Visual Pathways
Light hits Retina
→ action potential
à optic nerve
→ optic chiasm (NASAL fibres cross over)
→ LGN (lateral geniculate nucleus)
→ optic radiation
→ cortex
Lateral Geniculate Nucleus
A nucleus in the thalamus
Organises input from retina- is the sorting station or post office!
Organises into L or R eye and into magnocellular or parvocellular neurones
Output to visual cortex [via optic radiation]
Outputs from LGN also go to
i] hypothamaus (circadian rhythm)
ii] pretectum (PLR)
iii] superior colliculi (eye movement orientation)
The Visual Cortex
aka V1 or Brodmann’s Area
Lies along the calcrine fissure of the occipital lobe
Receives major input from the LGN – arranged retinotopically
The centre of vision (especially the fovea) dominates the retinal projection to VI due to near 1:1
relationship of photoreceptor to ganglion cell
The LGN projection is mainly to layer IV of the cortex
These layer IV neurones then project to other neurones in the cortex e.g memory areas
Extra-striate areas
V3 in involved in depth perception and visual acuity
V4 is primarily involved in colour perception – can lead to central colour blindness if damaged
V5 is primarily involved in motion and direction
Extra-striate areas
Lesions in Visual Pathway
A = damage to the optic nerve – loss of vision in the right eye
B = Bitemporal hemianopia –loss of peripheral vision due to damage in the optic chiasm – only
the nasal retinal fibres (stimulated by peripheral vision) cross, the temporal fibres remain in
the optic tract and so are not damaged
C = Homonymous hemianopia – the left nasal and right temporal fibres are in the optic tract
and are damaged leading to loss of left peripheral and right nasal vision
D = Left inferiour quandrantopia – specific loss of quadrants as only some radiations are
affected
E = Left homonomous hemianopia with macular sparing – total lesion at the visual cortex at the
end of the optic radiation – macula not affected, otherwise the same as C
REFLEXES: Pupillary Light reflex
Direct – light on the eye leads to pupil constriction
Consensual – constriction of the pupil in response to light being shone on the other eye –
contralateral constriction/dilation
*works on unconscious people so a test for brainstem death*
Pathway of reflex
Rod and cone photoreceptors
→ CN II (optic)
→ exit at the posterior third of the optic tract
→ Prectectal Nuclei of the midbrain
→ bi-lateral projections to Edinger Westphal nucleus
→ parasympathetic to cillary muscles via CN III
(oculomotor)
→ pupil constriction
(Afferent (dotted line) and efferent pathways (full line))
REFLEXES: Accomodation
Pupils constrict when adjusting for accommodation – vision for near objects
Involves:
Papillary miosis (sphincter pupillae)
Convergence (medial rectus muscle)
Accomodation (ciliary muscle)
Near: Pupil is constricted, lens is fat
Far: Pupil is dilated, lens is thin
All 3 have a common efferent pathway – III (oculomotor)
REFLEXES: Corneal Reflex
Blinking – elicited by sensory stimulation of cornea
A direct and consensual response
Sensory: CNV1 (ophthalmic division of trigeminal)
Motor: CN VII (facial)
How we see an object
The light rays enter the eye through the cornea (transparent front portion of eye to focus the
light rays)
Then, light rays move through the pupil, which is surrounded by Iris to keep out extra light
Then, light rays move through the crystalline lens (Clear lens to further focus the light rays )
Then, light rays move through the vitreous humor (clear jelly like substance)
Then, light rays fall on the retina, which processes and converts incident light to neuron signals
using special pigments in rod and cone cells.
These neuron signals are transmitted through the optic nerve,
Then, the neuron signals move through the visual pathway - Optic nerve > Optic Chiasm > Optic
Tract > Optic Radiations > Cortex
Then, the neuron signals reach the occipital (visual) cortex and its radiations for the brain's
processing.
The visual cortex interprets the signals as images and along with other parts of the brain,
interpret the images to extract form, meaning, memory and context of the images.
Eye movement
Oculocephalic reflex = doll’s eyes
Oculovestibular reflex = cold caloric test
Oculocephalic reflex
Rapidly turn the head 90° on both sides
Normal response = deviation of the eyes to the opposite side of head turning
Brain death = oculocephalic reflexes are absent (no Doll’s eyes) = no eye movement in
response to head movement
Not Barbie, but old fashioned type dolls
Cold calorics
Elevate the HOB 30°
Irrigate one tympanic membrane with iced water
Observe pt for 1 minute after each ear irrigation, with a 5 minute wait between testing
of each ear
Facial trauma involving the auditory canal and petrous bone can also inhibit these
reflexes
Cold calorics interpretation
Not comatose
Nystagmus; both eyes slow toward cold, fast to midline
Coma with intact brainstem
Both eyes tonically deviate toward cold water
No eye movement
Brainstem injury / death
Movement only of eye on side of stimulus
Internuclear ophthalmoplegia
Suggests brainstem structural lesion