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

Eye Exam

Eyes are the window to the brain!

Pg. 1

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.

Learning Objectives

Pg. 1

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

Pg. 2

The Visual Pathway

VISUAL
FIELD

RETINA

ON
OT
LGN

OC

Pathway extends from the

front to the back of the
brain.
Precise retinotopic
organization
Deficits due to lesions of
the pathway give valuable
localizing information.

OPTIC
RADIATIONS

ON = Optic Nerve
OC = Optic Chiasm
OT = Optic Tract
LGN = Lateral Geniculate Nucleus of Thalamus

VISUAL
CORTEX

Beginning of the Pathway

Pg. 2

Pg. 2

Ganglion cells

axons form the optic nerve

Bipolar cells

Rods and Cones

(Receptors)

Cells
of the
Retina

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

in the macula lutea)

Pg. 2

Retinal Quadrants
Left retina

Right retina

Vertical Meridian
UTQ

UNQ

LTQ

LNQ

UNQ

UTQ

LNQ

LTQ

nose

Macula with
fovea centralis

Horizontal Meridian

Papilla (optic
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.

Pg. 2

Visual Fields & the Visual Pathway

VISUAL
FIELD

RETINA

ON
OT

OC

The following slides

begin with the
visual fields and
then follow the
pathway from the
retina to the visual
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

Confrontational method

(see Dr. Meyersons

Neurological Exam notes)

Perimetry (Manual or
Automated)

Monocular Visual Fields:

Nasal Field of
Left Eye

Vertical Horizontal
Meridian Meridian

UTQ

UNQ
F

Lower Field of
Left Eye

Mapping of Visual Fields:

Upper Field of
Left Eye

can be seen by the patient

without movement of the head and
with the eyes fixed on a single
spot.

Temporal Field of
Left Eye

LTQ

LNQ

Normal Monocular Visual

Field of Left Eye

Normal Monocular Visual

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

Normal Monocular Visual

Field of Left Eye

Normal Monocular Visual

Field of Right Eye

Lower Field of
Left Eye

On the horizontal
meridian

Nasal Field of
Left Eye

Upper Field of
Left Eye

15 to the temporal side

of the visual field of each
eye

Temporal Field of
Left Eye

Corresponds to the
location of the optic
nerve head 15 to the
nasal side of the retina of
each 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.

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Visual Fields:
Binocular

Temporal Field of
Left Eye

Pg. 3

Nasal Field of
Left Eye

Binocular field combines the two monocular

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

Normal Monocular Visual

Field of Right Eye
Right Visual Field

Left Visual Field seen by both the left & right

eyes.
Right Visual Field seen by both the left &
right eyes.

Monocular
Crescent of
Left Eye

Upper Fields

Monocular crescent for each eye (blue for left

eye & green for right eye) is only seen by the
nasal retina of the same eye.

Monocular
Crescent of
Right Eye
Lower Fields

Normal Binocular Visual Field

Understand the difference between the monocular visual field of the left eye vs.
the binocular left visual field and vice versa for the right counterparts.

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Visual Fields:
Binocular
Demonstration of the Binocular
Visual Field & Monocular Crescent:
Look straight ahead
Close your right eye
Move your finger to the right
until it disappears
Open right eye to see the pencil
-- in the right temporal
monocular crescent of your
visual field.

Temporal Field of
Left Eye

Pg. 3

Nasal Field of
Left Eye

Normal Monocular Visual

Field of Left Eye

Normal Monocular Visual

Field of Right Eye

Binocular vision is dependent upon the

extraocular muscles aligning the eyes so
that an image falls on corresponding
points on the retina of each eye. This is
essential for the brain to perceive a single
image. Diplopia occurs when the images
are not aligned to fall on corresponding
points of each retina.

Left Visual Field

Right Visual Field

Upper Fields

F
Lower Fields

Normal Binocular Visual Field

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Visual Fields
Monocular
Crescent of
Left Eye

Binocular

Pg. 4

Monocular
Crescent of
Right Eye

Visual Field

Retina of
Left Eye

NOTE:
DOTTED OUTLINE = MONOCULAR
FIELD OF LEFT EYE

Retina of
Right Eye

SOLID OUTLINE = MONOCULAR FIELD

OF 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
deficits, etc. will be described in terms of visual fields and not retinal quadrants.
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Visual Pathway

Left visual field

Pgs. 4 - 5

Right visual field

VISUAL FIELDS:

Upper field

Optic Nerve (ON)

Hatched = binocular
Stippled = monocular

Lower field

= Axons of ganglion cells in the retina

of the corresponding eye

Central area = macula

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

Right retina

Left retina

Optic Chiasm (OC)

Located just anterior to pituitary

Temporal Nasal

Partial crossing of optic nerve axons

in the OC is essential to binocular
vision
Axons from temporal fields cross

Right
temporal
retina
III

OC

Nasal Temporal

Ciliary
ganglion
Right LGN

Left LGN
UVF
lateral

LVF
medial

Axons from nasal fields do not

cross

OT

LVF
midbrain

UVF

medial

III

lateral

E.W.

pretectal
nuclei

Wilbrands knee may be artifact

Retinotopic representation
Central (macular) vision
Peripheral vision
Note: Reference point = Visual Fields

Nasal
ON
retina

Left
temporal
retina

cuneus

lingual
gyrus

Left visual cortex

16

Right visual
cortex

Calcarine
sulcus

Visual Pathway

Left visual field

Post-Chiasmatic portion of the pathway:

From optic tract to visual cortex, each side of the brain
deals with the contralateral visual field.

Pgs. 4 - 5

Right visual field

VISUAL FIELDS:

Upper field

Hatched = binocular
Stippled = monocular

Lower field

Central area = macula

Optic Tract (OT)

Optic nerve fibers from the optic chiasm
continue as the optic tract & terminate in
the lateral geniculate nucleus of thalamus.

Right retina

Left retina

Each tract contains axons that carry input

from the contralateral visual field.
Left OT receives from R. visual field

Temporal Nasal

Right OT receives from the L. visual

field

Right
temporal
retina
III

OC

Nasal Temporal

Ciliary
ganglion
Right LGN

Left LGN

Lateral Geniculate Nucleus (LGN)

Primary termination of OT fibers

Nasal
ON
retina

Left
temporal
retina

UVF
lateral

LVF
medial

OT

LVF
midbrain

UVF

medial

III

lateral

E.W.

Each LGN receives input from the

contralateral visual field.
pretectal
nuclei

OT Projections to pretectum for reflexes

Retinotopic representation
Central (macular) vision
Peripheral vision
Note: Reference point = Visual Fields

cuneus

lingual
gyrus

Left visual cortex

17

Right visual
cortex

Visual Pathway

Left visual field

Post-Chiasmatic portion of the pathway:

From optic tract to visual cortex, each side of the brain
deals with the contralateral visual field.

Pgs. 4 - 5

Right visual field

VISUAL FIELDS:

Upper field

Hatched = binocular
Stippled = monocular

Lower field

Central area = macula

Geniculocalcarine Tract (= optic

radiations)
Axons of LGN neurons travel to primary
visual cortex (Area 17) via the
geniculocalcarine tract located in the
retrolenticular and sublenticular portions
of the internal capsule.

Temporal Nasal

Axons from upper visual fields take a

looping course into the temporal lobe on
the way to visual cortex. (=Meyers loop)
Axons from lower visual fields take a
more direct route to visual cortex.

Right retina

Left retina

Right
temporal
retina
III

OC

Nasal Temporal

Ciliary
ganglion
Right LGN

Left LGN
UVF
lateral

LVF
medial

Macular fibers are in an intermediate

location in the optic radiation.

Retinotopic representation
Central (macular) vision
Peripheral vision
Note: Reference point = Visual Fields

Nasal
ON
retina

Left
temporal
retina

OT

LVF
midbrain

UVF

medial

III
E.W.

pretectal
nuclei

lateral
Meyers
loop

Optic radiation or
geniculocalcarine
tract

cuneus

lingual
gyrus

Left visual cortex

18

Right visual
cortex

Calcarine
sulcus

Visual Pathway

Left visual field

Primary Visual Cortex (Area 17)

Pgs. 4 - 5

Right visual field

VISUAL FIELDS:

Upper field

Hatched = binocular
Stippled = monocular

Lower field

Located on either side of & within the

calcarine fissure.

Central area = macula

Upper fields project to the lingual gyrus.

Lower fields project to the cuneus.
Macular representation is most caudal in Area
17.
Peripheral field representation is in the rostral
2/3rds of Area 17.

Temporal Nasal

Lesions of Area 17 result in blindness in the

contralateral visual field.

Association Visual Cortex (Areas 18

& 19)

Right retina

Left retina

Right
temporal
retina
III

OC

Nasal Temporal

Ciliary
ganglion
Right LGN

Left LGN
UVF

lateral

LVF
medial

Input from Area 17 & elsewhere

Deals with complex aspects of vision

OT

LVF
midbrain

UVF

medial

III
E.W.

pretectal
nuclei

Lesions of result in visual agnosia.

Retinotopic representation
Central (macular) vision
Peripheral vision
Note: Reference point = Visual Fields

Nasal
ON
retina

Left
temporal
retina

lateral
Meyers
loop

Optic radiation or
geniculocalcarine
tract

cuneus

lingual
gyrus

Left visual cortex

19

Right visual
cortex

Calcarine
sulcus

Pg. 6

Lesions of the Visual Pathway

Left
1. Normal visual fields

Right

Fields, not
retinal
quadrants

2. Blindness of the right eye

Definitions
Strabismus
Diplopia

3. Blindness of right eye + contralateral left upper

quadrantanopia

Amblyopia
Scotoma
Quadrantanopsia - # 3, 6

4. Bitemporal heteronymous hemianopsia

Hemianopsia - # 4, 5, 7
5. Left homonymous hemianopsia

Aka
field
cuts

Heteronymous Defects - # 3, 4

6. Left upper homonymous quadrantanopsia

Homonymous Defects - # 5, 6, 7
Congruous Defects - # 5, 6, 7

7. Left homonymous hemianopsia with macular

sparing
Masked area = area
of visual loss

Incongruous Defects - # 3
Altitudinal Defects - # 6

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Pg. 6

Lesions of the Visual Pathway

Left
1. Normal visual fields

Right

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

21

Pg. 7

Pupillary Constriction
Right
Direct
Reflex

Afferent limb =
Optic Nerve (SSA)

(Miosis)
Left
Consensual
Reflex

AKA Pupillary Light

Reflex

Efferent limb = Oculomotor Nerve (GVE)

Postganglionic
Preganglionic

Nolte 17-38

22

Reflex abolished if afferent or efferent is damaged.

Pg. 7
Right

Left

Right

Left

Afferent
defect

C
Right

Left

Efferent
defect

Nolte 17-38
23

Pupillary Dilation

Pg. 7-8

(Mydriasis)
Decreased light to pupil
Severe pain
Strong emotional stimulus

Cortex,
Thalamus &
Hippocampus

Hypothalamus
(CNS control center
for ANS)

Reticular
Formation

Reticulospinal
fibers
Dilation
of pupil

(post-ganglionic
sympathetic)

Superior
Cervical
Ganglion

(pre-ganglionic
sympathetic)

Preganglionic
Sympathetic Neurons
in Thoracic Cord (T1T2)

Horners Syndrome

Pupillary Constriction
Ptosis
Flushed & Dry Skin

Loss of Sympathetics
Lesion can be in CNS or PNS
Deficits ipsilateral to lesion

24

Pg. 8

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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TIFF (Uncompressed) decompressor
are needed to see this picture.

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