 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!

 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

 → 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)

 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

 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