Visual Pathway & its Lesions

Field Of Vision
Visual

area seen by an eye at a given instant Charting of field of vision is done by a process called PERIMETRY Field of vision is divided into 4 parts Temporal, nasal, upper & lower Blind spot

Visual pathway
The

visual nerve signals leave the retinas through the optic nerves. At the optic chiasm, the optic nerve fibers from the nasal halves of the retinas cross to the opposite sides, where They join the fibers from the opposite temporal retinas to form the optic tracts.

 The

fibers of each optic tract then synapse in the dorsal lateral geniculate nucleus of the thalamus. Geniculocalcarine fibers pass by way of the optic radiation (also called the geniculocalcarine tract) to the primary visual cortex in the calcarine fissure area of the medial occipital lobe.

 Visual

fibers also pass to several older areas of the brain; suprachiasmatic nucleus of the hypothalamus pretectal nuclei in the midbrain superior colliculus ventral lateral geniculate nucleus of thalamus.

Visual cortex The primary visual

cortex lies in the calcarine fissure area, extending forward from the occipital pole on the medial aspect of each occipital cortex Visual area I. Still another name is striate cortex (Brodman's area 17)

 The

secondary visual areas, also called visual association areas, lie lateral, anterior, superior, and inferior to the primary visual cortex. Brodmanns area 18

1 Partial optic nerve Ipsilateral scotoma 2 Complete optic nerve Blindness in that eye 3 Optic chiasm Bitemporal hemianopia 4 Optic tract Homonymous hemianopia 5 Meyers loop Homonymous upper quadrant anopia 6 Optic radiation Homonymous hemianopia 7 Visual cortex Homonymous hemianopia 8 Macular cortex Central scotomas (bilateral) (A scotoma is a patch of blindness.)

Damage to the right optic nerve (1) leads to blindness in the right eye (total loss of visual field) Damage in the optic chiasma (2), leads to bitemporal hemianopia - blindness in both temporal half-fields, since damage involves the crossing fibres from the nasal half of the retinae, which view inputs from the temporal fields. Damage in the right optic tract (3) which carries axons from the right temporal and the left nasal retinal halves, will lead to homonymous hemianopia - the loss of vision in the same, contralateral (left) half of the visual field in both eyes. Focal damage in the right optic radiations (4,5,6) which are spread out, will lead to less extensive losses, confined to the superior or inferior quadrants of the contralateral visual fields of both eyes, depending upon the location of the lesion.

Macular sparing, that is, loss of peripheral vision with intact macular vision, is also common with occipital lesions because the macular representation is separate from that of the peripheral fields and very large relative to that of the peripheral fields. Therefore, occipital lesions must extend considerable distances to destroy macular as well as peripheral vision Blind sight: Bilateral destruction of the occipital cortex in humans causes subjective blindness. However, there is appreciable blindsight, that is, residual responses to visual stimuli even though they do not reach consciousness.

 When

light is directed into one eye, the pupil constricts -pupillary light reflex. The pupil of the other eye also constricts -consensual light reflex.

Fibers leave the optic nerve and enter pretectal nucleus the second-order neurons project to the ipsilateral and contralateral EdingerWestphal nucleus The third-order neurons pass from this nucleus to the ciliary ganglion in the oculomotor nerve, and the fourth-order neurons pass from this ganglion to the ciliary body.

Argyll Robertson pupil

The

light response is sometimes lost while the response to accommodation remains intact. One cause of this abnormality is CNS syphilis, The Argyll Robertson pupil is also seen in other diseases producing selective lesions in the midbrain.

Horners Syndrome
1.

2. 3. 4.

The sympathetic nerves to the eye are occasionally interrupted at the cervical sympathetic chain. Interruption of sympathetic nerve fibers to the pupillary dilator muscle, the pupil remains persistently constricted to a smaller diameter than the pupil of the opposite eye. The superior eyelid droops The blood vessels on the corresponding side of the face and head become persistently dilated. Sweating (which requires sympathetic nerve signals) cannot occur on the side of the face and head affected by Horners syndrome.

Strabismus
is a misalignment of the eyes and one of the most common eye problems in children It is characterized by one or both eyes turning inward (crossed-eyes), outward (wall eyes), upward, or downward. Strabismus is also commonly called "wandering eye" or "crossed-eyes." Visual images do not fall on corresponding retinal points.

Basic types of strabismus.

Near Response
In

addition to accommodation, the visual axes converge and the pupil constricts when an individual looks at a near object. This three-part response accommodation, convergence of the visual axes, and pupillary constrictionis called the near response