Effect of aging on human rectus extraocular muscle paths demonstrated by magnetic resonance imaging

To compare normal functional anatomy of rectus extraocular muscles (EOMs) and pulleys in normal older humans with previously reported findings in younger subjects.

Experimental study of the orbits of normal healthy older volunteers by magnetic resonance imaging (MRI).

In planes perpendicular to the orbital axis, contiguous MRI images spanned the anteroposterior extents of 22 orbits in 12 older adults with an average age of 65.2 years (range, 56-74). Images were obtained in central gaze in all subjects and repeated in supraduction, infraduction, abduction, and adduction in some subjects. Mean EOM cross-sectional area centroids were normalized to an oculocentric coordinate system and plotted over the length of each EOM to determine paths.

Compared with images obtained using identical technique in 12 younger subjects (average age, 28.5 years, range 21-33), the horizontal rectus EOMs in the 12 older subjects were significantly displaced inferiorly throughout the anteroposterior extent of the orbit. The vertical rectus EOM was positioned identically to those of younger subjects. Inflections in EOM paths produced by the connective tissue pulleys could not be determined in most older subjects, because of difficulties in maintaining extreme eccentric gaze. For one subject who was able to do this, the anteroposterior location of the medial rectus pulley inferred from path inflection was similar to that of younger subjects.

The horizontal rectus EOMs are displaced inferiorly in the elderly relative to the globe center. This displacement presumably reflects an inferior location of the corresponding pulleys, partially converting horizontal rectus EOM force to depression. This may contribute to the observed impairment of elevation in older people and predispose them to a characteristic pattern of incomitant strabismus.