Aim: To review the clinical implications of rectus extraocular muscle (EOM) pulleys in normal subjects and those with incomitant strabismus.
Methods: A literature-based review of rectus EOM pulleys in normal and abnormal ocular motility is presented.
Results: Rectus EOM pulleys stabilise the EOM path and support the dynamic role of the direction of muscle pull in ocular motility. The coronal plane location of each rectus pulley in relation to the orbital wall is highly uniform and stable across normal subjects when the eyes move from primary into secondary gaze positions. Studies of Incomitant strabismus associated with advancing age, alphabet patterns, high myopia or dysfunction of oblique EOMs, have provided evidence that resultant patterns of strabismus and/or abnormal ocular motility may depend on static pulley positions, pulley instability and coexisting globe translation.
Conclusion: Rectus EOM pulleys are fundamental to ocular motility and should be considered in the differential diagnosis of patients with incomitant deviations.