Anatomy 6.

February 21, 2012

Dr.Cristina Elma-Zulueta

Visual Pathways
OUTLINE
I. Anatomy of the Eyes and Optics
II. Visual Pathways
III. Visual Field
A. Visual Field Defects
IV. Visual Reflex Pathway
A. Pupilary Light Reflex
B. Accommodation Reflex
C. Pupilary Dilatation
V. Visual Pathways II
A. Extraocular Muscles
B. Cranial Nerves Concerned in Eye Movements
C. EOMs Innervation
D. Neural Bases of Extraocular Movement
E. Medial Longitudinal Fasciculus
F. Saccadic System
G. Dolls Eye Reflex

II. VISUAL PATHWAY

Retinal Field is the actual pathway
o Something seen on the retinal field at the superotemporal side, it
is projected in the inferonasal side on the visual field. This is
due to the optical properties of the lens that will invert and
reverse the image.
- The image is INVERTED and REVERSED.

I. ANATOMY OF THE EYES AND OPTICS

Light Cornea (greatest refractive index) Aqueous humor
Lens Vitreous humor Retina (Transduction in the rod and
cone cells; the only nervous part of the eye)

Fig 2:Visual Pathway

Fig 1: Anatomy of the Eyes

Ciliary muscle- contracts: thickening of the lens; suspensory

ligament relaxes
Pupil- controlled by sphincter (constrict) and dilator (dilate)
papillae
Retina: Ganglion cell layer- forms optic nerve
o Cones color vision and high visual acuity
o Rods light perception and low visual acuity with good contrast
o Layers 4,6,7,8- the only layers with cell bodies
Fovea Centralis
o A small depression at the center of the macula lutea
o Area of the most acute vision
o Only closed packed cones are present
o Each cone projects to one ganglion cell mediating high
resolution
Peripheral Retina
o There are more rods than cones
o Many project to a single ganglion cell mediating high light
sensitivity but poor resolution
Physiologic Blind Spot
o Temporal side of the macula lutea
o Corresponds to the optic disc which has no rods and cones

Pathway:
1. Receptor Photoreceptors: Rods and cones
2. N1 bipolar neurons (Retina)
3. N2 ganglion cells(Retina)
Axons of ganglion cell becomes the optic nerve. Fibers that
arise from retina eventually goes to the Lateral Geniculate
Body. (hearing and vetibular sys. medial geniculate body)
Retinogeniculate fibers: (1)will form the optic nerve (2) join the
optic chiasm (3) go to the optic tract
Note: A small number of axons terminate in the
suprachiasmatic nucleus of the hypothalamus (circadian
rhythm).
4. N3 Lateral Geniculate Body (LGB) of the Thalamus
Lateral projections at the LGB-Meyers Loop
Geniculocalcarine (from LGB to Calcarine cortex)
geniculostriate fibers or optic radiation
Optical Tract ending in this prominence

or

Note: The area of the cortex that receives the optic radiations
surrounds the calcarine fissure on the medial side of the occipital
lobe. The cuneus, the gyrus above the calcarine fissure receives
visual impulses from the upper quadrants of the retina / upper optic
radiation. The lingual gyrus below the calcarine fissure receives
visual impulses from the lower quadrants of the retina.

Group 8 ! |, , , , , G. J. & R.,

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5. Primary Visual Cortex

o A.k.a. Striate Cortex d/t heavy lamina of myelinated fibers at
layer 4 = the stria or lines of Gennari
o A.k.a. Broadmann Area 17, or Calcarine cortex
o Influences from BA 17 are relayed to BA 18 and 19 (visual
association areas) for interpretation of the images seen.

VF

RF
Fig 3: Visual Field

A. VISUAL FIELD DEFECTS

Fig 3: Primary Visual Cortex

At the optic chiasm:

o Partial decussation:
o Nasal fibers crosses over to contralateral side.
o Temporal fibers remain ipsilateral.
After the chiasm:
o Each fiber will contain the temporal fibers of the ipsilateral side
and the nasal fibers of the contralateral side
REVIEW:
o Light Cornea Aqueous humor Lens Vitreous humor
Retina transduction of signal in photoreceptors N1:
bipolar neurons N2: ganglion cells optic nerve
@chiasm, crossing of nasal fibers and temporal fibers stay on
same side optic tract (ipsilateral temporal and contralateral
nasal fibers) N3: LGB optic radiation upper (end up in
cuneus) and lower radiation (end up in lingual gyrus) BA 17
BA 18 & 19 for visual perception
Difference between Visual Field and retinal field:
(1) Visual Field - corresponds to the environment viewed by each
eye; final manifestation of the patient. eg. blind spot of the patient
(2) Retinal Field on the eye itself

Fig 4: Visual Field Defects

Lesions in the Visual Pathway: Lesions along the pathway from the
eye to the visual cortex result in deficits in the visual fields shown
as black areas on the corresponding visual field diagram.
Table 1. Lesions

III. VISUAL FIELD

Divided into 4 quadrants
The optical properties of the lens invert the projection of the
visual field on the retina producing an inverted and reversed
image on the retina.
Upper Retinal Quadrants- Lower Field of Vision
Lower Retinal Quadrants- Upper Field of Vision
Anything in the superior temporal quadrant in the visual field will
be projected to the inferior nasal quadrant of the retinal field

LESION
A. (R) Optic Nerve

B. Optic Chiasm

C. (R) Angle Of
Chiasm
D. (R) Optic Tract

E. (R) Optic Radiation

F. (R) 1 Visual
Cortex
G. (R) Cuneus
Group 8 ! |, , , , , G. J. & R.,

DEFECT
(R) Eye Blindness
Denervate the retina that will affect
both temporal and nasal fibers forming
the optic nerve
Bitemporal Homonymous Hemianopsia
Affects the right and left nasal retinal
fibers. After the chiasm, everything is
made up of the same fibers.
(R) Nasal Hemianopsia
Affects the right temporal retinal fibers
Contralateral Homonymous
Hemianopsia Affects right temporal
retinal fibers and the left nasal retinal
fibers
(L) Homonymous Hemianopsia
(L) Homonymous Superior Quadrantic
Anopsia
(L) Homonymous Inferior Quadrantic
Anopsia

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H. (R) Meyer Loop

(L) Homonymous Heminanopsia
Scotoma an area lost of function in the visual field.
Macular Sparing Since one cone is projected to one ganglion cell,
the representation of the macula is very big (2/3) in the primary
visual cortex. To injure the macula, you have to injure almost the
whole visual cortex or it takes a massive injury or big occlusion to
the primary visual cortex before the area of the macula is
affected.
Homonymous- both right or both left fields
Heteronymous- both temporal fields affected
Note: Macula Lutea is represented on the posterior part of B.A 17
and the periphery of the retina is represented anteriorly.

IV. VISUAL REFLEX PATHWAY

A. PUPILARY LIGHT REFLEX
Shine a light from the side to elicit papillary light reflex ->
stimulate optic nerve ->pupils of both eyes constrict
(parasympathetic) -> contraction of sphincter pupillae muscles of
the iris.
Afferent arm Optic Nerve
Efferent arm Oculomotor Nerve (innervate sphincter papillae
iris)
Direct reflex response of stimulated eye
Consensual or indirect reflex response of unstimulated eye due
to posterior commisure that goes to contralateral side and affect
the eye
Papillary dilatation - sympathetic
Pathway:
Optic nerve
Optic chiasm
Optic tract

Pretectum
(Posterior Commissure)

Edinger-Westphal nucleus

Oculomotor nerve

Ciliary ganglion

Sphincter pupillae

Fig 5: Pupillary Light Reflex

Difference of visual pathway and pupillary light reflex pathway is

that pupillary light reflex pathway will not pass to the LGB then
impulses will go to the midbrain at area of pretectal nucleus.
Postganglionic parasympathetic fibers via short ciliary nerves
innervate the sphincter papillae muscles. Long ciliary nerves will
reach the constrictor papillae
Constriction on other side is due to the posterior commissure,
which will cause impulses to reach the contralateral EdingerWestphal nucleus via the posterior commissure.
Case 1: Light was flashed on the right eye (+) Direct reflex; (-)
Consensual reflex
= impulses travel to the optic nerve, no problem in the R CN II,
(+) direct reflex = have papillary constriction on the R, R CN III
should be intact,
(-) consensual reflex = no constriction of pupil on the left
Defect: L Oculomotor nerve (Final effect did not reach L eye)
Light was flashed on the left eye (-) Direct reflex;(+) Consensual
reflex = light was seen by L CN II because you have consensual
reflex, R CN III is ok
(-) direct reflex= no constriction of the pupil on the L, L CN III
problem
Case 2: Right eye (+) Direct reflex (+) Consensual reflex
(+) Direct reflex = light seen by CN II, R CN III is okay;
(+) Consensual reflex = L CN III is not the problem
Left eye (-) Direct reflex () Consensual reflex
= no impulses recognized by CN II
Defect: L CN II
Case 3: Elicit blink reflex on the right, (+) Direct blink reflex(-)
Consensual blink reflex
= problem in L CN VII = impulses travel to the R CN V
(+) Direct blink reflex = theres a stimulation of the R
orbicularisoculi innervated by R CN VII
(-) Consensual blink reflex = problem in L CN VII
Left eye () Direct blink reflex (+) Consensual blink reflex
=have impulses travel to CN V because you have at least one
reflex response, no direct blink so theres really a problem in L CN
VII
Defect: L CN VII

B. ACCOMODATION REFLEX
Accommodation
o Occurs when focusing on near objects
Group 8 ! |, , , , , G. J. & R.,

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o miosis-pupil constriction
o lens becoming more globular or more convex-contraction of
ciliary muscle that causes relaxation of suspensory ligament of
the lens
o ocular convergence- contraction of medial rectus

corticobulbar and corticomesencephalic fibers go to the

oculomotor nucleus to produce the reflex
Argyll Robertson Pupil - Lesion on periaquaductal gray of
midbrain- more accommodation fibers than pupillary light fibers,
(-) papillary light reflex, (+) normal accommodation
Difference between Pupillary and Accommodation Pathways
o Impulses will not bypass the LGB. It will proceed the usual way
up to the primary visual cortex and travel to areas 18 and 19
because there have to be some interpretations on what you are
seeing. And areas 18 and 19 are the visual association areas
where interpretation of what you will saw will occur.
o Pupillary light reflex pathway will bypass the LGB, will
immediately go to the superior colliculus. While accomodation
reflex will have to reach the usual visual pathway but will also
have to reach areas 18 and 19.

C. PUPILARY DILATATION
1. Due to low intensity light:
Impulses from retina go to optic tract

Superior Colliculus

Tectospinal Tract (descending tract)

Intermediolateral cell column T1 and T2

Preganglionic sympathetic fibers ascend sympathetic trunk

Synapse at the superior cervical ganglion

Carotid plexus (outside internal carotid artery)

innervate
Dilator papillae muscle (through long ciliary nerves)

Fig 6: Accomodation Reflex

Pathway:
Area 17

Areas 18 and 19

Optic radiation

Superior colliculus

Pretectal area

Edinger-Westphal nucleus

Ciliary ganglion
(CN III)

NOTE: Long ciliary nerve (sympathetic fibers) vs. Short ciliary nerve
(parasympathetic fibers)

Episcleral ganglion

Ciliary ms.
(more convex lens)

CN III nucleus
(Medial rectus)
-convergence

Sphincter pupillae
-contraction papillary ms.
Skip LGB does not need fibers of the Meyers Loop and Optic
Radiation
Will pass through the visual cortex because the person voluntary
looks at the object
Nucleus of Perlia one of the nuclei of the oculomotor nuclear
complex stimulated other than the Edinger-Westphal nucleus
during accommodation, responsible for ocular convergence.
Alternate Pathway for the Accommodation Reflex
o Impulses from area 18 and 19 go to the motor cortex of the
frontal lobe through the superior longitudinal fasciculus,

Fig 7: Pupilary Dilatation Pathway

Pupillary dilation is a sympathetic response (ex. When youre

trying to see in a dark movie house)
Lesion of sympathetic supply of the eye Horners syndrome:
characterized by miosis, anhydrosis and pseudoptosis

Group 8 ! |, , , , , G. J. & R.,

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o Miosis: Predominant effect of parasympathetic innervation to

the eye
o Anhidrosis: face that is dry, red and warm
o Pseudoptosis: Denervation of Mullers muscle (associated wit
levator palpebrae superioris that elevates the upper eye lid)
2. Due to severe pain (ciliospinal reflex) / strong emotional state
pathway (example watching a horror movie):
Impulses reach the:
a) Ciliospinal-tectobulbar tract CN VII innervates the
orbicularis oculi which causes closing of the eye
Retina
optic tract
superior colliculus
tectobulbar tract
nuclei of facial nerves
supplies
orbicularis OCULI

eye closure
b)
Superior colliculus
tectospinal or reticulospinal tract
Reticular formation

Anterior horn cells of CERVICAL spinal cord

Arm musculature (arms thrown upward across the face)

Fig 8: Extraocular Muscles

EXTRAOCULAR MUSCLES: YOKE MUSCLES

LEFT
RIGHT DIRECTION
MR
LR
LEFT TO RIGHT
LR
MR
RIGHT TO LEFT
IO
SR
UP AND LEFT
SR
IO
UP AND RIGHT
SO
IR
DOWN AND LEFT
IR
SO
DOWN AND RIGHT
IO + SR SR + IO STRAIGHT UP
SO + IR IR + SO STRAIGHT DOWN

V. VISUAL PATHWAYS II
CONJUGATE MOVEMENTS
Movements
o Lateral gaze
o Vertical gaze upward
o Vertical gaze downward
To permit accurate conjugate movements, the 12 EOMs, their 6
cranial nerves and nuclei and the MLF must operate as a unit
Lesion: diplopia or double vision

B. CRANIAL NERVES CONCERNED IN EYE MOVEMENTS

A. EXTRAOCULAR MUSCLES
Muscle
Superior Rectus
Inferior Rectus
Superior Oblique
Inferior Oblique
Medial Rectus
Lateral Rectus
Levator
Palpebrae
Superioris

Action(s)
Elevation,Adduction,Intorsion
Depression,Adduction,Extorsion
Abduction,Depression,Intorsion
Abduction, Elevation, Extorsion
Adduction
Abduction
Elevation of Upper Eyelid

Nerve
CN III
CN III
CN IV
CN III
CN III
CN VI
CN III

REVIEW:
o All muscles are innervated by CN III except: Superior Oblique (CN
IV) and Lateral Rectus (CN VI)
o All recti muscles are adductors except LR w/c is an abductor
o All obliques are abductors including LR
o All superior muscles are intorters
o All inferior muscles are extorters
o SO & IR are depressors
o IO and SR are elevators

Oculomotor Nerve (CN III) located in the midbrain at the level of

the superior colliculus.
o Oculomotor nuclear complex:
1. Paired nuclei
Lateral nucleus to supply SR, IR, MR, IO
Edinger-Westphal
nucleus,
the
parasympathetic
component to supply the sphincter pupillae and ciliary
muscles.
2.Midline nuclei
Caudal central nucleus to supply levator palpebrae
superioris
Nucleus of Perlia: The convergence nucleus
3.Association nuclei
Nucleus of DARKSCHEWITSCH and interstitial nucleus of
Cajal: associated with vertical eye movements
Trochlear Nerve (CN IV) located in the midbrain at the level of
the inferior colliculus. Supplies Superior Oblique.
th
Abducens Nerve (CN VI) located below the floor of the 4
ventricle at the junction of the pons and medulla. Supplies Lateral
Rectus.

Group 8 ! |, , , , , G. J. & R.,

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1-2.NAME/DRAW VISUAL FIELD DEFECT AT THE LEVEL OF THE OPTIC

CHIASM.
3. RIGHT OPTIC TRACT
4. LEFT LINGUAL GYRUS
5. AREA OF THE EYE WHERE THERE ARE NO RODS NOR CONES
6-8. 3 REFLEX CHANGES DURING ACCOMODATION
9. OCULOMOTOR NERVE NUCLEUS WHICH IS
PARASYMPATHETIC(PUPILLARY LIGHT/ACCOMODATION REFLEX)
10. CN III NUCLEUS RESPONSIBLE FOR OCULAR CONVERGENCE

C. EOMs INNERVATION
Oculomotor Nerve
o superior rectus
o inferior rectus
o inferior oblique
o medial rectus
o levator palpebrae superioris
Trochlear Nerve
o superior oblique
Abducens Nerve
o lateral rectus
Fig 10: Neural Bases of Extraocular Movement

E. MEDIAL LONGITUDINAL FASCICULUS

o Extends full length of the brainstem to upper cervical levels
o Major fxn: control & coordination of eye movements
o Visual inputs: PPRF and vestibular nuclei

F. SACCADIC SYSTEM

Fig 9: Extrinsic Eye Muscles, Innervation and Action

D. NEURAL BASES OF EXTRAOCULAR MOVEMENT

Supranuclear level (cerebral hemispheres & brainstem)
o Frontal gaze center (area 8):voluntary rapid eye movement
o Occipital gaze center (areas 18 & 19): smooth pursuit
movement
o PPRF: center for lateral gaze
o RiMLF(pretectal region near superior colliculus): center - for
vertical eye movements
Nuclear level
o Nucleus of CN II and IV in the midbrain & CN VI in the pons
Infranuclear level
o CN III, IV, VI

Saccades: fast conjugate eye movements that place an object on

the fovea.
Horizontal Voluntary Rapid Eye Movement
o Impulse: area 8
o Corona radiata and anterior limb of internal capsule to reticular
formation
o Decussation in midbrain
o PPRF
o Abducens nucleus (supply ipsilateral LR) and via MLF to
oculomotor nucleus (supply contralateral MR)
Vertical Voluntary Rapid Eye Movement
o Impulse: area 8
o Corona radiata and anterior limb of internal capsule
o Pretectal region at RiMLF
o Some fibers cross (MLF); some do not
o Oculomotor nuclei (supply SR, IR, IO) and Trochlear nuclei
(supply SO)

G. DOLLS EYE REFLEX

Done in unconscious patient
Head rotated to the right eyes will move conjugately to the left
Indicates that the brainstem mechanisms for regulating eye
movements are intact

Group 8 ! |, , , , , G. J. & R.,

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