Efferent Visual System

(Ocular Motor Pathways)

Disti Hardiyanti
Marisa Rachim
Riskha Pangestika
Ocular Motor Control
 Efferent Visual System

1. Cranial Nerves
(III,IV,VI)
2. Horizontal and
Vertical Gaze
Centre
3. Saccadic and
Smooth Pursuits
Control
The ultimate purpose of the ocular motor system is to establish clear,
stable, and binocular vision. To perform these tasks, 2 basic human eye
Movements (Moving objects present a special challenge) exist:
1. gaze shift
2. gaze stabilization
Ocular Motor System
Supranuclear

Each system appears to be under the control of—and modulated

by—different regions of the brain (cortex) and brainstem, with
considerable anatomical and functional overlap.
Ocular Motor Control

Supranuclear pathways : Affect both eyes simultaneously

Infranuclear pathways : Affect eyes differently
 Cortical Input
• The efferent visual system
spans a large segment of
the central nervous
system, with many areas of
the brain generating eye
movements
Eye Movement
These movements can be further divided into several functional systems or classes
Saccadic System
In general, these cortical fibers
project to the following structures
• subcortical structures: SC, BG, and
thalamus
• brainstem neural network or
premotor neurons: several types
of pontine neurons, including
omnipause cells of the RIP and
long-leadburst cells of the NRTP
• brainstem saccade generators:
PPRF and riMLF
• motoneurons of the ocular motor
cranial nerves: CNs III, IV, and VI
 Saccadic System
• STIMULUS
Visually reflexive – Parietal lobe Contralateral
Memory guided or volitional – Frontal lobe
Contralateral
• CENTRE
Horizontal Saccades -> PPRF -> Pons
Vertical Saccades -> riMLF & PC -> Midbrain
Smooth Pursuit

There are 2 major visual pathways,

one for the movement of images (magnocellular: M
cells) and the other for discrimination of images
(parvocellular: P cells).
 PPC LGN
Smooth Pursuit

DLPN
PPRF
NRTP
Saccadic and Smooth Pursuit Dysfunction
 Brainstem

Following is a description of the important structures

within the brainstem that allow for controlling gaze.
In general, the midbrain is concerned with vertical eye
movements and the pons with horizontal eye
movements.
Vertical Eye Movements
• Vertical gaze is controlled through the midbrain.
• The primary gaze center is located in the riMLF (Fig 1-27).
• This area receives input from the medial and superior vestibular nuclei via
the MLF and other internuclear connections.
• Other areas in the rostral midbrain, including the INC and the nucleus of
Darkschewitsch, also modulate vertical motility.
• Burst cell input may come in part from the PPRF caudally but also locally
within the riMLF.
 Vertical Eye Movements

• The INC (neural integrator for vertical and torsional gaze) receives signals from the riMLF
and from the vestibular nuclei and projects to the motoneurons of the CN III and CN IV
nuclei through the PC.

• Activity from the vertical gaze center is distributed to the CN III and CN IV nuclei.

• Information involved in upgaze crosses in the PC.

• Damage to this pathway results in the dorsal midbrain syndrome, a disorder that includes
vertical gaze difficulty (most commonly, impaired supraduction), skew deviation, light–
near pupillary dissociation, eyelid retraction, and convergenceretraction nystagmus
Vertical Eye Movements
Horizontal Eye Movement
• Horizontal gaze is coordinated through the CN VI nucleus in the dorsal
caudal pons (Fig 1-28).
• This nucleus receives tonic input from the contralateral horizontal
semicircular canal through the medial and lateral vestibular nuclei.
• Burst information is supplied from the PPRF that is directly adjacent to
the CN VI nucleus and MLF.
• The burst cells are normally inhibited by omnipause neurons located in
the RIP.
• Saccades are thought to be initiated by supranuclear inhibition of the
omnipause cells, which allows burst cell impulses to activate the
horizontal and vertical gaze centers (Fig 1-29).
Horizontal Eye Movement
• To produce horizontal movement of both eyes, a signal to increase
firing must be distributed to the ipsilateral lateral rectus and the
contralateral medial rectus muscles.
• The lateral rectus muscle is supplied directly through ipsilateral CN VI
• The contralateral medial rectus muscle is stimulated by interneurons
that cross in the pons and ascend in the contralateral MLF.
• Therefore, pathology affecting the right MLF will result in a right
internuclear ophthalmoplegia—a right (ipsilateral) adduction deficit
with attempted left gaze—often accompanied by abducting
nystagmus of the left (contralateral) eye and a skew deviation.
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Ocular Motor Cranial Nerves
Extraocular Muscle

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 Classification of the Cranial Nerves
No Name Function Site of nucleus Opening in the skull
I Olfactory Smell Temporal Lobe Cribriform plate
II Optic Vision Occipital lobe Optic canal
III Oculomotor Motor Midbrain Superior orbital fissure
IV Trochlear Motor Midbrain Superior orbital fissure
Trigeminal: Midbrain, Pons
V Ophthalmic Sensory Pons Superior orbital fissure
Maxillary Sensory Medulla oblongata Foramen rotundum
Mandibular Mixed Upper C. spinal cord Foramen ovale
VI Abducent Motor Pons Superior orbital fissure
VII Facial Mixed Pons Internal acoustic meatus, Facial canal,
Stylomastoid foramen

VIII Vestibulo-cochlear Hearing and Pons Internal acoustic meatus

balance

IX Glossopharyngeal Mixed Medulla oblongata Jugular foramen

X Vagus Mixed Medulla oblongata Jugular foramen
Motor Medulla oblongata & C1- Jugular foramen
XI Accessory C4 AHC
of spinal cord 23
XII Hypoglossal Motor Medulla oblongata Hypoglossal canal
 The Ocular Nerves (III, IV, VI)
1. Oculomotor nerve: (Latin for "eye" and "moving").
Function:
1. Motor function: movement of the eye ball.
2. Autonomic (parasympathetic): pupillary reaction.
2. Trochlear nerve:
Function:
Motor nerve → supplies the superior oblique muscles.
3. Abducent nerve: (Latin for "abduction").
Function:
motor nerve → abducts (laterally) the eye ball → supplies
the lateral rectus muscle.
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 The Actions of the Ocular Muscles

1. Lateral Rectus Muscle: abducts (laterally) the eye ball.

2. Medial Rectus Muscle: adducts (medially) the eye ball.
3. Superior Rectus Muscle: elevates, adducts and rotates
medially.
4. Inferior Rectus Muscle: depresses, adducts and rotates
medially.
5. Superior Oblique Muscle: depresses, abducts and
rotates laterally.
6. Inferior Oblique Muscle: elevates, abducts and rotates
laterally.

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 Lesion of the Oculomotor Nerve

• Ptosis: paresis of the levator palpebrea superior muscle.

• Diplopia: occurs only on elevation of eye lid.

• Squint: divergent paralytic.

• Mydriasis: dilated fixed pupil.

• Loss of light and accommodation reflexes.

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 Lesion of the Trochlear Nerve
1. Diplopia on looking down and out.
2. Limitation of movement during examination
for eye movement down and out.

Lesion of the Abducent Nerve

1. Diplopia on looking out wards.
2. Limitation during examination of eye movement
in the outward direction.
3. Convergent paralytic squint.
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 Causes of the Ocular Nerves Lesion

1. Lesions of the III, IV, and VI cranial nerves or nuclei.

2. Disorders of the neuromuscular junction (e.g.myasthenia
gravis, Botulism).
3. Disorder of the ocular muscles (e.g myopathy).
4. Injury of the ocular muscle.
5. Orbital lesion (mass, inflammation).

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 Complete External Ophthalmoplegia

Describes the immobile eye when the III, IV, and VI nerves are
paralysed by:
1. Orbital tumor or inflammation.
2. Cavernous sinus thrombosis.
3. Tolosa-Hunt syndrome: is characterized by painful
ophthalmoplegia (weakness of the eye muscles) and is
caused by an idiopathic granulomatous inflammation of the
cavernous sinus.

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 Parasympathetic Supply of the Pupils

The nucleus of oculomotor nerve (Edinger-Westphal

nucleus) in midbrain → through oculomotor nerve →
nerve to inferior obliqe muscle → ciliary ganglion →
fiber in the short cilliary nerve → supply the
constrictor pupillae muscle → pupil constriction

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REFLEKS
PUPIL
 Sympathetic Supply of the Pupils

The fibers start from hypothalamus, descends through

the brain stem and cervical part of the spinal cord to the
lateral horn cells of C8 – T2 segment → preganglionic
fibers → sympathetic chain → relay in the superior
cervical sympathetic ganglion. Postganglionic fibers
pass with carotid plexus (around ICA) → long ciliary
nerve → dilator pupillae muscle → pupil dilatation.

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 TERIMA KASIH
Mohon Bimbingan & Saran

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