Visual Pathway

Med 6573: Nervous System

University of Minnesota Medical School Duluth
Donna J. Forbes, Ph.D.
29 February 2008
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References
Nolte Chapter 17
Netter: Plates 86 and 114
Related materials from other faculty
Dr. Downing: Histology of the Eye
Dr. Stauffer: Physiology of the Eye
Dr. Trachte: Pharmacology of the Eye
Dr. Hollenhorst: Clinical Ophthalmology
Dr. Meyerson: Neurological Exam

Washington University: The Basic Visual Pathway

http://thalamus.wustl.edu/course/basvis.html

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Eye Exam Eyes are the window to the brain!
Visual Acuity: Eye, CN II & beyond in the visual pathway
Visual Fields: Central & Peripheral Vision (retina to cortex)
Ocular Motility: (CN III, IV, VI)
Reflexes
Pupillary Light Reflex (CN II & III)
Accommodation (Near) Reflex
Corneal Reflex (CN V & VII)
Retina including Optic disc: (Increased intracranial
pressure; status of blood vessels reflecting hypertension,
diabetes, etc.)
Visual Pathway: Since it is precisely organized & extends
from the rostral to caudal aspect of the hemispheres, lesions
along the pathway produce specific deficits that can aid in 3
localizing the lesion.
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Learning Objectives
Relationship of bipolar & ganglion cells to the visual pathway
Relationship of retinal quadrants to visual field quadrants
Understanding of monocular vs. binocular visual fields
Importance of corresponding points on the retinae & the Blind spot
Components of the visual pathway; nuclei involved; location of
decussations, etc.
Representation of the visual field within the structures of the visual
pathway. [Upper vs. lower fields; Nasal vs.Temporal fields; Macular vs.
Peripheral fields representation]
Visual field deficits associated with damage along the visual pathway
Components & basis of the:
Direct & consensual pupillary light reflex
Pupillary dilation
Accommodation or near reflex
Definition or description of terms: amblyopia, Argyll Robertson pupil,
diplopia, hemianopsia, heteronymous, homonymous, Horners syndrome,
Meyers loop, quadrantanopsia, retinotopic, scotoma, strabismus
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The Visual Pathway

VISUAL
Pathway extends from the
FIELD
front to the back of the
brain.
RETINA Precise retinotopic
organization
ON OC Deficits due to lesions of
OT the pathway give valuable
LGN
localizing information.
OPTIC
RADIATIONS

ON = Optic Nerve
OC = Optic Chiasm
OT = Optic Tract
LGN = Lateral Geniculate Nucleus of Thalamus
VISUAL
CORTEX
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Beginning of the Pathway
Pg. 2

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Ganglion cells axons form the optic nerve

Bipolar cells

Cells
of the
Rods and Cones
(Receptors) Retina

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 Pg. 2

Object to be seen

The next slide looks

at the retina as if you
are looking through
the patients pupil via
your
ophthalmoscope.

Peripheral Retina

Central Retina (fovea

8
in the macula lutea)
 Pg. 2

Retinal Quadrants
Right retina Left retina

Vertical Meridian
UTQ UNQ UNQ UTQ
nose
LTQ LNQ LNQ LTQ Horizontal Meridian

Macula with Papilla (optic

fovea centralis nerve head)

Retina as you would see it through the

ophthalmoscope & the patients pupil
Temporal Hemiretina Nasal Hemiretina
UTQ = upper temporal quadrant UNQ = upper nasal quadrant
LTQ = lower temporal quadrant LNQ = lower nasal quadrant

The blind spot in the Visual Field corresponds to the location of

the optic nerve head on the NASAL side of the retina.
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 Pg. 2

Visual Fields & the Visual Pathway

VISUAL
FIELD
The following slides
begin with the
RETINA
visual fields and
then follow the
ON
pathway from the
OC
retina to the visual
OT cortex.
LGN
OPTIC
RADIATIONS

ON = Optic Nerve
OC = Optic Chiasm
OT = Optic Tract
LGN = Lateral Geniculate Nucleus of Thalamus
VISUAL
CORTEX
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 Visual Fields Pg. 3

Monocular Visual Fields

Definition: The entire area that Temporal Field of Nasal Field of
can be seen by the patient Left Eye Left Eye
without movement of the head and Vertical Horizontal
Meridian Meridian
with the eyes fixed on a single

Upper Field of
Left Eye
spot.
UTQ UNQ
Mapping of Visual Fields: F F
Confrontational method

Lower Field of
(see Dr. Meyersons
LTQ LNQ

Left Eye
Neurological Exam notes)
Perimetry (Manual or
Automated)
Normal Monocular Visual Normal Monocular Visual
Monocular Visual Fields: Field of Left Eye Field of Right Eye

Each eye is tested separately.

The monocular visual field is plotted with the Fovea (F) at the center.
The monocular visual field (colored area -- blue for left; green for right in this example) is
not round.
Horizontal and Vertical Meridians correspond to those of the retina and divide the visual
field into upper temporal, upper nasal, lower temporal and lower nasal quadrants.
Imagine that this is your visual field, i.e. all that you can see with your left eye and your right
eye (tested separately) when you look straight ahead and do not move your head or eyes.
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Visual Fields Pg. 3

Blind Spot
Temporal Field of Nasal Field of
15 to the temporal side Left Eye Left Eye

of the visual field of each

Upper Field of
eye

Left Eye
On the horizontal
meridian F F

Lower Field of
Corresponds to the

Left Eye
location of the optic
nerve head 15 to the
nasal side of the retina of Normal Monocular Visual Normal Monocular Visual
each eye. Field of Left Eye Field of Right Eye

Demonstration of the Blind Spot:

Draw the star and box on a piece of paper.
Close your left eye; Look at the star with your right eye; Move paper back and forth
until the green box disappears.
Open your left eye and the box can be seen because even though it was falling on the
blind spot of the right eye, it is not falling on the blind spot of your left eye.
With both eyes open & binocular vision intact, you dont realize that there is a blind
spot since the corresponding spot on the contralateral retina will see the object. 12
 Visual Fields: Temporal Field of
Left Eye
Nasal Field of
Left Eye
Pg. 3

Binocular
F F

Binocular field combines the two monocular

visual fields with the foveas (F) aligned withNormal Monocular Visual Normal Monocular Visual
one another. (i.e. the pink area in the image Field of Left Eye Field of Right Eye
to the right) Left Visual Field Right Visual Field

Left Visual Field seen by both the left & right

eyes. Upper Fields

Right Visual Field seen by both the left & Monocular Monocular
Crescent of Crescent of
right eyes. Left Eye F Right Eye
Monocular crescent for each eye (blue for Lower Fields
left eye & green for right eye) is only seen by
the nasal retina of the same eye.

Normal Binocular Visual Field

Understand the difference between the monocular visual field of the left eye vs. 13
the binocular left visual field and vice versa for the right counterparts.
 Temporal Field of Nasal Field of Pg. 3
Visual Fields: Left Eye Left Eye

Binocular
Demonstration of the Binocular
Visual Field & Monocular Crescent: F F

Look straight ahead

Close your right eye
Move your finger to the right
until it disappears Normal Monocular Visual Normal Monocular Visual
Open right eye to see the pencil Field of Left Eye Field of Right Eye
-- in the right temporal Left Visual Field Right Visual Field
monocular crescent of your
visual field. Upper Fields
Binocular vision is dependent upon the
extraocular muscles aligning the eyes so
F
that an image falls on corresponding
points on the retina of each eye. This is Lower Fields

essential for the brain to perceive a single

image. Diplopia occurs when the images
are not aligned to fall on corresponding Normal Binocular Visual Field
points of each retina.
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 Visual Fields Pg. 4

Monocular Binocular Monocular

Crescent of Crescent of
Left Eye Right Eye
NOTE:
Visual Field
DOTTED OUTLINE = MONOCULAR
FIELD OF LEFT EYE
SOLID OUTLINE = MONOCULAR FIELD
OF RIGHT EYE
Retina of Retina of
Left Eye Right Eye

The image of an object in the visual field is inverted and reversed right to left on the retina.
Temporal field of left eye (red & purple) is seen by the nasal retina of the left eye
Nasal field of the left eye (green & yellow) is seen by the temporal retina of the left eye.
Superior field of the left eye (red & green) is seen by the inferior retina of the left eye.
Inferior field of the left eye (purple & yellow) is seen by the superior retina of the left eye.
Similarly, the image is inverted & reversed for the right eye.

Note: To avoid confusion and abide by convention, central representation, visual

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deficits, etc. will be described in terms of visual fields and not retinal quadrants.
 Pgs. 4 - 5

Visual Pathway
Left visual field Right visual field

VISUAL FIELDS:
Upper field
Optic Nerve (ON) Lower field
Hatched = binocular
Stippled = monocular

= Axons of ganglion cells in the retina Central area = macula

of the corresponding eye

Outgrowth of diencephalon, so is a
CNS tract & not a true cranial nerve.
Myelinated by oligodendrocytes. Left retina Right retina

Optic Chiasm (OC)

Nasal
ON
Located just anterior to pituitary Left
temporal
retina Right
temporal
Tempora Nasal Nasal Tempora
l retina retina l
Partial crossing of optic nerve axons III Ciliary
OC
in the OC is essential to binocular ganglion

vision Left LGN Right LGN

OT
UVF LVF LVF UVF
Axons from temporal fields cross
lateral medial III medial lateral
midbrain
Axons from nasal fields do not E.W.

cross
Wilbrands knee may be artifact pretectal
nuclei

Retinotopic representation cuneus

Central (macular) vision

Peripheral vision lingual 16 Calcarin
gyrus e sulcus
Left visual cortex Right visual
Note: Reference point = Visual Fields cortex
 Pgs. 4 - 5

Visual Pathway
Left visual field Right visual field

VISUAL FIELDS:
Post-Chiasmatic portion of the pathway: Upper field
Hatched = binocular

From optic tract to visual cortex, each side of the brain Lower field Stippled = monocular
Central area = macula
deals with the contralateral visual field.

Optic Tract (OT)

Optic nerve fibers from the optic chiasm
continue as the optic tract & terminate in Left retina Right retina
the lateral geniculate nucleus of thalamus.
Each tract contains axons that carry input
from the contralateral visual field. Nasal
Left ON Right
retina
Left OT receives from R. visual field Tempora Nasal temporal
retina
temporal
retina
Nasal Tempora
l l
Right OT receives from the L. visual OC
III Ciliary
ganglion
field
Left LGN Right LGN
Lateral Geniculate Nucleus (LGN) UVF LVF
OT
LVF UVF

Primary termination of OT fibers lateral medial

midbrain
III medial lateral
E.W.
Each LGN receives input from the
contralateral visual field.
pretectal
OT Projections to pretectum for reflexes nuclei

Retinotopic representation cuneus

Central (macular) vision

Peripheral vision lingual 17
gyrus
Left visual cortex Right visual
Note: Reference point = Visual Fields cortex
 Pgs. 4 - 5
Visual Pathway Left visual field Right visual field

Post-Chiasmatic portion of the pathway: Upper field

VISUAL FIELDS:
Hatched = binocular
From optic tract to visual cortex, each side of the brain Lower field Stippled = monocular
deals with the contralateral visual field. Central area = macula

Geniculocalcarine Tract (= optic

radiations)
Axons of LGN neurons travel to primary Left retina Right retina
visual cortex (Area 17) via the
geniculocalcarine tract located in the
retrolenticular and sublenticular portions Nasal
Left ON
of the internal capsule. temporal
retina Right
temporal
Tempora Nasal Nasal Tempora
l retina retina l
Axons from upper visual fields take a III Ciliary
OC
looping course into the temporal lobe on ganglion

the way to visual cortex. (=Meyers loop) Left LGN

OT
Right LGN

UVF LVF LVF UVF

Axons from lower visual fields take a
lateral medial III medial lateral
more direct route to visual cortex. midbrain
E.W.
Meyers
Macular fibers are in an intermediate loop

location in the optic radiation. pretectal

nuclei Optic radiation or
geniculocalcarine
tract

Retinotopic representation cuneus

Central (macular) vision

Peripheral vision lingual 18 Calcarin
gyrus e sulcus
Left visual cortex Right visual
Note: Reference point = Visual Fields cortex
 Pgs. 4 - 5
Visual Pathway Left visual field Right visual field

Primary Visual Cortex (Area 17)

VISUAL FIELDS:
Upper field
Hatched = binocular
Stippled = monocular
Located on either side of & within the Lower field
Central area = macula
calcarine fissure.
Upper fields project to the lingual gyrus.
Lower fields project to the cuneus.
Macular representation is most caudal in Area Left retina Right retina

17.
Peripheral field representation is in the rostral
Nasal
2/3rds of Area 17. Left retina
ON Right
Tempora Nasal temporal temporal Nasal Tempora
retina
Lesions of Area 17 result in blindness in the l
III
retina
Ciliary
l
OC
contralateral visual field. ganglion

Left LGN Right LGN

Association Visual Cortex (Areas 18 UVF LVF
OT
LVF UVF
& 19) lateral medial
midbrain
III medial lateral
E.W.
Input from Area 17 & elsewhere Meyers
loop

Deals with complex aspects of vision pretectal

nuclei Optic radiation or
Lesions of result in visual agnosia. geniculocalcarine
tract

Retinotopic representation cuneus

Central (macular) vision

Peripheral vision lingual 19 Calcarin
gyrus e sulcus
Left visual cortex Right visual
Note: Reference point = Visual Fields cortex
 Pg. 6
Lesions of the Visual Pathway
Left Right
1. Normal visual fields Fields, not
retinal Definitions
quadrants
2. Blindness of the right eye
Strabismus
Diplopia
3. Blindness of right eye + contralateral left upper Amblyopia
quadrantanopia
Scotoma
4. Bitemporal heteronymous hemianopsia Quadrantanopsia - # 3, 6 Aka
field
Hemianopsia - # 4, 5, 7 cuts
5. Left homonymous hemianopsia
Heteronymous Defects - # 3, 4
Homonymous Defects - # 5, 6, 7
6. Left upper homonymous quadrantanopsia
Congruous Defects - # 5, 6, 7
Incongruous Defects - # 3
7. Left homonymous hemianopsia with macular
sparing Altitudinal Defects - # 6
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Masked area = area
of visual loss
 Pg. 6
Lesions of the Visual Pathway
Left Right
1. Normal visual fields

2. Blindness of the right eye

3. Blindness of right eye + contralateral left upper

quadrantanopia

4. Bitemporal heteronymous hemianopsia

5. Left homonymous hemianopsia

6. Left upper homonymous quadrantanopsia

7. Left homonymous hemianopsia with macular

sparing
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 Pg. 7
Pupillary Constriction
(Miosis)
Right
Afferent limb =
Optic Nerve (SSA) Left
AKA Pupillary Light
Direct Consensual Reflex
Reflex Reflex

Efferent limb = Oculomotor Nerve (GVE)

Postganglionic
Preganglionic

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Nolte 17-38
Reflex abolished if afferent or efferent is damaged.
Pg. 7

Right Left
Right Left

Afferent
defect

Right Left

Efferent
defect

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Nolte 17-38
 Pg. 7-8

Pupillary Dilation
(Mydriasis)
Decreased light to pupil Cortex, Hypothalamus
? Thalamus & ? Reticular
Severe pain (CNS control center
Hippocampus for ANS) Formation
Strong emotional stimulus

Reticulospinal
fibers

Dilation Superior Preganglionic

of pupil (post-ganglionic Cervical (pre-ganglionic Sympathetic Neurons
sympathetic) Ganglion sympathetic) in Thoracic Cord (T1-
T2)

Horners Syndrome
Pupillary Constriction Loss of Sympathetics
Ptosis Lesion can be in CNS or PNS
Flushed & Dry Skin Deficits ipsilateral to lesion

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Accommodation (or Near) Reflex

1. Initiated by shift in gaze from far to near.
Ocular convergence
2. Three components: Pupillary constriction
Lens thickening

3. Efferent limb: GSE & GVE of Oculomotor

4. Afferent limb & Central Connections:
Optic nerve Optic tract Lateral Geniculate Nucleus Optic Radiation
Primary Visual Cortex Association Visual Cortex Optic Radiation
Br. of Superior Colliculus Superior Colliculus Oculomotor Nuclei
Oculomotor Nerve

Argyll Robertson pupil: Pupillary constriction occurs as part of the

accommodation reflex, but not in response to light.
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See Visual Pathway
Practice Quiz

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