The Visual Pathway

Key anatomy
Key anatomy
Temporal Nasal

• Optic disc
• Optic nerve head
• Optic nerve

• Macula
• Fovea
• Fovealis
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
 Retina
Chiasma

Optic Nerve

LGB
Lower fibres
(Temp lobe)

Optic
radiation

Occipital
Upper fibres
Cortex
(ant parietal lobe)
The Eye Muscles
Extra Ocular Eye Muscles
 IO SR
SR

LR MR LR

IR SO IR
 IO SR
SR

LR MR LR

IR SO IR

Lateral Rectus:

• Origin = tendinous ring on bony orbit around optic foramen

• Insertion = lateral wall of eyeball
• Action = turns eye laterally
 IO SR
SR

LR MR LR

IR SO IR

Medial Rectus:

• Origin = tendinous ring on bony orbit around optic foramen

• Insertion = Medial wall of eyeball
• Action = turns eye medially
 IO SR
SR

LR MR LR

IR SO IR

Superior Rectus:

• Origin = tendinous ring on bony orbit around optic foramen

• Insertion = Superior and central part of eyeball
• Action = turns eye upwards and outwards
 IO SR
SR

LR MR LR

IR SO IR

Inferior Rectus:

• Origin = tendinous ring on bony orbit around optic foramen

• Insertion = inferior and central part of eyeball
• Action = turns eye downwards and inwards
 IO SR
SR

LR MR LR

IR SO IR

Superior Oblique:

• Origin = tendinous ring on bony orbit around optic foramen

• Insertion = between superior and lateral recti muscles
• Action = rotates eyeball on its axis – directs cornea downwards and laterally
(note – via the trochlear)
 IO SR
SR

LR MR LR

IR SO IR

Inferior Oblique:

• Origin = maxilla (front of orbital cavity)

• Insertion = between inferior and lateral recti muscles
• Action = rotates eyeball on its axis – directs cornea upwards and laterally
Superior Rectus Muscle
 Nose

Superior Oblique
Superior Rectus Inferior Oblique Medial Rectus

Inferior Rectus Superior Oblique Lateral Rectus

R = Superior Rectus
Both = Superior Recti R = Inferior Oblique
L = Inferior Oblique
& Inferior Oblique L = Superior Rectus

R = Lateral Rectus R & L = Primary Position R = Medial Rectus

L = Medial Rectus L = Lateral Rectus

R = Inferior Rectus Both = Inferior Recti R = Superior Oblique

L = Superior Oblique & Superior Oblique L = Inferior Rectus
Superior Rectus Inferior Rectus
& Inferior Oblique & Superior Oblique
Left VI Nerve Palsy (lateral Rectus)
Left IV Nerve Palsy Superior Oblique)
Left III Nerve Palsy
 IO SR
SR

LR MR LR

IR SO IR

Lateral Rectus = VI cranial nerve (Abducens)

 IO SR
SR

LR MR LR

IR SO IR

Lateral Rectus = VI cranial nerve (Abducens)

Superior Oblique = IV cranial nerve (Trochlear)

 IO SR
SR

LR MR LR

IR SO IR

Lateral Rectus = VI cranial nerve (Abducens)

Superior Oblique = IV cranial nerve (Trochlear)

All others = III cranial nerve (Occulomotor)

The Pupils
Pupils
• Parasympathetic
– Originate from the subnucleus of the III nerve
and synapse in the cilliary ganglion
– Supplies the constrictor pupillae of the iris
• Sympathetic
– Originate in the hypothalamus, pass down the
brain stem, cervical spine to emerge at T1
and return to the eye
Pupils
• Lesions of the sympathetic pathway produce
Horner’s syndrome
– Constricted pupil
– Partial ptosis
– Unilateral Ahydrosis
• Optic nerve lesions produce Afferent defects
– Impairs direct response to light
– Consensual response unaffected in diseased eye
• III nerve lesions, cilliary ganglion and sympathetic
supply produce Efferent disorders of the pupil
Afferent Pathway Efferent Pathway

Cilliary Body - Iris

Optic Nerve

Cilliary
Ganglion

Convergence
Centre
Lateral Geniculate
Body

Edinger – Westphal
Nucleus of III

Pretectal Nucleus
Pupils
Afferent = Optic nerve (II)
Efferent = Occulomotor (III)

Direct Pupil Reaction to Light

Pupils
Afferent = Optic nerve (II)
Efferent = Occulomotor (III)

Consensual Pupil Reaction to Light

Pupils Diseased Eye
Afferent = Optic nerve (II)
Efferent = Occulomotor (III)

Afferent Pupil Defect

Pupils Diseased Eye
Afferent = Optic nerve (II)
Efferent = Occulomotor (III)

Afferent Pupil Defect –

no pupil response
Pupil defects
• RAPD – Marcus Gunn Pupil
– Partial Damage to optic nerve (therefore Afferent defect)
– Pupils symmetrical but degree of dilation is variable
– Retrobulbar neuritis etc
– Use ‘swinging torch test’ to detect affected pupil

• Argyle Robertson Pupil

– Mid brain lesion, Neuro-syphilis
– Small irregular pupils, fixed to light but constricts on convergence

• Holmes Adie Pupil (Adie pupil)

– Cilliary ganglion lesion
– Unilateral Fully dilated pupil, un-reactive to light

• III Nerve Palsy

– Dilated pupil + Infero-lateral position of the eye, complete ptosis