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Extraocular Muscle: Cellular Adaptations for a Diverse Functional Repertoire

Abstract: Oculomotor control systems are considerably more complex and diverse than are spinal skeletomotor systems. Moreover, individual skeletal muscles are frequently functional role‐specific, while all extraocular muscles operate across a very wide dynamic range. We contend that the novel phenotype of the extraocular muscles is a direct consequence of the functional demands imposed upon this muscle group by the central eye movement controllers. This review highlights five basic themes of extraocular muscle biology that set them apart from more typical skeletal muscles, specifically, the (a) novel innervation pattern, (b) heterogeneity in contractile proteins, (c) structural and functional compartmentalization of the rectus and oblique muscles, (d) diversity of extraocular muscle fiber types, and (e) relationship between the novel muscle phenotype and the differential response of these muscles in neuromuscular and endocrine disease. Finally, new data from broad genome‐wide profiling studies are reviewed, with global gene expression patterns lending substantial support to the notion that the extraocular muscles are fundamentally different from traditional skeletal muscle. This novel eye muscle phenotype represents an adaptation that exploits the full range of variability in skeletal muscle to meet the needs of visuomotor systems.