VISUAL SYSTEM

Anatomy of the eye

Cornea
Anterior chamber
Contains aqueous humor

Posterior chamber
Contains vitreous humor

Iris
Pupil
Lens

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Retina

Composed of 2 layers
Neural retina
7 layers of the neural retina
Photoreceptor cell outer & inner segments
Outer nuclear layer
Outer plexiform layer
Inner nuclear layer
Inner plexiform layer with ganglion cell bodies
Nerve fiber layer (optic fiber layer)

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2 Limiting membranes
Outer limiting membrane is between layers 2 & 7
Photoreceptors in this layer interdigitate with the
pigmented cells of the retina
Combine with the iris to contract/dilate which
protects the photoreceptor cells from damage
from bright light
Inner limiting membrane is between the nerve fiber
layer & the vitreous humor

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Pigmented retina
Continuous sheet of cuboidal cells
Functions include
Nutritional supply for the neural retina glucose &
essential ions
Protects photoreceptors in the retina from
potentially damaging levels of light
Vital role in maintenance of the photoreceptors by
phagocytosis

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Connection between neural & pigmented retina
Remnant of the embryologic optic cup
Location of a detached retina
Important in diabetics

CLINICAL CORRELATIONS
Retinal detachment

Common in diabetics
Secondary to inherent problems in the
microcirculatory system

Other etiologies
Trauma
Blow to the head

Increased ICP

Treatment
Surgical reattachment

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Photoreceptor cells

Function is photoreception
Humans can detect 1 photon of light

2 basic types rods & cones

Similar in design
Light is transduced in the outer segment
Oriented towards the pigmented epithelium
Cilium (stalk) connects the outer segment to the inner
segment
Cell terminates in the outer plexiform layer
Synaptic ribbon

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Rods

Location of transduction
Photon electrical impulse
Dependent on rhodopsin
Have a limited shelf life

Responsible for
Black white differentiation
Secondary to this, humans can detect more shades of
gray than colors

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Cones

Location of transduction
Tip of the cone
Continuously decreasing numbers of cells
Gives the cone its characteristic shape

Dependent on cone opsin

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3 types of cones
Absorb different wavelengths of light
L cones
Referred to as red cones
Sensitive to long wavelengths of light
M cones
Referred to as green cones
Sensitive to medium wavelengths of light
S cones
Referred to as blue cones
Sensitive to short wavelengths of light

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Colors are perceived secondary to different
amounts of photoreceptors stimulated
Colors are represented by a unique
combination of these stimulations in the 3 types
of cones

CLINICAL CORRELATIONS
Color blindness

Not true blindness

Secondary to a genetic defect
1 or more of the cone types are missing

Individual can see color

Perception of the color is different

Most common type is red / green

Individual is missing the L cones (red)

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Steps in the interpretation of sight

Photoreceptor cells gather photons

Photons are transduced into electrical
signals
Ganglion cells in the retina send axons to
locations in
Diencephalon
Midbrain

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Nuclei involved in this interpretation include

Suprachiasmatic nucleus
Hypothalamic region
Responsible for diurnal rhythms

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Pupillary light reflex

Edinger Westphal nucleus

Accesory optic nucleus
Olivary pretectal nuclei
Superior colliculus
Assists in controlling eye movements
Projects to the pulvinar

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Pulvinar receives input from
Superior colliculus
Pretectum
Visual cortex
Pulvinar sends output to
Visual association areas
Accomplished via association neurons

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Optic nerve

Extends from the retina to the optic chiasm

Encased in arachnoid mater
Bathed in CSF
Elevated ICP can be detected through the eyes
Papilledema
Swelling of the optic nerve head
Result is partial / total loss of vision in that eye

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Optic chiasm

Optic nerves from each eye converge here

Secondary to location, the optic chiasm is
susceptible to damage

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Optic tract

Composed of axonal fibers from the retinal

ganglion cells
Terminate in the diencephalon
Lateral geniculate nucleus

CLINICAL CORRELATIONS
Visual field defects

Etiology
Lesions / trauma along

Optic nerve
Optic chiasm
Optic tract
Optic radiations
Visual cortex
Occipital lobe

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Visual cortex

Brodmanns area 17
Located in the occipital lobe
Specifically along the calcarine sulcus
Cuneus gyrus
Input from inferior portion of the contralateral
hemifields
Lingual gyrus
Input from superior portion of the contralateral
hemifields

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Neocortex of Brodmann area 17

Contains all 6 layers of the neocortex
Layer VI is extremely thick

Highly integrated association neuron

arrangement
Allows for interpretation of sensory photon reception
Occurs n different regions
Helps preserve vision secondary to damage

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extraocular muscles

6 Extraocular muscles
4 are innervated by the oculomotor nerve (CN
III)

Superior rectus muscle

Medial rectus muscle
Inferior oblique muscle
Inferior recuts muscel

Superior oblique muscle is innervated by the

trochlear nerve (CN IV)
Lateral rectus muscle is innervated by the
abducens nerve (CN VI)

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Intraocular muscles

Ciliary muscle
Responsible for changing the thickness &
curvature of the lens
Facilitates accomodation

Sphinctor pupillae muscle

Controls constriction of the pupil

Dilator pupillae muscle

Controls dilation of the pupil

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Eyelid

Controlled by 3 muscles
Levator palpebrae muscle
Innervated by the oculomotor nerve CN III
Function is to hold the eyelid up

Obicularis oculi muscle

Innervated by the facial nerve CN VII
Functions to close the eyelid

Tarsal or Muller muscle

Innervated by postganglionic sympathetic fibers
Functions to help keep the eyelid up

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Motor nuclei associated with the visual
motor system

Oculomotor nucleus
Coordinates movements of the globe & eyelid

Edinger Westphal nucleus

Controls pupillary reflexes

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Trochlear nucleus
Innervates the contralateral superior oblique
extraocular muscles

Abducens nucleus
Innervates the contralateral lateral rectus
muscles

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Targeting movements

Saccades
Rapid movements of the eye
From 200 700 degrees / second
Includes fixation points at each point

Includes both horizontal & vertical gaze

Smooth pursuit
Slow moving targets
30 degrees / second or less
Can pursue a target at 100 degrees / second

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Vergence eye movements

Responsible for accomodation

Focusing on a target at a distance
Changing to focus on a target that is closer

Vergence movements are much slower than

saccades
Vergence & saccades may occur in
combination
Hand eye coordination

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Reflex eye movements

Optokinetic eye movements

Panoramic / wide angle view of the world

Pupillary light reflex

Reflex arc mediated by the Edinger Westphal
nucleus
Lesions here result in a fixed, dilated (blown) pupil &
is a grave sign

Blink reflex
Corneal wink reflex
Automatic blink if an object is headed for the eye

CLINICAL CORRELATIONS
Horners syndrome

Triad of signs / symptoms that include

Ptosis
Droopy eyelid

Miosis
Pupil cannot be dilated

Anhydrosis
Lack of sweating on the affected side

May indicate a Pancoast tumor

Bronchogenic lung cancer

CLINICAL CORRELATIONS
Argyll Robertson pupil

Loss of light reflex constriction

May be unilateral or bilateral
Sometimes called prostitutes eye
Accomodates but does not react

Pathognomonic for tertiary syphilis

Tabels dorsalis
Central nervous system syphilis