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1 From the Departments of Ophthalmology and 2 Neurology, Jules Stein Eye Institute, University of California, Los Angeles; and the 3 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PURPOSE. Orbital and global layers of rectus extraocular muscles (EOMs) are believed to serve different functions. This study sought anatomic and functional evidence of differing blood flow in the two layers of rectus EOMs.
METHODS. Four human orbits ranging in age from 17 months to 93 years were
serially sectioned and stained for muscle fibers with Masson’s trichrome and for vascular smooth muscle with monoclonal antibody to smooth muscle 
-actin. Digitally assisted microscopy was used to
obtain measurements of luminal cross sections and counts of muscular blood vessels, as well as measurements of muscle fiber number and cross-sectional areas of the two layers. Findings were correlated with
first-pass gadodiamide contrast magnetic resonance imaging (MRI) in two
living humans to demonstrate relative perfusion of EOMs.
RESULTS. In all rectus EOMs, the orbital layer had significantly more vessels per unit area, more vessels per fiber, and more total vascular luminal area, than the global layer (P < 0.05). Vascularity of EOMs was greatest in the youngest specimen. First-pass contrast MRI was consistent with perfusion of the orbital layer earlier than the global layer of living human rectus EOMs.
CONCLUSIONS. Orbital layers of human rectus EOMs have significantly more muscular vessels than the global layers and stain earlier after intravenous bolus injection of paramagnetic MRI contrast. These findings suggest higher and even more rapid blood flow in the orbital layers that may correlate with greater metabolic activity. Greater blood flow is consistent with more sustained mechanical loading of the orbital than the global layer.
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