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  Upper Limb  
  Lower Limb  
orbit - superior rectus
Superior rectus, inferior rectus, superior oblique, inferior oblique-
During abduction of the eye, the SR (superior rectus) is the main elevator and the IR (inferior rectus) is the main depressor. During adduction of the eye the IO (inferior oblique) is the main elevator and the SO (superior oblique) is the main depressor.
Strabismus is a disorder where the optic axes of the eyes are not fixed on the same point, leading to diplopia (double vision). Hypertropia refers to the condition where one eye aims higher than the other. Diagnosis of paresis or paralysis of the extraocular eye muscles can be made by eliciting eye movements that call suspected muscle into action. For example, if right SO paralysis is suspected, ask the patient to look down and to the left in an adducted position, the right eye requires the action of the right SO and so if there is a problem with the SO, the right eye will be elevated relative to the left.

When patients with strabismus hold their heads in an unusual position that allows their optic axes to converge on the same point to avoid diplopia, this head positioning is termed ocular torticollis.

The Bielschowsky head-tilt test is a method used to test the oblique and recti muscles eliciting their cyclorotatory actions. When the neck the laterally flexed (such as when an ear touches the ipsilateral shoulder) the ipsilateral eye incycloducts and the contralateral eye excycloducts. During neck flexion as the SO incycloducts and depresses, the SR elevates to cancel out vertical movement and incylcoduction prevails; as the IO excycloducts and elevates, the IR depresses and excyloduction prevails. So, if there is a problem with one of the muscles in a pair (SO/SR or IO/IR) the ipsilateral eye will deviate vertically due to unopposed action of the unaffected muscle.
For example, upon a head tilt to the right, the right eye in a patient with right SO paralysis will deviate upward due to an unopposed SR. This test is generally more useful for detecting SO or IO problems.
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