!Eyes - Eye Muscles

!!Anatomy
We have extra- and intraocular eye muscles. The intraocular muscles are described in the chapter "((Sensory - Eyes - Iris|Iris - Ciliary body))". The __extraocular muscles__ are ((Musculoskeletal - Skeletal Muscles|striated muscles)), voluntarily and unvoluntarily controlled. The unvoluntary control and alignment is directed by the midbrain and ((Musculoskeletal - Muscle Fascia|muscle fascia)). When these muscles are habitually contracted , they have the ability to change the shape of the eyeball, which leads to shortsightedness or squint. The eye muscles are the fastest reacting muscles of the body.

Five of the extraocular muscles have their origin in the back of the orbit in a ((Musculoskeletal - Connective Tissue|fibrous)) ring called the __annulus of Zinn__: the four rectus muscles and the superior oblique muscle. The four rectus muscles attach directly to the __sclera of the front half of the eye__. 
*The __superior and inferior recti__ do not pull straight back on the eye, because both muscles also pull slightly medially. This posterior medial angle causes the eye to roll with contraction of either the superior rectus or inferior rectus muscles. 
*The __superior oblique muscle__ originates at the back of the orbit,  getting rounder as it courses forward to a rigid, cartilaginous pulley, called the trochlea, on the upper, nasal wall of the orbit. It travels posteriorly for the last part of its path, going over the top of the eye. Due to its unique path, the superior oblique, when activated, pulls the eye downward and medially.
*The __inferior oblique muscle__ originates at the lower front of the nasal orbital wall, and passes under the LR to insert on the lateral, posterior part of the globe. Thus, the inferior oblique pulls the eye upward and laterally. 

{img fileId="64" thumb="y" rel="box[g]"} 

{img fileId="65" thumb="y" rel="box[g]"} 

The eye muscles are controlled by 3 __cranial nerves__:
*N. oculomotorius (Cranial nerve III) supplies 4 of 6 external eye muscles plus the levator palpebrae
*N. trochlearis (Cranial nerve IV) controls the superior oblique muscle
*N. Abducens (Cranial nerve VI) controls the rectus lateralis muscle

{img fileId="208" thumb="box"} Cranial nerve origin, view from below

graphics: [https://commons.wikimedia.org/w/index.php?curid=7510715|Patrick J. Lynch]

!!Brain
{img fileId="202" thumb="box"}brain parts

{img fileId="123" thumb="box"}cerebral cortex areas

!!!Relay:
1. __Cerebral Cortex__ ( - | + ) lateral motoric area left & right, for motoric innervation
{img fileId="104" thumb="box"}

2. __Cerebral Medulla__ ( - | + ) frontal for muscle trophic
{img fileId="175" thumb="box"}

3. __Midbrain__ (+/-)-pattern for muscle fascia and muscle alignment
compare Brain Stem: {img fileId="190" thumb="box"}

!!Mind
!!!Theme:
1. (CC): Not able to evade visual stress

2. (CM): Visual Overwhelm and Strain, Self-devaluation

3. (MB): Endure visual stress

!!!Emotions, Thoughts:
__Pressure, frustration, resistance__
*This is too much and I can’t see it anymore. 
*Why can´t I see that? 
*I have to recognize that!
*I mustn't lokk there!
*I can't look away!
*I need to find the way out!

!!!META-Meaning:
*Now, I see the beauty and ease in life.
*I use all my senses to get a complete picture.
*When I am calm, I feel powerful to perceive everything.

!!Organ
!!!Stress Phase Symptoms:
1. (CC): Transmission reduction in the affected cranial nerve, __paresis/paralysis__ in certain eye muscles.

2. (CM): After a self-devaluation concerning vision, weakening and cell loss (__dystrophy, necrosis__) in muscles can be detected. This often follows theme 1 or 3. In imbalances, a squint develops (__strabism__).

3. (MB): Tension in eye muscles. The possible symptoms are eye fatigue, changes in the shape of eyeballs and thereby nearsightedness (__myopia__) or farsightedness (__hyperopia__). These forms of vision defects can be treated with eye relaxation exercises or vision training.

!!!Regeneration Phase Symptoms:
1. (CC): Fluctuating return of function.

2., 3. Relaxation of eye muscles, increased muscle trophic and tissue replenishment. By the Cerebral Medulla reaction pattern, this reinforcement can lead to reduced flexibility and __myopia__, __astigmatism__ or squint (__strabism__).

!!!Healing Peak
Spasms, twitching or muscle tic. The direction of the tic reveals the attempted way out of the threat.

!!!Biological Meaning:
1. (CC): Short-termed paralysis "playing dead" is an emergency survival strategy. 

2., 3. The muscular tension in stress phase is meant to help to focus on the aim, as well as the strengthening of the tissue after finished regeneration.

!!Social
!!!Examples:
*The patient is overworking and is overexerting his eyes with computer work. His nearsightedness gets stronger.
*A mother of four is overwhelmed by the task of keeping all children under control, she can´t have an eye on all at the same time. She gets far-sighted.
*A baby is separated from her mother after birth. Her left eye muscles become partly paralyzed. (Klapp)

!!Additional Information
Although under voluntary control, most eye movement is accomplished without conscious effort. The III, IV, and VI cranial nerves are involved in the innervation of the extraocular eye muscles, meaning that there are __nerve fibers from brain stem, cerebral medulla and cortex__ (with their emotional representations) connected.

The __vestibulo-ocular reflex__ stabilizes images on the ((Sensory - Eyes - Retina|retina)) during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. This reflex is driven by signals from the ((Sensory - Ear Inner - Vestibular System|vestibular system)) in the inner ear.

!!!Constellations:
__Visual Megalomania __(Muscles of both eyes/hemispheres affected): often combined with visual constellation in Cerebral Cortex producing visions or hallucinations.

!!!Differential Diagnosis:
__((Sensory - Eyes - Retina|Retina ))__(Cerebral Cortex -/+): Ulceration in stress phase (persecution fear); retina detachment in regeneration phase A, degenerative processes in long or repeating processes. Short- or far-sightedness can then be residual states.

__((Sensory - Eyes - Crystalline Lens|Crystalline Lens)) __(Cerebral Cortex -/+): Decrease in trophic, thinning of the lense in stress phase (lost meaning in life); reinforcement and possibly loss of elasticity in regeneration phase, leading to presbyopia, astigmatism or myopia.

__((Sensory - Eyes - Cornea|Cornea)) __(Cerebral Cortex -/+): Loss of visual contact - Processes of thinning/damage and reinforcement can lead to changed shape of the cornea, resulting in astigmatism.

__((Urinary - Kidneys - Collecting Tubules|Kidney Collecting Tubules)) Constellation__(Brain Stem +/-): produces a divergent squint (strabismus divergens) with the goal of circumferential vision without movement. ("Waiting for things to change")
