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Cranial nerves III, IV, VI.

Ocular Motility
Oculomotor function can be divided into two categories: (1) extraocular muscle function and (2)
intrinsic ocular muscles (controlling the lens and pupil). The extraocular muscles include: the medial,
inferior, and superior recti, the inferior oblique, and levator palpebrae muscles, all innervated by the
oculomotor nerve (III); the superior oblique muscle, innervated by the trochlear nerve (IV); and the
lateral rectus muscle, innervated by the abducens nerve (VI). The intrinsic eye muscles are innervated
by the autonomic systems and include the iris sphincter and the ciliary muscle (innervated by the
parasympathetic component of cranial nerve III), and the radial pupillodilator muscles (innervated by
the ascending cervical sympathetic system with its long course from spinal segments T1 through T3).

Pupillary function
The iris receives both sympathetic and parasympathetic innervation: (1) the sympathetic nerves
innervate the pupillary dilator muscles; and (2) the parasympathetic nerve fibers (from CN III)
innervate the pupillary constrictor (sphincter) muscles as well as the ciliary apparatus for lens
accommodation. Figures 4-7 and 4-8 show the origins and courses of these two systems.
During the normal waking state the sympathetics and parasympathetics are tonically active.
They also mediate reflexes depending in part on emotionality and ambient lighting. Darkness
increases sympathetic tone and produces pupillodilation. Increased light produces increased
parasympathetic tone and therefore pupilloconstriction (this also accompanies accommodation for
near vision). During sleep, sympathetic tone is depressed and the pupils are small. Normal waking
pupil size with average ambient illumination is 2 to 6 mm. With age, the average size of the pupil
decreases. Approximately 25% of individuals have asymmetric pupils (anisocoria), with a difference of
usually less than 0.5 mm in diameter. This must be kept in mind when attributing asymmetry to
disease, particularly if there are no other signs of neurologic dysfunction.
At the bedside, the first step in evaluating pupil dysfunction is observation of the resting size and
shape. A small pupil suggests sympathetic dysfunction; a large pupil, parasympathetic dysfunction.
Loss of both systems would leave one with a nonreactive, midposition pupil, 4-7 mm in diameter, with
the size varying from individual to individual. This is seen most often in persons with lesions that
destroy the midbrain (see Chapter 17).

M. Levator palpebra berfungsi untuk mengangkat keopak mata diinervasi oleh N III
M. Orbicularis Oculi berfungsi untuk menutup bola mata diinervasi oleh N VII

TES KONFRONTASI
1. Pasien dipersilahkan duduk pada kursi yang berjarak 1 m dari kursi
pemeriksa, dengan posisi duduk berhadapan
2. Pasien diminta duduk dengan nyaman dan pandangan lurus ke arah
mata pemeriksa
3. Mata kiri pasien ditutup dengan telapak tangan. Mata kanan
pemeriksa ditutup dengan telapak tangan pemeriksa.
4. Minta agar mata kanan pasien memandang mata kiri pemeriksa dan
pasien dilarang melirik selama pemeriksaan
5. Jari pemeriksa diacungkan 1 dan diposisikan antara pasien dan
pemeriksa pada jarak yang sama, jari pemeriksa diposisikan
setinggi mata pasien
6. Jari diposisikan di perifer, dan tanyakan apakan pasien melihat jari
pemeriksa
7. Jari digerakkan perlahan ke arah sentral ( berhenti setiap 15 cm)
dan setiap kali berhenti tanyakan apakah pasien masih dapat
melihat jari pemeriksa
8. Dilanjutkan pemeriksaaan dari arah nasal menuju ke sentral dan
lakukan hal yang sama dengan poin 6 dan 7
9. Dilanjutkan pemeriksaaan dari arah atas menuju ke sentral dan
lakukan hal yang sama dengan poin 6 dan 7
10.
Dilanjutkan pemeriksaaan dari arah bawah menuju ke sentral
dan lakukan hal yang sama dengan poin 6 dan 7
11. Selanjutkan pemeriksaan dengan mata kiri. Ulangi prosedur di atas.

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