Anatomy of eye
The eye divided into three parts; the outer layer is fibrous and forms a cornea with the central sclera of the eye being white and covering the rest of the eye. The second layer consists of tissue which is the choroid (blood supply). to the retina) the iris (containing the cornea and smooth muscles that regulate thickness) and the ciliary body, which consists of muscles that extend from the sclera and are attached to the lens by a suspensory ligament. The middle layer contains the retina.
The extraocular nerve consists of seven muscles with cranial nerves responsible for eye movements under certain conditions when these muscles are affected thus affecting eye movements.
The movement of the eye continues around the triangle:
- Adduction (movement of the inner eye to the nose)/ Abduction (movement of the outer eye) around the vertical axis.
- Elevation (higher motion)/ Depression (lower motion) around the transverse axis.
- Intorsion/ Extorsion (movement away and into the nose) we need when rotating the head around the anteroposterior axis
The seven muscles of the posterior eyelids divided into 4 recti 2 obliques muscles and one levator palpebrae superiors which are responsible for elevation of the upper eyelid.
MuscleOriginInsertionNerve supplyActionSuperior rectuscommon tendinous ringsuperior and anterior aspect of scleraoculomotor nerve (cranial nerve III)elevation and contributes to adduction and intorsionInferior rectusinferior and anterior aspect of scleradepression contributes to adduction and extorsionMedial rectusmedial aspect of scleraadducts eyeLateral rectuslateral aspect of scleraabducens muscle (cranial nerve VI)abducts eyeSuperior obliquebody of sphenoid boneat sclera posterior to superior rectusTrochlear nerve cranial nerve IV)abduction depression and eye insertionInferior obliqueanterior aspect of orbital floorat sclera posterior to lateral rectus.Oculomotor nerve (cranial nerve III)increased abduction and retrieval of eyesLevator palpebrae superiorssphenoid bonesuperior eyelidoculomotor nerve (cranial nerve III)ocular surface.
Oculomotor N palsy lt eye
Extraocular muscle paralysis can occur due to injury or disease as affected cranial nerve palsy of the oculomotor nerve will affect most of the extraocular muscles with eye disease recognized in the down and out position. Weakness of the abducens muscle will affect the back rectus and the eye becomes treated by the medial rectus. If the trochlear nerve is affected the patient complains of diplopia.
Strabismus from weakness of the nerve control nerves or injury to the inferior rectus muscle may be involved.
Assessment Of Extraocular Muscles
Extraocular muscle function can be assessed by asking the patient to look in nine directions by following the doctor’s finger as he draws an ”H” in the air. The patient will look up down right left and right and left and right and left.
Visual alignment is tested by several methods for example the corneal-light reflex.
Effect Of Eye Muscle Exercises
Who benefits from exercises:
- Digital vision loss as in people who work on computers for long periods of time and can cause blurred vision blurred vision and headaches.
- Increased light sensitivity.
- Surgery needed to strengthen muscles
- If there is a problem with reading eye fixation.
- Convergence insufficiency.
- Lazy eyesight in some children – eye exercises stimulate vision areas in the brain.
Effects of oculomotor and eye stability exercises:
- Ocular-motor exercises improve dynamic visual acuity (DVA) in dynamic sports that have a significant impact on athlete performance for example basketball in this study of female basketball players, the intervention consists of four weeks 6 sessions per week for ten minutes twice a day ].
- Visual and visuo-motor improve balance and stability in healthy adults and a study proves that it may be promising for improving balance after stroke. . . . .
- This exercise improves symptoms of eye fatigue it strengthens the muscles behind the eyes.
- Relief eye strain, improve blinking.
Eye Muscles Exercises
- Blinking exercises are like giving your eyes a break, it helps keep them looking fresh and focused for longer periods of time. Blinking can improve symptoms of digital eye strain, dry eye and blinking habit, and a 10-second blinking exercise every 20 minutes will help.
- Eye movement Slowly move the eyes up and down three times, then slowly move the eyes from right to left three times and then rest.
- Figure 8 Another Eye Movement Exercise Imagine a large figure of 8 8-9 feet away from you, then move your eyes in the direction of this infinite loop for about 30 seconds, then switch directions.
- Change focus Move your finger a few inches away from you, then focus on it, then focus on something else far away from you, now bring your gaze back to your finger.
- Pencil push-ups . Patient places pencil/patient’s thumb on outstretched arm between eyes Instruct patient to attempt to hold single image of pencil while slowly moving pencil towards nose until now pencil is no longer visible in single image Consultation Patiently move it slowly to the nearest point where there is an image of a pencil. This exercise can help patients with symptomatic convergent insufficiency.
- Brock string can improve convergence and eye coordination .
For more exercises description:
Eye movement exercises. Physiology page.
Gaze stabilization exercises.
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- Minoonejad H, Barati AH, Naderifar H, Heidari B, Kazemi AS, Lashay A. Effect of four weeks of ocular-motor exercises on dynamic visual acuity and stability limit of female basketball players. Gait & posture. 2019 Sep 1;73:286-90.
- Morimoto H, Asai Y, Johnson EG, Lohman EB, Khoo K, Mizutani Y, Mizutani T. Effect of oculo-motor and gaze stability exercises on postural stability and dynamic visual acuity in healthy young adults. Gait & posture. 2011 Apr 1;33(4):600-3.
- Pimenta C, Correia A, Alves M, Virella D. Effects of oculomotor and gaze stability exercises on balance after stroke: Clinical trial protocol. Porto Biomedical Journal. 2017 May 1;2(3):76-80.
- Gupta SK, Aparna S. Effect of yoga ocular exercises on eye fatigue. International Journal of Yoga. 2020 Jan 1;13(1):76.
- Kim AD, Muntz A, Lee J, Wang MT, Craig JP. Therapeutic benefits of blinking exercises in dry eye disease. Contact Lens and Anterior Eye. 2020 May 12.
- Kim KM, Chun BY. Effectiveness of home-based pencil push-ups (HBPP) for patients with symptomatic convergence insufficiency. Korean Journal of Ophthalmology. 2011 Jun 1;25(3):185-8.
- Kirscher DW. Sports vision training procedures. Optometry clinics: the official publication of the Prentice Society. 1993;3(1):171-82.
- Jang JU, Jang JY, Tai-hyung K, Moon HW. Effectiveness of vision therapy in school children with symptomatic convergence insufficiency. Journal of ophthalmic & vision research. 2017 Apr;12(2):187.
- drvickyfischer. drvickyfischer. Available from: http://www.youtube.com/watch?v=BuvMrCAt6TU[last accessed 4/6/2020]
- iDoc2008. Brock String Training Video. Available from: http://www.youtube.com/watch?v=EGlCVTdNqfw[last accessed 4/6/2020]