VESTIBULO-OCULAR REFLEX

AND NYSTAGMUS
REIVANDY
G0015202
 PREFACE
• COMPONENTS OF THE VESTIBULAR SYSTEM
two components:

1. SEMICIRCULAR CANALS: motion detectors

lesions induce the sensation of SPINNING
2. OTOLITH ORGANS (utricle and saccule): gravity detectors
lesions induce the sensation of TILT
• vestibular system is involved in balance and posture, co-ordination of
head and body movements and in fixating the visual image on the
fovea (esp. VOR)
• Ask yourself why text is readable when your head is moving, but
blurred when the book is moving?
• outputs from the vestibular system are integrated with information
from other sensory receptors (proprioception=perception of body in
space), and are not perceived as separate
• however, when other sensory inputs are in conflict with the vestibular
system, the vestibular signal seems to act as the reference postural
signal with which other sensory inputs are compared
• unexpected or conflicting inputs from the vestibular system can result
in vertigo, nystagmus and/or motion sickness
 Vestibulo-ocular reflex ("doll's eyes")
• PURPOSE: adjust eye position to compensate for head movements
goal is to keep the visual image focused on the fovea

• BOTTOM LINE: rotation of the head in one direction results in

contraction of the extraocular muscles to slowly rotate the eyes in the
opposite direction
• in an awake, "normal" person, VOR is suppressed by voluntary eye
movements
• responsible for the pursuit phase (slow component) of nystagmus
1. The reflex sequence begins with a turn of the head to the
LEFT (top of diagram).
2. As described previously (and shown at the bottom of the
diagram), head rotation to the LEFT causes:
• DEPOLARIZATION in the LEFT HORIZONTAL CANAL
• HYPERPOLARIZATION in the RIGHT HORIZONTAL CANAL.
3. This is followed by EXCITATION in the LEFT VESTIBULAR NUCLEI,
and INHIBITION in the RIGHT VESTIBULAR NUCLEI.
4. Due to the organization of the pathway, at the level of the
extraocular motor nuclei, there is:
• EXCITATION of cells in the LEFT OCULOMOTOR and RIGHT
ABDUCENS nuclei
• INHIBITION of cells in the RIGHT OCULOMOTOR and LEFT
ABDUCENS nuclei
5. This pattern of extraocular motor activity results in:
• CONTRACTION of the LEFT MEDIAL RECTUS and RIGHT LATERAL
RECTUS muscles.
• RELAXATION of the RIGHT MEDIAL RECTUS and LEFT LATERAL
RECTUS muscles.
6. Movement of the eyes to the RIGHT.
 NYSTAGMUS

• Plane may be horizontal, vertical, or torsional.

• Frequency describes how rapidly the eyes oscillate: high,
moderate or low.
 Nystagmus
• DEFINITION: rhythmical oscillation of the eyeballs (at least 37 different kinds are recognized).
1. Commonly used to refer to JERKY NYSTAGMUS:
• slow drift of the eyes in one direction (PURSUIT) followed by a rapid recovery movement in the opposite
direction (SACCADE)

• direction is named for the fast component:

• i.e, a rightward nystagmus consists of slow movement of eyes to the left, followed by fast recovery to the
right

2. Can be induced in normal individuals by vestibular stimulation, but it only lasts a few seconds at most
• nystagmus in the absence of vestibular stimulation indicates some kind of pathology
• horizontal nystagmus is usually a problem in the inner ear; any other nystagmus is usually of central origin

3. PURSUIT is controlled by vestibulo-ocular reflex

4. SACCADE is controlled by higher centers (e.g., cortex)

INTERPRETATION
• induction of nystagmus is a clinically useful mechanism for assessing
brain function (caloric test)

• normal patient: NYSTAGMUS (PURSUIT + SACCADE)

• loss of cortical function: PURSUIT ONLY
• brainstem death: neither pursuit nor saccade
 Thank you!
References:
Costanzo, L. S. (2018). Physiology 6th ed. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins; p:98
Hall, J. E., & Guyton, A. C. (2016). Guyton and Hall textbook of medical
physiology 13th ed. Philadelphia, PA: Saunders Elsevier.
Kanski JJ, Bowling B.(2016).Clinical Ophthalmology: A Systematic Approach. 8th
ed. Philadelphia: Elsevier/Saunders; p:832-838.
Vaughan, D., & Asbury, T. (2018). Vaughan & Asbury's general ophthalmology
18th ed. New York: Lange Medical Books/McGraw-Hill.