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Curr Eye Res 2019 Jan 9. Epub 2019 Jan 9.

b Department of Anatomy, Research Institute of Medical Science , Konkuk University School of Medicine , Seoul , Republic of Korea.

Purpose: The intramuscular nerve distribution in the extraocular muscles may be crucial for understanding their physiological and pathological responses. This study aimed to determine the oculomotor nerve distribution in the medial rectus muscle (MR) using Sihler's staining.

Method: Thirty-seven MRs from 23 cadavers were investigated. Read More

Medicine (Baltimore) 2018 Dec;97(50):e13624

Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China.

Rationale: Occurrence of granulosa cell tumors (GCTs) in the eye are rare and may be diagnosed by imaging examination and immune-histochemical studies. Two common signs of a rectus muscle tumor are the proptosis of the eye ball and the complaint of bi-ocular diploma.

Patient Concerns: A 45-year-old man visited our ophthalmology department with an about a 3-year history of vertical diplopia. Read More

Medicine (Baltimore) 2018 Nov;97(44):e13027

Department of Ophthalmology.

Rationale: Ewing sarcoma localized in the paranasal sinuses, compressing the optic nerve, is very rare, with no prior case reports PATIENT CONCERNS:: A 68-year-old woman presented with decreased visual acuity in her left eye and paresthesia of the left face. Brain magnetic resonance imaging showed heterogeneously enhancing mass in the left paranasal sinuses with adjacent bone destruction, extending to the extraocular muscles and optic nerve of the left orbit. A biopsy of the nasal cavity confirmed Ewing sarcoma. Read More

Invest Ophthalmol Vis Sci 2018 Oct;59(12):4847-4855

Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden.

Purpose: To investigate the effect of absence of desmin on the extraocular muscles (EOMs) with focus on the structure and composition of the cytoskeleton.

Methods: The distribution of synemin, syncoilin, plectin, nestin, and dystrophin was evaluated on cross and longitudinal sections of EOMs and limb muscles from 1-year-old desmin knockout mice (desmin-/-) by immunofluorescence. General morphology was evaluated with hematoxylin and eosin while mitochondrial content and distribution were evaluated by succinate dehydrogenase (SDH) and modified Gomori trichrome stainings. Read More

Curr Opin Ophthalmol 2018 Nov;29(6):477-484

Department of Neurology, St Elizabeth's Medical Center, Boston, Massachusetts, USA.

Purpose Of Review: Myasthenia gravis is an autoimmune disease that commonly affects the palpebral and extraocular muscles. Ocular myasthenia gravis (OMG) is a variant of the disease that is confined to the ocular muscles but frequently becomes generalized over time. The diagnosis of OMG is often challenging but both clinical and laboratory findings are helpful in confirming the clinical suspicion. Read More

J Breast Cancer 2018 Sep 20;21(3):339-342. Epub 2018 Sep 20.

Department of Gynaecology, Coimbra University Hospital Centre, Coimbra, Portugal.

Orbital metastasis is a rare event, and metastatic disease affecting the extraocular muscles is an even less frequent complication of solid tumors. Herein, we report an unusual case of ptosis as the initial presentation of an invasive breast cancer. A 68-year-old woman presented with III and VI partial nerve paresis, secondary to a compressive retrobulbar mass. Read More

J Neurophysiol 2018 Sep 19. Epub 2018 Sep 19.

Ophthalmology, University of California Los Angeles.

We employed magnetic resonance imaging (MRI) to quantify human extraocular muscle contractility during centered target fusion, and fusional divergence repeated with each eye viewing monocularly at 20 cm through 8Δ, and at 400 cm through 4Δ base in prism. Contractility, indicated by posterior partial volume (PPV) change, was analyzed in transverse rectus and in medial and lateral superior oblique (SO) muscle compartments, and by cross sectional area change in the inferior oblique (IO). At 20 cm, 3. Read More

Clin Nucl Med 2018 Nov;43(11):864-866

From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Neuroendocrine tumors have a propensity to metastasize, but rarely to the orbits. A 69-year-old woman with history of neuroendocrine tumor of pancreatic primary underwent routine follow-up In-pentetreotide (OctreoScan) imaging, with 24-hour whole-body planar images showing subtle right periorbital tracer uptake that localized to extraocular muscles on subsequent SPECT/CT. Orbital MRI further defined the location of these highly suspicious orbital metastases, which were treated with external radiation, with follow-up MRI showing decreased size of the orbital metastases. Read More

Pract Neurol 2018 10;18(5):348-349

J Pediatr Ophthalmol Strabismus 2018 Aug 29;55:e20-e21. Epub 2018 Aug 29.

Plication and resection are surgical procedures commonly used for the treatment of strabismus. Further studies are needed to understand the postoperative effects of plication on muscle tissue. This case report examines a pathological section of a plicated medial rectus muscle, revealing myocyte injury and replacement with fibroconnective tissue. Read More

J Pediatr Ophthalmol Strabismus 2018 Nov 29;55(6):356-362. Epub 2018 Aug 29.

Purpose: To examine extraocular rectus muscle tendons in patients with Graves' ophthalmopathy using optical coherence tomography (OCT).

Methods: This was a cross-sectional observational study conducted with 55 healthy controls, 45 patients with clinically inactive Graves' ophthalmopathy, and 12 patients with clinically active Graves' ophthalmopathy. Scanning was performed at the 3- and 9-o'clock positions. Read More

BMC Ophthalmol 2018 Aug 22;18(1):206. Epub 2018 Aug 22.

Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China.

Background: Goldenhar syndrome has variable presentations and can affect multiple regions of the body. Diagnoses are based on clinical manifestations. The association of Goldenhar syndrome with blepharophimosis and limb deformities has not previously been reported. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):405-421

Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A.

Purpose: To review the recent data about orbital development and sort out the controversies from the very early stages during embryonic life till final maturation of the orbit late in fetal life, and to appreciate the morphogenesis of all the definitive structures in the orbit in a methodical and timely fashion.

Methods: The authors extensively review major studies detailing every aspect of human embryologic and fetal orbital morphogenesis including the development of extraocular muscles, orbital fat, vessels, nerves, and the supportive connective tissue framework as well as bone. These interdisciplinary studies span almost a century and a half, and include some significant controversial opposing points of view which the authors hopefully sort out. Read More

J Craniofac Surg 2018 Oct;29(7):1832-1833

Department of Adnexal, Reconstructive and Orbital Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.

Trapdoor fractures are common in children because of elastic nature of the pediatric bone. Clinical signs and radiological evidence in these cases may be minimal.This study involves a 14-year-old girl who sustained blunt trauma to her left eye. Read More

J Undergrad Neurosci Educ 2018 15;16(2):R33-R38. Epub 2018 Jun 15.

School of Science and Health, Western Sydney University, Penrith, NSW, Australia, 2751.

When the term muscular paralysis is used, most people will think of large muscle groups such as the upper and lower limbs or life-dependent muscles such as the diaphragm. However, the extrinsic extraocular muscles can also succumb to paralysis (whether partial or otherwise). Ophthalmoplegia can arise from a number of neural conditions, and in conjunction with the complex anatomy of the ocular orbit, it can be difficult to teach such syndromes. Read More

Invest Ophthalmol Vis Sci 2018 Jun;59(7):2944-2954

Institute of Anatomy and Cell Biology, Ludwig-Maximilians-Universität, Munich, Germany.

Purpose: To further chemically characterize palisade endings in extraocular muscles in rhesus monkeys.

Methods: Extraocular muscles of three rhesus monkeys were studied for expression of the calcium-binding protein calretinin (CR) in palisade endings and multiple endings. The complete innervation was visualized with antibodies against the synaptosomal-associated protein of 25 kDa and combined with immunofluorescence for CR. Read More

Indian J Ophthalmol 2018 07;66(7):895

Pediatric Ophthalmology and Strabismology Services, Narayana Nethralaya, Narayana Health City, Bengaluru, Karnataka, India.

Rev Fac Cien Med Univ Nac Cordoba 2017 12 14;74(4):372-378. Epub 2017 Dec 14.

Hospital Privado Centro Medico Universitario de Córdoba.

Background: Diseases of the orbit represent a surgical challenge, particularly those compromising the orbital apex. Optimal surgical access should provide the best possible exposure, allowing to identify certain key anatomical structures, called landmarks.

Objective: Describe the endoscopic anatomy of the structural unit formed by the Inferior Orbital Fissure (IOF) and the Müller’s muscle (MM) at the orbital apex (OA), thus generating a new endoscopic anatomical landmark. Read More

BMJ Case Rep 2018 Jun 8;2018. Epub 2018 Jun 8.

Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

A young male patient presented to our ocular emergency department with chief complaints of progressive pain, redness, diplopia and a right-sided face turn. Ocular examination revealed severely restricted extraocular movements along with retinal folds in the left eye. Initial orbital ultrasound and CT findings were equivocal; however, serology favoured an infective cause. Read More

Ophthalmic Plast Reconstr Surg 2018 Jul/Aug;34(4S Suppl 1):S7-S12

Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, U.S.A.

Purpose: To review and summarize the clinical findings in thyroid eye disease (TED) related to the unique anatomical structures of the eyelids and orbit.

Methods: A PubMed search was performed searching for anatomical relationships between eyelid and orbital anatomy and the clinical findings of TED.

Results: The major clinical findings associated with TED are varied. Read More

Anticancer Res 2018 Jun;38(6):3763-3766

Department of Radiation Oncology, Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, NY, U.S.A.

Background/aim: Orbital metastasis of systemic cancer is exceedingly rare. This is a case report of a patient treated for locally recurrent vulvar melanoma who later presented with unilateral proptosis and was found to have an isolated biopsy-proven extraocular muscle metastasis.

Patients And Methods: A 94-year-old female with locally recurrent vulvar melanoma presented with eye discomfort and blurry vision. Read More

BMC Ophthalmol 2018 May 30;18(1):128. Epub 2018 May 30.

Department of Ophthalmology & Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Republic of Korea.

Backgound: To identify and compare specific protein levels between overacting inferior oblique (IO) muscles in superior oblique (SO) palsy patients and normal IO muscles.

Methods: We obtained 20 IO muscle samples from SO palsy patients with IO overaction ≥ + 3 who underwent IO myectomies (IOOA group), and 20 IO samples from brain death donors whose IO had functioned normally, according to their ophthalmological chart review (control group). We used MyoD for identifying satellite cell activation, insulin-like growth factor binding protein 5 (IGFBP5) for IGF effects, thioredoxin for oxidative stress, and p27 for satellite cell activation or oxidative stress in both groups. Read More

J Pediatr Ophthalmol Strabismus 2018 Sep 29;55(5):335-338. Epub 2018 May 29.

Purpose: To assess the outcome of free tenotomy of the medial rectus muscle in post-natal monkeys.

Methods: The medial rectus muscle was disinserted in both eyes of 6 macaques at age 4 weeks to induce an alternating exotropia. After the impact on the visual cortex and superior colliculus was investigated, the animals were examined post-mortem to assess the anatomy of the medial rectus muscles. Read More

PLoS One 2018 24;13(5):e0198002. Epub 2018 May 24.

Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Purpose: To determine whether the inferior oblique (IO) muscle weakening procedure combined with exotropia surgery affects the surgical correction of exotropia.

Design: Institutional, retrospective study.

Methods: We retrospectively reviewed the medical records of 310 patients who had undergone exotropia-correcting surgery combined with IO weakening (group A, 64 patients) or without IO weakening (group B, 246) with a postoperative follow-up of 6 months or more. Read More

Korean J Ophthalmol 2018 06 20;32(3):221-227. Epub 2018 Mar 20.

Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.

Purpose: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology.

Methods: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. Read More

Graefes Arch Clin Exp Ophthalmol 2018 Sep 5;256(9):1777-1782. Epub 2018 May 5.

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.

Purpose: To determine whether an infratrochlear nerve block (ITB) can reduce the oculocardiac reflex (OCR) during strabismus surgery on the medial rectus muscle (MR).

Methods: This prospective, randomized single-masked study included 60 patients with intermittent exotropia scheduled for unilateral MR resection/lateral rectus recession under general anesthesia. Patients were randomly allocated to receive a regional nerve block of the infratrochlear nerve (ITB group) prior to surgery or standard treatment without a nerve block (control group). Read More

J Anat 2018 Aug 3;233(2):243-254. Epub 2018 May 3.

Department of Medical Biology, Section Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Congenital muscle diseases, such as myopathies or dystrophies, occur relatively frequently, with estimated incidences of up to 4.7 per 100 000 newborns. To diagnose congenital diseases in the early stages of pregnancy, and to interpret the results of increasingly advanced in utero imaging techniques, a profound knowledge of normal human morphological development of the locomotor system and the nervous system is necessary. Read More

J Emerg Med 2018 07 30;55(1):110-113. Epub 2018 Apr 30.

Oculoplastic Service, Department of Surgery (Ophthalmology), Alpert Medical School of Brown University, Providence, Rhode Island.

Background: Nonspecific orbital inflammation (NSOI) is a rare idiopathic ocular pathology characterized by unilateral, painful orbital swelling without identifiable infectious or systemic disorders, which can be complicated by optic nerve compromise.

Case Report: A 50-year-old man presented to the Emergency Department with recurring, progressive painless left eye swelling, decreased visual acuity, and binocular diplopia in the absence of trauma, infection, or known malignancy. His physical examination was notable for left-sided decreased visual acuity, an afferent pupillary defect, severe left eye proptosis and chemosis, and restricted extraocular movements; his dilatated funduscopic examination was notable for ipsilateral retinal folds within the macula, concerning for a disruption between the sclera and the retina. Read More

Strabismus 2018 09 25;26(3):133-141. Epub 2018 Apr 25.

a Department of Ophthalmology , UZ Leuven , Leuven , Belgium.

Ocular neuromyotonia (ONM) is a rare eye movement disorder, presenting as a paroxysmal involuntary spasm of one or more extra-ocular muscles, that can persist for a few seconds up to several minutes. The phenomenon is caused by the contraction of an extra-ocular muscle, excited by a damaged nerve, which leads to delayed muscle relaxation. We present eight patients with this rare condition together with an overview of the literature on all published ONM cases. Read More

Strabismus 2018 09 19;26(3):142-144. Epub 2018 Apr 19.

a Department of Ophthalmology , Chiang Mai University , Chiang Mai , Thailand.

Purpose: To report a case of recovery of a medial rectus which was accidentally disinserted after surgical treatment of a recurrent pterygium.

Method: Report of a case of inadvertent medial rectus disinsertion after pterygium excision at a secondary care hospital which was referred to a tertiary care hospital in Northern Thailand.

Result: A 40-year-old healthy woman was referred by a general ophthalmologist at a secondary care center to our hospital. Read More

Anat Rec (Hoboken) 2018 Apr 16. Epub 2018 Apr 16.

Department of Human Anatomy and Psychobiology, School of Medicine, University of Murcia, Murcia, Spain.

Amphioxus is the living chordate closest to the ancestral form of vertebrates, and in a key position to reveal essential aspects of the evolution of the brain Bauplan of vertebrates. The dorsal neural cord of this species at the larval stage is characterized by a small cerebral vesicle at its anterior end and a large posterior region. The latter is comparable in some aspects to the hindbrain and spinal cord regions of vertebrates. Read More

Genesis 2018 06 16;56(6-7):e23097. Epub 2018 Apr 16.

Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY.

Patterning of craniofacial muscles overtly begins with the activation of lineage-specific markers at precise, evolutionarily conserved locations within prechordal, lateral, and both unsegmented and somitic paraxial mesoderm populations. Although these initial programming events occur without influence of neural crest cells, the subsequent movements and differentiation stages of most head muscles are neural crest-dependent. Incorporating both descriptive and experimental studies, this review examines each stage of myogenesis up through the formation of attachments to their skeletal partners. Read More

J Comp Neurol 2018 Aug 29;526(11):1749-1759. Epub 2018 Apr 29.

Department of Biology, The University of Akron, Akron, Ohio.

Functionally distinct retinal ganglion cells have density and size gradients across the mouse retina, and some degenerative eye diseases follow topographic-specific gradients of cell death. Hence, the anatomical orientation of the retina with respect to the orbit and head is important for understanding the functional anatomy of the retina in both health and disease. However, different research groups use different anatomical landmarks to determine retinal orientation (dorsal, ventral, temporal, nasal poles). Read More

Facial Plast Surg 2018 Apr 9;34(2):178-182. Epub 2018 Apr 9.

Department of Otolaryngology, Medical School, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil.

Dermatochalasis is a skin excess in the upper eyelid which may be associated with either an aesthetic and functional defect, blocking the peripheral vision. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis and to restore youthful contours to the periorbita. It is one of the most commonly performed procedures in aesthetic plastic surgery; however, there is still a lack of consensus about this procedure. Read More

Invest Ophthalmol Vis Sci 2018 03;59(3):1178-1190

The Discipline of Physiology and the Bosch Institute, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia.

Purpose: Extraocular muscles express 10 myosin heavy chain (MyHC) isoforms that cater for a wide range of contractile speeds. We aim to characterize the variations in MyHC expression along the length of singly (SIFs) and multiply innervated fibers (MIFs) in the orbital layer of rabbit superior rectus muscle.

Methods: Monospecific antibodies to nine MyHCs, including an anti-slow-tonic antibody characterized here were used to immunohistochemically map variations in MyHC distribution in serial sections along the muscle's full length. Read More

Korean J Ophthalmol 2018 04 13;32(2):156-157. Epub 2018 Mar 13.

Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Acta Biol Hung 2018 Mar;69(1):42-57

1 Department of Biostructure and Animal Physiology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences , Kozuchowska 1/3, 51-631 Wroclaw , Poland.

The aim of the study was to describe the morphology and the development of the extraocular muscles (EOMs) in the pre-hatchling and post-hatchling African black ostrich. The study involved 50 birds aged between 28 days and 3 years. The EOMs were analyzed morphologically with respect to the location and length of the straight and oblique muscles and the third eyelid muscles, the length and breadth of their tendons as well as the distance and shape of the muscle tendon insertions at the corneal limbus. Read More

Korean J Ophthalmol 2018 04 19;32(2):83-88. Epub 2018 Mar 19.

Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea.

Purpose: To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients.

Methods: This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. Read More

Strabismus 2018 06 20;26(2):62-70. Epub 2018 Mar 20.

a Department of Ophthalmology , University Hospital Essen , Germany.

Background/aims: We performed a retrospective analysis to examine clinical results, establish a dose-effect coefficient and analyze the long-term efficacy of tendon elongation with bovine pericardium (Tutopatch®) for surgical correction of severe esotropia, occurring after three-wall orbital decompression for dysthyroid optic neuropathy in patients with Graves' orbitopathy (GO).

Methods: Tendon elongation of the medial rectus muscle (MR) was performed in our institution using an interponate of bovine pericardium in 60 patients (27 underwent unilateral and 33 bilateral surgery). Success-rate (total horizontal deviation of 10 prism-diopters (PD) or less and evidence of binocular single vision with or without prism glasses) and horizontal motility were examined 3 months, 1 and >4 years after surgery. Read More

J Neurol 2018 Oct 19;265(Suppl 1):18-25. Epub 2018 Mar 19.

Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany.

Vestibulo-ocular reflexes (VOR) are mediated by three-neuronal brainstem pathways that transform semicircular canal and otolith sensory signals into motor commands for the contraction of spatially specific sets of eye muscles. The vestibular excitation and inhibition of extraocular motoneurons underlying this reflex is reciprocally organized and allows coordinated activation of particular eye muscles and concurrent relaxation of their antagonistic counterparts. Here, we demonstrate in isolated preparations of Xenopus laevis tadpoles that the discharge modulation of superior oblique motoneurons during cyclic head motion derives from an alternating excitation and inhibition. Read More

World Neurosurg 2018 Jun 13;114:e631-e640. Epub 2018 Mar 13.

Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. Electronic address:

Background: A pterional-orbital or subfrontal-orbital approach is recommended as a surgical treatment in cranio-orbital lesions. We describe a less invasive approach through an eyebrow incision combined supraorbital minicraniotomy and orbital osteotomy for treating some selected cranio-orbital lesions.

Methods: Sixteen patients with different cranio-orbital lesions were treated using this less invasive approach. Read More

Strabismus 2018 06 16;26(2):77-83. Epub 2018 Mar 16.

b Child Sight Institute, Pediatric Ophthalmology & Strabismus , L V Prasad Eye Institute , Hyderabad , India.

Purpose: The aim of the study was to determine the risk of anterior segment ischemia (ASI) after simultaneous three rectus muscle surgery.

Methods: A retrospective cohort study was conducted. All patients who underwent simultaneous three rectus muscle surgery from January 2003 to December 2014 were included. Read More

J Craniofac Surg 2018 Jul;29(5):e465-e467

The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: Fibrous histiocytomas (FHs) involving the orbit are uncommon. To our knowledge, here the authors report the first patient with an orbital low-grade malignant FH originating from the medial rectus muscle.

Methods: A clinical report relating clinical features as well as imaging and histopathologic findings is presented. Read More

Exp Eye Res 2018 06 9;171:62-67. Epub 2018 Mar 9.

Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; University of Illinois at Chicago (UIC), Chicago, IL, USA.

To determine the changes in the cross-sectional area (CSA) of myofibers and their subtype distribution based on the myosin isoform expression after bupivacaine (BUP) injection in the EOM of rabbits and help the understanding of strabismus correction after BUP injection in the clinical practice. A total of 32 rabbits received 0.3 mL of 1. Read More