached to the fovea or spina trochlearis
on the frontal bone a few millimeters behind the orbital
margin on the medial wall of the orbit. Immediately before
entering the pulley striated muscle joins the tendon, which is
enclosed in a synovial sheath, beyond which a strong fibrous
sheath accompanies the tendon to the eye.
• Innervation – The superior oblique is supplied by the 4th or
trochlear nerve which, having divided into three or four
branches, enters the muscle on the upper-surface near its
lateral border; the most anterior branch at the junction of the
posterior and middle thirds, the most posterior about 8 mm.
from its origin.
39.
40. INFERIOR OBLIQUE
• Origin – The inferior oblique is the only extrinsic muscle to
take origin from the front of the orbit; arises from a rounded
tendon in a depression on orbital floor near orbital rim
(maxilla), just behind the orbital margin and lateral to orifice
of the naso-lacrimal duct. Some of its fibres may arise from
the fascia covering the lacrimal sac.
• Insertion – inserted posterior inferior temporal quadrant at
level of macula
• Blood supply – the inferior branch of ophthalmic artery and
infraorbital artery
• Size – 37 mm long; the shortest tendon of insertion
(essentially no tendon) and it is 9.6 mm wide at insertion.
41. INFERIOR OBLIQUE
• Relations – Near its origin the lower surface of the muscle
contacts the periosteum of the orbital floor, laterally it is
separated from the floor by fat. Just before the insertion of the
muscle, this surface which now faces laterally is covered by
the lateral rectus and Tenon's capsule. The upper aspect
contacts fat, then the inferior rectus, then finally spreading
out and becoming concave it moulds itself on the eye.
• Innervation– the inferior division of the oculomotor nerve,
crosses above the posterior border to enter the muscle on its
upper-surface at about the middle of the muscle.
• Blood-supply -comes from the infraorbital artery and the
inferior muscular branch of the ophthalmic artery.
.
42.
43. LEVATOR PALPEBRAE
SUPERIORIS
• The levator palpebrae superioris (LPS) is the
only muscle involved in raising the superior
eyelid. A small portion of this muscle contains a
collection of smooth muscle fibres – known as
the superior tarsal muscle. In contrast to the
LPS, the superior tarsal muscle is innervated by
the sympathetic nervous system.
44.
45. • It is a striated muscle to elevate the eyelid. The levator palpebrae
superioris arises from the under-surface of the lesser wing of the
sphenoid above and in front of the optic foramen by a short
tendon which is blended with the underlying origin of the
superior rectus. The flat ribbon-like muscle belly 40 mm in
length passes forwards below the roof of the orbit and on the
superior rectus to about 1 cm. behind the orbital septum (at the
upper fornix or a few millimeters in front of the equator of the
eye), where it ends in a membranous expansion or aponeurosis.
The tendon is about 10-15 mm in length and extend from the
equator forward. This spreads out in a fan-shaped manner, so as
to occupy the whole breadth of the orbit and thus gives the whole
muscle tendon complex the approximate form of an isosceles
triangle.
LEVATOR PALPEBRAE
SUPERIORIS
46. Attachments:
• (a) The main insertion of the levator is to the skin of the
upper lid at and below the upper palpebral sulcus. It
reaches this by intercalating with the fibres of the
orbicularis.
• (b) To the Tarsal Plate. – Some of the fibres of the
aponeurosis are attached to the front and lower part of the
tarsal plate, but the main attachment of the levator here is
via the smooth superior palpebral muscle of Muller. This is
continuous with the fleshy part of the levator, and is
attached to the upper border of the tarsus.
LEVATOR PALPEBRAE
SUPERIORIS
47.
48. LEVATOR PALPEBRAE
SUPERIORIS
• Relations– Above the levator and between it and the
roof of the orbit are the 4th and frontal nerves and the
supraorbital vessels. The 4th nerve crosses the muscle
close to its origin from lateral to medial to reach the
superior oblique. The supraorbital artery is above the
muscle in its anterior half only. The frontal nerve crosses
the muscle obliquely from the lateral to the medial side.
Below the levator is the medial part of the superior
rectus.
• Innervation– The superior division of the 3rd nerve
reaches the muscle either by piercing the medial edge of
the superior rectus or curving around its medial border.