Eye muscle exercise

Original Editor - Aarti Sareen Top Contributors - Khloud Shreif, Aarti Sareen and Lucinda hampton

Introduction

Anatomy of eye

The eye divided into three layers; the outermost layer is a fibrous layer and it is consists of the cornea that is transparent located at the center of the eye, the sclera is white and covers the rest of the eye. The second layer is a vascular layer it is consists of the choroid (contain blood supply to the retina), the iris (contains pupils and smooth muscles that controls its diameter[1]), and the ciliary body which is a tissue extends from the sclera and attaches to the lens via suspensory ligament. The inner layer and it contains the retina.

The extraocular muscles are seven muscles supplied by cranial nerves that are responsible for eye movement, in some cases when these nerves are affected consequently they affect eye movements.

Eye Muscles

The ocular movement occurs around the three axis[2]:

  • Adduction (medial pupil movement toward nose)/ Abduction (lateral pupil movement) around the vertical axis.
  • Elevation (superior movement)/ Depression (inferior movement) around the transverse axis.
  • Intorsion/ Extorsion (the movement away and toward nose) that we need during tilting the head around the anteroposterior axis
The seven muscles of extraocular muscles divided into 4 recti, 2 obliques muscles, and one levator palpebrae superiors that are responsible for elevation of the superior eyelid.[3]
Extraocular muscles
Muscle Origin Insertion Nerve supply Action
Superior rectus common tendinous ring superior and anterior aspect of sclera oculomotor nerve (cranial nerve III) elevation and contributes to adduction and intorsion
Inferior rectus inferior and anterior aspect of sclera depression and contributes to adduction and extorsion
Medial rectus medial aspect of sclera adducts eye
Lateral rectus lateral aspect of sclera abducens nerve (cranial nerve VI) abducts eye
Superior oblique body of sphenoid bone at sclera posterior to superior rectus Trochlear nerve cranial nerve IV) abduction, depression, and intorsion of eye
Inferior oblique anterior aspect of orbital floor at sclera posterior to lateral rectus. Oculomotor nerve (cranial nerve III) abduction, elevation, and extortion of eye
Levator palpebrae superiors sphenoid bone superior eyelid oculomotor nerve (cranial nerve III) elevation of the superior eyelid.
Oculomotor N palsy lt eye

Clinical Significance

Extraocular muscle paralysis may happen due to injury or disease according to the cranial nerve that will be affected, palsy of the oculomotor nerve will affect the majority of extraocular muscles and the eye ill adopted in a down and out position. Palsy of the abducens nerve will affect the lateral rectus and the eye will be addicted by medial rectus. If the trochlear nerve is affected the patient will complain of diplopia[4].

Strabismus, due to abnormalities in neuromuscular control weakness or injury to the inferior rectus muscle may be involved.[5]

Horner's syndrome

Horner's syndrome.

Assessment Of Extraocular Muscles

Assessment of extraocular muscle function can be done by asking the patient to look in nine directions by following the clinician's finger as he draws ''H'' in the air. The patient will look at up, down, right, left, up and right, up and left, down and right, down and left.[5]

Ocular alignment is tested by several methods, for example, corneal-light reflex.

Effect Of Eye Muscle Exercises

Who benefits from exercises:

Images.jpg.jpg
  • Digital eye strain as in people who work on a computer for along time and that may cause dry eyes, eye strain, blurred vision, and headaches.
  • Increased light sensitivity.
  • A surgery that needs strengthening the muscles
  • If there is a problem in focusing eyes to read.
  • Convergence insufficiency.
  • Lazy eye that develops in some children - eye exercises stimulate the vision centers in the brain[6][7].

Effect of oculomotor and gaze stability exercise:

  • Ocular-motor exercises improve dynamic visual acuity (DVA) in dynamic sports that have a significant effect on athletes' performance for example basketball, in this study on female basketball players the intervention was for four weeks 6 sessions per week for ten min twice daily [8].
  • Gaze and ocular-motor improve balance and stability in normal adults[9] and a study proves that it may be promising to improve balance after stroke[10].
  • These exercises improve symptoms of eye fatigue[11], strengthen the extraocular muscles.
  • Relief eye strain, improve blinking.

Eye Muscles Exercises

  • Blinking exercises is like a rest for your eyes it helps to keep them fresh and focus for a longer time. Blinking improves symptoms of digital eye strain, dry eye, and blinking habits[12], a ten-second of blinking exercises every 20 minutes will be with the help.
  • Eye movement, slowly move your eyes up and down and repeat for three times then again move your eye slowly from right to left and repeat for three times then rest.
Figure-Eight-Improved-Vision.jpg
  • Figure of 8, another exercise for eye movement, imagine there is a large figure of 8 away 8-9 feet from you, then move the eye in the direction of this infinity loop for about 30 seconds then switch the direction.
  • Focus change, hold your finger a few inches away from you and focus the gaze on it then focus on another thing away from you, now return the gaze to your finger.
  • Pencil pushups[13]. the patient holds a pencil/patient's thumb on outstretched arm midway between eyes, instruct the patient to try to keep the single image of the pencil while slowly moving the pencil toward the nose till it is not possible to see the pencil in a single image anymore, now ask the patient to move it slowly away to the closest point where there is a single image of pencil achieved. This exercise help patients with symptomatic convergence insufficiency.
  • Brock string it shows to improve convergence and eye coordination[14][15].

For more exercises description:

Ocular-motor exercises. physiopedia page.

Gaze stabilization exercises.

References

  1. Rehman I, Hazhirkarzar B, Patel BC. Anatomy, head and neck, eye. StatPearls. 2019 Abril.
  2. Rehman I, Hazhirkarzar B, Patel BC. Anatomy, head and neck, eye. StatPearls. 2020 May.
  3. https://geekymedics.com/eye-anatomy/
  4. https://teachmeanatomy.info/head/organs/eye/extraocular-muscles/
  5. 5.0 5.1 Shumway CL, Motlagh M, Wade M. Anatomy, head and neck, eye extraocular muscles. InStatPearls [Internet] 2019 Jun 26. StatPearls Publishing.
  6. https://www.healthline.com/health/eye-health/eye-exercises
  7. https://www.webmd.com/eye-health/eye-exercises
  8. 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.
  9. 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.
  10. 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.
  11. Gupta SK, Aparna S. Effect of yoga ocular exercises on eye fatigue. International Journal of Yoga. 2020 Jan 1;13(1):76.
  12. 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.
  13. 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.
  14. Kirscher DW. Sports vision training procedures. Optometry clinics: the official publication of the Prentice Society. 1993;3(1):171-82.
  15. 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.
  16. drvickyfischer. drvickyfischer. Available from: http://www.youtube.com/watch?v=BuvMrCAt6TU[last accessed 4/6/2020]
  17. iDoc2008. Brock String Training Video. Available from: http://www.youtube.com/watch?v=EGlCVTdNqfw[last accessed 4/6/2020]