Redefining all check ligaments of extraocular muscles using true color sectioned images

Abstract Purpose Visualizing the check ligaments of extraocular muscles is essential to understand their role as stabilizers of the extra-ocular muscles, acting as their antagonists. Although all extraocular muscles are expected to have corresponding check ligaments, this is not consistently documented in anatomical literature. This study aims to clarify the check ligaments using acquired high-resolution true color sectioned images and surface modeling. Methods From the sectioned images of one male cadaver, the check ligaments and related structures were outlined and surfaces models were reconstructed using 3D Slicer and Maya to analysis their morphology. Results The seven check ligaments corresponding to the seven extraocular muscles, along with the supporting ligaments, were clearly delineated. Previously unrecognized attachment points of the check ligaments, especially to fasciae, were highlighted. In addition to exploring in more detail the tendinous role of Whitnall’s ligament and Lockwood’s ligament, we focused on the morphology of the ligaments on the lower eyelid. Conclusion Through the reconstruction of surface models based on true color sectioned images, we were able to differentiate all extraocular check ligaments and supporting structures, aligning to their respective roles.