Superior oblique muscle
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View Rohit Sharma's current disclosures- Obliquus oculi superior
- Superior oblique
The superior oblique muscle is one of the six extraocular muscles that control eye movements. It abducts, depresses and internally rotates the eye.
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Summary
innervation: trochlear nerve (CN IV)
origin: lesser wing of sphenoid bone adjacent to the annulus of Zinn
course: tendon passes through the cartilaginous trochlea of the superior oblique located superiorly in the orbit on the nasal aspect of the frontal bone
insertion: globe (posterosuperior quadrant)
primary function: one of two ocular internal rotators
secondary function: one of the two ocular depressors
tertiary function: one of the three ocular abductors
Gross anatomy
Origin
Superior oblique arises from the lesser wing of the sphenoid bone, adjacent to the annulus of Zinn and superomedial to the origin of superior rectus 1.
Insertion
Superior oblique runs anteriorly in the superomedial part of the orbit to reach the trochlea, a fibrocartilaginous pulley located just inside the superomedial orbital rim on the nasal aspect of the frontal bone 1,2. Passing through the trochlea it changes direction, passes deep to the superior rectus muscle, and inserts into the superior surface of the sclera, posterior to the midpoint of the eye 3.
Arterial supply
Branches of the ophthalmic artery, itself a branch of the internal carotid artery.
Innervation
Superior oblique is unique among the extraocular muscles in being supplied by the trochlear nerve.
Action
In the neutral position, the primary action of the superior oblique is to internally rotate the eye (see figure 1) 3. However, because the apex of the orbit is placed medially in the skull, the orbital axis does not correspond with the optical axis of the eye in its neutral position. This means that the superior oblique has secondary actions of ocular depression and abduction (see figures 2 and 3).
If the eye is abducted by the lateral rectus such that the optical axis lines up with the orbital axis, the superior oblique produces internal rotation only, as it is acting roughly perpendicular to the orbital axis.
If the eye is adducted by the medial rectus, the optical axis runs roughly perpendicular to the orbital axis, and as a result is lined up with the axis of the post-trochlear part of the superior oblique muscle. Therefore, in adduction the superior oblique muscle produces ocular depression, and is solely responsible for this movement.
Thus, when the physician testing eye movements first asks the patient to follow their finger medially then inferiorly in the familiar H-shape, the superior oblique muscle (and the trochlear nerve that supplies it) are being directly tested 3.
Related pathology
See also
References
- 1. Gray's basic anatomy. Churchill Livingstone. ISBN:1455710784. Read it at Google Books - Find it at Amazon
- 2. Netter FH. Atlas of Human Anatomy. (2018) ISBN: 9780323393225
- 3. Moore KL, Agur AMR, Dalley AF. Clinically Oriented Anatomy. (2013) ISBN: 9781451119459
- 4. Imaging of the Head and Neck. Thieme. (2012) ISBN:3131505311. Read it at Google Books - Find it at Amazon
Incoming Links
- Nasociliary nerve
- Extraocular muscle nerve supply (mnemonic)
- Ocular depressors
- Ocular abductors
- Orbital apex
- Ocular globe
- Internal palpebral artery
- Brown syndrome (orbit)
- Duane syndrome
- Superior oblique myokymia
- Orbital nerve supply
- Extraocular muscles
- Trochlear nucleus
- Trochlear nerve palsy
- Trochlea (eye)
- Eye movements
- Supraorbital artery
- Extraocular muscle involvement in thyroid associated orbitopathy (mnemonic)
- Lateral rectus muscle
- Frontal bone
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