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The oculomotor nerve (CN III) is responsible for movements of the eyeball and eyelid.

Cranial Oculomotor Nerve (CN III)

Cranial Nerve III: Oculomotor
Nerve
Nerve
Anatomy
Key Arises from midbrain, passes through lateral aspect of cavernous sinus, exits skull through superior orbital ssure
FRCEM Success anatomy

Function Motor: innervates four extraocular muscles (inferior oblique, superior, inferior and medial rectus muscles), levator
palpebrae superioris muscle (elevation of upper eyelid), sphincter pupillae muscle (pupillary constriction), ciliary muscle
(accommodation), e erent pathway of pupillary light re ex

Assessment Eye movements, accommodation, pupillary light re ex

Clinical Depressed and abducted (down and out) eye, diplopia, ptosis, xed and dilated pupil with loss of accommodation and
e ects of abnormal pupillary light re ex
injury

Causes of Tumours, aneurysms (posterior communicating), subdural or epidural haematoma, diabetes mellitus

KEYWORDS
injury
Cranial Nerves Oculomotor Nerve

Function
RELATED TOPICS
Anatomy Head and Neck
The oculomotor nerve is a motor nerve innervating all of the extraocular muscles responsible for eyeball movements (except for the superior
Cranial Nerve Lesions Orbit and Eye oblique and lateral rectus muscles) and the levator palpebrae superioris muscle responsible for elevation of the upper eyelid. It also provides the
parasympathetic supply to the sphincter pupillae (pupillary constriction) and ciliary muscle (accommodation).

Something wrong?
Anatomical Course

The oculomotor nerve arises from the anterior aspect of the midbrain and then passes forwards between the posterior cerebral and superior
cerebellar arteries, very close to the posterior communicating artery. It pierces the dura near the edge of the tentorium cerebelli, and passes
through the lateral part of the cavernous sinus (together with CN IV and VI nerves and the ophthalmic division of CN V) to enter the orbit
through the superior orbital ssure.

OBLIQUE SECTION THROUGH THE RIGHT CAVERNOUS SINUS. (IMAGE BY HEN RY VAN DYKE CARTER [PUBLIC DOMA IN] , V IA W IKIME DIA CO MMO NS)

At this point it divides into a superior branch innervating the superior rectus and levator palpebrae superioris muscles and an inferior branch
innervating the inferior rectus, medial rectus and inferior oblique muscles and supplying parasympathetic innervation to the sphincter pupillae
and ciliary muscles. The parasympathetic bres pass on the periphery of the oculomotor nerve.

OCULOMOTOR N ERV E. (IMAGE BY HEN RY VAN DYKE CARTER [PUBLIC DOMA IN] , V IA W IKIME DIA CO MMO NS)

Assessment

The oculomotor nerve should be assessed by testing:

Ocular movements (which also tests the trochlear nerve (CN IV) and the abducens nerve (CN VI))
Pupillary accommodation
Pupillary light re ex (which also tests the a erent optic nerve (CN II)).

Likely Causes of Disease or Injury

Causes of CN III palsy:

Compressive aetiology

Tumours (commonly by compression against the xed edge of the tentorium as the medial part of the temporal lobe herniates
down)
Aneurysms (carotid or posterior communicating artery)
Subdural or epidural haematoma
Trauma
Cavernous sinus disease

Ischaemic aetiology
Diabetes mellitus
Hypertension

Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic bres run peripherally in the nerve and are
easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically a ect the central bres
resulting in pupillary sparing.

Common Clinical E ects

CN III palsy results in:

A depressed and abducted eye (down and out pupil) due to unopposed action of the lateral rectus and superior oblique muscles
Diplopia on looking up and in
Ptosis
Fixed pupillary dilatation
Loss of accommodation (cycloplegia)
Abnormal pupillary light re ex
Ipsilateral direct re ex lost
Contralateral consensual re ex intact
Contralateral direct re ex intact
Ipsilateral consensual re ex lost