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Proc Natl Acad Sci U S A 2019 02 13;116(9):3837-3846. Epub 2019 Feb 13.

Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, 41012 Sevilla, Spain;

Extraocular muscles contain two types of muscle fibers according to their innervation pattern: singly innervated muscle fibers (SIFs), similar to most skeletal muscle fibers, and multiply innervated muscle fibers (MIFs). Morphological studies have revealed that SIF and MIF motoneurons are segregated anatomically and receive different proportions of certain afferents, suggesting that while SIF motoneurons would participate in the whole repertoire of eye movements, MIF motoneurons would contribute only to slow eye movements and fixations. We have tested that proposal by performing single-unit recordings, in alert behaving cats, of electrophysiologically identified MIF and SIF motoneurons in the abducens nucleus. Read More

Sci Rep 2019 Jan 30;9(1):991. Epub 2019 Jan 30.

Department of Radiology, Howard University College of Medicine, Washington, USA.

This paper is part of the emerging field of Evolutionary Developmental Pathology, dedicated to study the links between normal and abnormal development, evolution and human pathologies. We analyzed the head musculoskeletal system of several 'natural mutant' newborn lambs displaying various degrees of abnormality, from mild defects to cebocephaly and to cyclopia, and compared them with humans. Interestingly, muscle defects are less marked than osteological ones, and contrarily to the latter they tend to display left-right assymetries. Read More

Curr Eye Res 2019 Feb 27:1-5. Epub 2019 Feb 27.

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

Ophthalmic Res 2019 6;61(2):120-124. Epub 2018 Dec 6.

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu,

Purpose: To evaluate the efficacy of bilateral lateral rectus muscle recession (BLR) to treat recurrent exotropia after bilateral medial rectus muscle resection (BMR).

Methods: Twenty-four patients who underwent BLR for recurrent exotropia and were followed up for more than 6 months were included in this retrospective study. All of them had prior BMR. Read More

J Craniofac Surg 2019 Jan;30(1):e26-e28

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital.

A study on immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with destructive changes in periorbital soft tissues was presented. The patient was an 89-year-old-man who developed a left-sided orbital lesion involving the globe, lacrimal gland, and extraocular muscles. A diagnosis of definite IgG4-ROD was made based on clinical and histopathologic findings. Read More

Yonsei Med J 2018 Dec;59(10):1190-1196

Department of Pediatrics, Gangnam Severance Hospital, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: To evaluate the classification, diagnosis, and natural course of ophthalmoplegia associated with mitochondrial disease.

Materials And Methods: Among 372 patients with mitochondrial disease who visited our hospital between January 2006 and January 2016, 21 patients with ophthalmoplegia were retrospectively identified. Inclusion criteria included onset before 20 years of age, pigmentary retinopathy, and cardiac involvement. 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 Nov 19;120(5):2571-2582. Epub 2018 Sep 19.

Department of Ophthalmology University of California , Los Angeles, California.

We employed magnetic resonance imaging 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

PLoS One 2018 24;13(8):e0202861. Epub 2018 Aug 24.

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, United States of America.

Recent microarray and RNAseq experiments provided evidence that glial derived neurotrophic factor (GDNF) levels were decreased in extraocular muscles from human strabismic subjects compared to age-matched controls. We assessed the effect of sustained GDNF treatment of the superior rectus muscles of rabbits on their physiological and morphological characteristics, and these were compared to naïve control muscles. Superior rectus muscles of rabbits were implanted with a sustained release pellet of GDNF to deliver 2μg/day, with the contralateral side receiving a placebo pellet. 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

Strabismus 2018 12 30;26(4):198-202. Epub 2018 Jul 30.

a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran.

Objectives: To report the clinical outcomes of a new modification to muscle belly union surgery in heavy eye syndrome.

Methods: Muscle belly union was performed in patients with large-angle esotropia and characteristic findings of heavy eye syndrome on orbital imaging. After isolation of superior and lateral rectus muscle and passing a single armed suture in each muscle belly, approximation was achieved via tying of both arms of separate sutures together. 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 06;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

Eye (Lond) 2018 09 24;32(9):1493-1497. Epub 2018 May 24.

David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Background: Both external levator resection (ELR) and Müller's muscle-conjunctival resection (MMCR) are procedures well known to improve marginal reflex distance (MRD1) in patients with ptosis. This study aims to understand differential post-operative changes in eyelid contour for MMCR and ELR surgery.

Methods: In this cross-sectional cohort study, patients affected by involutional ptosis were randomized into two groups: those who underwent ELR or MMCR surgery. 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

Exp Neurol 2018 08 2;306:138-148. Epub 2018 May 2.

Department of Emergency Medicine, Emory University, 1365B Clifton Road NE, Suite 5100, Atlanta, GA 30322, USA. Electronic address:

In adult mice with unilateral optic nerve crush injury (ONC), we studied visual response plasticity in the visual cortex following stimulation with sinusoidal grating. We examined visually evoked potentials (VEP) in the primary visual cortex ipsilateral and contralateral to the crushed nerve. We found that unilateral ONC induces enhancement of visual response on the side ipsilateral to the injury that is evoked by visual stimulation to the intact eye. 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) 2019 Mar 27;302(3):452-462. Epub 2018 Apr 27.

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