The first description of the eye muscle pulleys by Philibert C. Sappey (1888)

In this issue of Strabismus, in our Section ‘History of Strabismology’ that has already featured the first descriptions of ocular counterrolling (1838), strabismus surgery (1839–1840), Donders’ Law (1846), Listing’s Law (1853), Panum’s area (1858), Bielschowsky’s head-tilt test (1871) and other masterpieces, we present an English translation of the first description of the pulleys, or ‘poulies’ as they were actually first called. The need for eye muscle pulleys was evident in David Robinson’s model of eye muscle cooperation (1975). The shortest mathematical path of an eye muscle from origin to insertion is a great circle over the globe, but if that were always true, the bellies of the medial and lateral rectus muscles would move upward in upgaze, for example, and become elevators. David Robinson handled this problem by limiting the permitted twist of the tendon of the muscle at the insertion. Joel Miller from San Francisco, Richard Clement (now at the Childrens Hospital in Great Ormond Street, London) and I later studied Robinson’s model and all three of us have tried to find a better solution.

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