Dear Editor:

With reference to the article “Guidelines for the Ophthalmologic Examination: An Approach for Medical Students and General Practitioners,” published in Universitas Médica in 2017 (1), we would like to acknowledge its educational value and the sustained circulation it has received since publication. We consider this article a valuable resource for the clinical training of students and healthcare professionals. However, we believe it is important to raise a specific observation aimed at strengthening the anatomical accuracy of the published content.

Figure 18, which depicts the extraocular muscles and their movements, presents an inaccurate representation of the superior oblique muscle, omitting its course through the orbital trochlea. This structure is essential for understanding the biomechanics of the muscle, as it redirects its course toward the posterosuperior aspect of the globe.

From an anatomical standpoint, the superior oblique originates from the body of the sphenoid, superomedial to the optic canal and outside the common tendinous ring; it then courses through the trochlea, located at the superomedial angle of the orbit, and reflects posteriorly and laterally to insert into the posterosuperior quadrant of the sclera (2). This trochlear arrangement determines the muscle’s vector of pull and explains its characteristic actions: intorsion, depression—maximal in adduction—and abduction (3). Omission of its passage through the trochlea and oversimplification of its insertion may lead to interpretive errors, particularly in clinical settings such as the assessment of diplopia or fourth cranial nerve palsy.

Although we recognize that diagrams are intended for educational purposes and often involve simplification, we believe that even simplified representations should preserve anatomical fidelity, particularly in an academic journal with an educational mission such as Universitas Médica. The literature on anatomy education has emphasized that discrepancies between the anatomy depicted in atlases and textbooks and actual anatomy are not inconsequential: they influence the subsequent recognition of anatomical structures and have been associated with errors in clinical practice (4). The teaching of orbital anatomy has important implications, ranging from the diagnosis of strabismus to the assessment of complex orbital trauma (5).

Therefore, in a spirit of academic collaboration, we appreciate your consideration of this observation, which is offered respectfully and with the aim of contributing to the scientific and educational excellence that distinguishes Universitas Médica.

Sincerely,

Dr. Álvaro Puelles-Díaz

Anatomist

Funding

None.

Conflict of Interest

The author declares no conflicts of interest.

References

Author notes

Correspondence address: apuelles@userena.cl