What are the muscles and their corresponding actions around the orbit when viewed from a superior perspective?

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Extraocular Muscles Around the Orbit: Superior View Anatomy

Primary Rectus Muscles and Their Actions

When viewing the orbit from above, four rectus muscles are visible originating from the annulus of Zinn at the orbital apex, with the superior rectus positioned superiorly, the medial rectus positioned medially (nasally), the lateral rectus positioned laterally (temporally), and the inferior rectus positioned inferiorly 1.

Superior Rectus Muscle

  • Primary action: Elevation (upgaze) of the eye 1
  • Secondary actions: Adduction and intorsion
  • Positioned directly above the optic nerve when viewed from superior perspective 1
  • Most commonly injured during retrobulbar or peribulbar anesthesia along with the inferior rectus 1

Medial Rectus Muscle

  • Primary action: Adduction (movement toward the nose) 1
  • Positioned on the nasal side of the orbit 1
  • In thyroid eye disease, this muscle is frequently involved along with the inferior rectus, causing esotropia and hypotropia 1
  • Damage to this muscle during pterygium surgery can result in consecutive exotropia 1

Lateral Rectus Muscle

  • Primary action: Abduction (movement away from the nose) 1
  • Positioned on the temporal side of the orbit 1
  • Connected to the superior rectus by the lateral rectus-superior rectus (SR-LR) connective tissue band, which maintains fixed distance between these muscles 1
  • In sagging eye syndrome, age-related degeneration of the SR-LR band causes inferior displacement of the lateral rectus, impairing abduction 1

Inferior Rectus Muscle

  • Primary action: Depression (downgaze) of the eye 1
  • Secondary actions: Adduction and extorsion
  • Most commonly injured during retrobulbar or peribulbar anesthesia 1
  • Can be damaged during lower lid blepharoplasty, causing diplopia 1
  • Large bilateral inferior rectus recession may result in A-pattern exotropia in downgaze as the superior oblique becomes the dominant infraductor 1

Oblique Muscles and Their Actions

Superior Oblique Muscle

  • Primary action: Intorsion (internal rotation) 1
  • Secondary actions: Depression and abduction
  • Originates from the orbital apex, passes through the trochlea (pulley) at the superomedial orbit, then courses posterolaterally to insert on the superolateral posterior globe 1
  • Can be injured during retrobulbar/peribulbar blocks 1
  • Damage to the trochlea can occur during upper lid blepharoplasty 1
  • Becomes the dominant infraductor after large bilateral inferior rectus recession 1

Inferior Oblique Muscle

  • Primary action: Extorsion (external rotation) 1
  • Secondary actions: Elevation and abduction
  • Originates from the anteromedial orbital floor (not from the annulus of Zinn like the rectus muscles) 1
  • Can be injured during retrobulbar/peribulbar blocks 1

Critical Anatomical Relationships from Superior View

Muscle-to-Muscle Connections

  • The superior rectus and lateral rectus are connected by the SR-LR connective tissue band, maintaining a fixed distance as they course posteriorly 1
  • Age-related degeneration of this band causes sagging eye syndrome with medial shift of the superior rectus and inferior shift of the lateral rectus 1
  • In myopic strabismus fixus, rupture of the SR-LR band occurs due to increased axial length, causing inferior shift of lateral rectus and nasal shift of superior rectus 1

Relationship to Optic Nerve

  • The superior rectus lies directly above the optic nerve 1
  • The medial and lateral rectus muscles flank the optic nerve medially and laterally 1
  • Anomalous muscles linking superior and inferior rectus have been reported between the optic nerve and lateral rectus muscle 2, 3

Muscle Origins

  • All four rectus muscles originate from the annulus of Zinn (common tendinous ring) at the orbital apex 2, 3
  • The superior oblique also originates from the orbital apex but passes through the trochlea before inserting posterolaterally 1
  • The inferior oblique is unique in originating from the anteromedial orbital floor rather than the apex 1

Common Clinical Pitfalls

Surgical Considerations

  • Avoid assuming all muscles are in normal anatomical position: In thyroid eye disease, muscle enlargement and displacement can significantly alter anatomy 1
  • Recognize that muscle injury during anesthesia is common: Superior and inferior rectus are most vulnerable during retrobulbar/peribulbar blocks 1
  • Be aware of SR-LR band integrity: Failure of this band in elderly or high myopes dramatically alters muscle positions and function 1

Imaging Interpretation

  • Muscle involvement in thyroid eye disease shows tendon-sparing enlargement, with the inferior and medial rectus most frequently affected 1
  • In myopic strabismus fixus, measuring the dislocation angle between superior rectus and lateral rectus helps determine disease severity 1
  • CT or MRI is essential to confirm muscle position before surgery in complex cases 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Bilateral supernumerary rectus muscles of the orbit.

Clinical anatomy (New York, N.Y.), 1998

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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