Abstract
PURPOSE: Connective tissue pulleys inflect the extraocular muscles (EOMs) and receive insertions from some fibers. The authors investigated insertions and anatomic relationships of fiber fascicles within rectus EOMs to clarify the relationship to their pulleys. METHODS: Two human and two monkey orbits were removed intact, serially sectioned in the coronal plane, histologically stained, and digitally photographed. The authors traced representative fascicles in the human medial rectus (MR) and inferior rectus and monkey lateral rectus and superior rectus muscles. In the human MR, the authors computed average collagen fractions in the orbital layer (OL) and the global layer (GL). RESULTS: In human and monkey, OL fascicles remained distinct from each other and from the GL throughout. Most OL fascicles were inserted into the pulley through short tendons. Most GL fascicles bypassed the pulley without insertion. Collagen content in the human MR OL increased from 29% +/- 5% (SD) in midorbit to 65% +/- 9% in the anterior orbit but slightly decreased from 26% +/- 6% to 23% +/- 1% in the GL. Tracing of every fiber in a human MR OL fascicle demonstrated terminations on pulley tendons without myomyous junctions. CONCLUSIONS: Fibers in the primate rectus OL lack myomyous or GL junctions, but nearly all insert on the pulley through a broad distribution of short tendons and dense intercalated collagen. Fibers in the GL generally do not insert on pulley tissues and are associated with less collagen. These features support the distinct role of the OL in anteroposterior positioning of connective tissues proposed in the active pulley hypothesis and substantial mechanical independence of the OL and GL.