Anatomic and topographic features of oculomotor muscles and clinical manifestations in children with vertical strabismus

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Aim: To determine the anatomic and topographic features of the lateral (LRM) and medial rectus (MRM) muscles of the eyeball and clinical manifestations in children with vertical strabismus.

Material and methods: We examined 50 children aged 4–10 years with congenital squint (vertical, 38; horizontal, 12). Ophthalmologic, ultrasonography, and intraoperative studies were performed. Using the anatomic and topographic parameters of the LRM and MRM, the α angle (the angle of attachment of the tendons of these muscles) was determined.

Results: With horizontal divergence and convergence deviations of the eyeball from (±) 20 to (±) 70 prism, diopter angle α does not exceed 8°, with a combination of horizontal deviations from (±) 20 to (±) 70 and vertical deviations from 8 to 10 prism diopters and higher, the α angle varies from 10° to 20°. Moreover, the increase in the α angle is proportional to the increase in horizontal and vertical deviations of the eye. The echographic parameters of the thickness of the MRM and LRM in children with vertical and horizontal strabismus significantly exceed intraoperative ones (by 1.5–2.15 mm on average), which could be attributed to technical limitations in measurement.

Conclusion: The identified features, according to the authors, must be taken into account in surgery correction of vertical strabismus in children, that is when determining surgical dosage for resection, recession, and transposition of the horizontal muscles.

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About the authors

Lola S. Khamraeva

Tashkent Pediatric Medical Institute

Author for correspondence.
ORCID iD: 0000-0003-0221-702X

Uzbekistan, 100140, Tashkent, Bagishamal str., 223


Acida O. Giyasova

Tashkent Pediatric Medical Institute


Uzbekistan, 100140, Tashkent, Bagishamal str., 223


Lyubava Y. Bobokha

Tashkent Pediatric Medical Institute

ORCID iD: 0000-0002-8075-3293

Uzbekistan, 100140, Tashkent, Bagishamal str., 223



  1. Klyuka IV, Serdyuchenko VI. Methods for diagnosing binocular vision disorders with vertical strabismus. Oftal’mologicheskiy zhurnal. 1983;(7):439-41. (in Russian)
  2. Safina ER, Gabdrakhmanova AF, Verzakova IV. Possibilities of a complex ultrasound examination for concomitant strabismus in children. Vestnik oftal’mologii. 2011;(1):16-9. (in Russian)
  3. Spalton DJ, Hitchings RA, Hunter PA. Atlas of clinical ophthalmology. [Atlas po klinicheskoi oftal’mologii]. Moscow: MEDpress-inform; 2007. (in Russian)
  4. Aubakirova AZh. Vertical strabismus and tactics of its treatment. Oftal’mokhirurgicheskiy zhurnal. 1990;(4):221-3. (in Russian)
  5. Vasilevskaya NN. omparative evaluation of the effectiveness of treatment of children with strabismus, taking into account the initial clinic. Vestnik novykh meditsinskikh tekhnologii. 1999;2(4):96-8. (in Russian)
  6. Li Y, Zhao K. Superior oblique tucking for treatment of superior oblique palsy. J. Pediatr. Ophthalmol. Strabismus. 2014; 51(4):249-54. doi: 10.3928/01913913-20140527-01.
  7. Pineles SL, Velez G, Velez FG. Asymmetric inferior oblique anterior transposition for incomitant asymmetric dissociated vertical deviation. Graefes Arch. Clin. Exp. Ophthalmol. 2013; 251(11):2639-42. doi: 10.1007/s00417-013-2445-x.
  8. Klyuka IV, Serdyuchenko VI. Restoration of binocular functions as a result of surgical correction of vertical strabismus. Oftal’mologicheskiy zhurnal. 1985;40(2):73-7. (in Russian)
  9. Pen’kov MA, Konstantinovskaya KE. The condition of the external rectus muscles of the eye with different duration of strabismus. Oftal’mologicheskiy zhurnal. 1997;(3):439-41. (in Russian)
  10. Kanyukov VN, Kagan VI, Taiguzin RSh. Eksperimental’no morfologicheskoe obosnovanie mikrokhirurgii glazodvigatel’nykh myshts pri kosoglazii. In: Malyugin BE, Ivashina AI, Kachalina GF, Klimova TL, Pronina II, Yudaeva LL, ed. Fedorov readings: Collection of scientific articles. [Fedorovskie chteniya: Sbornik nauchnykh statei]. Moscow: Stolichnyi biznes; 2002:140-5. (in Russian)
  11. Robaei D, Rose KA, Kifley A, et al. Factors associated with childhood strabismus: findings from a population-based study. Ophthalmology. 2006;113(7):1146-53. doi: 10.1016/j.ophtha.2006.02.019.
  12. Asadova ShA. Efficiacy of the combined surgery for the treatment of superior oblique muscle palsy. Oftal’mologiya. 2009;(1):30-5. (in Russian)
  13. Zhukova OV, Markova TA, Zolotarev AV. On the question of dosing the effect of surgery in the surgical treatment of convergent strabismus in children. In: Proceedings of the National Russian Conference dedicated to the 105th anniversary of the birth of T.I. Eroshevsky. [Trudy Vserossiiskoi konferentsii, posvyashchennoi 105-letiyu so dnya rozhdeniya T.I. Eroshevskogo]. Samara; 2017:644-7. (in Russian)
  14. Kashchenko TP, Tarastsova MM. Study of binocular vision with color filters of increasing density. Oftal’mologicheskii zhurnal. 1985;(8):498. (in Russian)
  15. Caldeira JA. V-pattern esotropia: a review, and a study of the outcome after bilateral recession of the inferior oblique muscle, a retrospective study of consecutive patients. Binocul. Vis. Strabismus, 2003;18(1):35-48.
  16. Trifanenkova IG, Tereshchenko AV, Vydrina AA, et al. Stages in the surgical treatment of mixed strabismus with weakness of the superior oblique muscle. Sovremennye tekhnologii v oftal’mologii. 2017;(5):72-5. (in Russian)
  17. Churnova NS. The use of ultrasound in children with concomitant strabismus. Tochka zreniya. Vostok-Zapad. 2014;(1):246-8. (in Russian)
  18. Shchuko AG, Zhukova SI, Yur’eva TN. Ultrasound diagnostics in ophthalmology. [Ul’trazvukovaya diagnostika v oftal’mologii]. 2nd ed. Moscow: Oftal’mologiya; 2015. (in Russian)
  19. Barsegyan ML, Gabrielyan AR. On the issue of surgical treatment of concomitant horizontal-vertical strabismus. Vestnik stomatologii i chelyustno-litsevoi khirurgii. 2012;(4):26-8. (in Russian)
  20. Polyn’ VD. Clinical characteristics of vertical strabismus and the doctor’s tactics when choosing an operation. VI scientific-practical conference of eye doctors of the Krasnoyarsk region. [VI-nauchno-prakticheskaya konferentsiya glaznykh vrachei Krasnoyarskogo kraya]. Krasnoyarsk; 1972:115-8. (in Russian)
  21. Agafonova VV, Mitronina ML. Possibilities noninvasive visualization of extra-ocular muscles within surgical treatment of operated strabismus. Meditsinskaya vizualizatsiya. 2012;3:85-88. (in Russian)
  22. Buckley SA, Elston JS. Surgical treatment of supranuclear and intemuclear ocular motility disorders. Eye (Lond.). 1997; 11(Pt 3):377-80. doi: 10.1038/eye.1997.79.
  23. Donahue SP. Itharat P. A-pattern strabismus with overdepression in adduction: a special type of bilateral skew deviation. J. AAPOS. 2010;14(1):55-9. doi: 10.1016/j.jaapos.2009.11.009.
  24. Han J, Han SY, Lee JB, Han SH. Surgical management of long-standing antielevation syndrome after unilateral anterior transposition of the inferior oblique muscle. J. AAPOS. 2014;18(3):232-4. doi: 10.1016/j.jaapos.2013.12.002.
  25. Tibrewal S, Pehere N, Sachdeva V, Kekunnaya R. Inferior oblique transposition for large hypertropia after vertical rectus transposition. J. AAPOS. 2013;17(3):312-4. doi: 10.1016/j.jaapos.2012.12.154.
  26. Velez FG, Ela-Dalman N, Velez G. Surgical management of dissociated vertical deviation associated with A-pattern strabismus. J. AAPOS. 2009;13(1):31-5. doi: 10.1016/j.jaapos.2008.09.006.
  27. Avetisov ES. Concomitant squint. [Sodruzhestvennoe kosoglazie]. Moscow: Meditsina. 1977. 311 p. (in Russian)
  28. Levchenko OG, Pisarevskii SL. Diagnostics and surgical treatment of children with vertical strabismus. [Diagnostika i khirurgicheskoe lechenie detei s vertikal’nym kosoglaziem]. Tashkent: Abu Ali Ibn Sino; 1995. 61 p. (in Russian)
  29. Krasnov ML, Belyaev VS. Eye surgery guide. [Rukovodstvo po glaznoi khirurgii]. 2nd ed. Moscow: Meditsina; 1988. (in Russian)
  30. Somov EE. Selected sections of pediatric clinical ophthalmology. [Izbrannye razdely detskoi klinicheskoi oftal’mologii]. St. Petersburg: Chelovek; 2016. (in Russian)

Supplementary files

Supplementary Files Action
Fig. 1. Scans of oculomotor muscles (ocular muscles are visualized as tubular hypoechoic bands) A — internal rectus muscle. B — external rectus muscle.

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Fig. 2. Measurement of the attachment point of the muscle tendon-the distance from the limb.

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Fig. 3. measurement of muscle thickness.

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Fig. 4. Oblique attachment of the external rectus muscle of the eyeball.

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Fig. 5. Diagram of measuring the angle (α) of attachment of the muscle tendon. a — limb, b — muscle tendon attachment line (connects the upper and lower attachment points), с — a line drawn from the point of closest attachment of the muscle tendon, parallel to the limb, α — is the angle formed between lines b and с.

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