Oculomotor nerve

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Oculomotor nerve
Gray776.png
Nerves of the orbit. Seen from above.
Brain human normal inferior view with labels en.svg
Inferior view of the human brain, with the cranial nerves labelled.
Details
From Oculomotor nucleus, Edinger-Westphal nucleus
To Superior branch, inferior branch
Innervates Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris, sphincter pupillae (parasympathetics), ciliaris muscle (parasympathetics)
Identifiers
Latin nervus oculomotorius
MeSH D009802
NeuroNames 488
TA98 A14.2.01.007
TA2 6187
FMA 50864
Anatomical terms of neuroanatomy

The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements of the eye and that raise the eyelid. The nerve also contains fibers that innervate the intrinsic eye muscles that enable pupillary constriction and accommodation (ability to focus on near objects as in reading). The oculomotor nerve is derived from the basal plate of the embryonic midbrain. Cranial nerves IV and VI also participate in control of eye movement. [1]

Contents

Structure

The oculomotor nerve originates from the third nerve nucleus at the level of the superior colliculus in the midbrain. The third nerve nucleus is located ventral to the cerebral aqueduct, on the pre-aqueductal grey matter. The fibers from the two third nerve nuclei located laterally on either side of the cerebral aqueduct then pass through the red nucleus. From the red nucleus fibers then pass via the substantia nigra [ citation needed ] to emerge from the substance of the brainstem at the oculomotor sulcus (a groove on the lateral wall of the interpeduncular fossa). [2]

On emerging from the brainstem, the nerve is invested with a sheath of pia mater, and enclosed in a prolongation from the arachnoid. It passes between the superior cerebellar (below) and posterior cerebral arteries (above), and then pierces the dura mater anterior and lateral to the posterior clinoid process, passing between the free and attached borders of the tentorium cerebelli.[ citation needed ]

It traverses the cavernous sinus, above the other orbital nerves receiving in its course one or two filaments from the cavernous plexus of the sympathetic nervous system, and a communicating branch from the ophthalmic division of the trigeminal nerve. As the oculomotor nerve enters the orbit via the superior orbital fissure it then divides into a superior and an inferior branch. [1]

Superior branch

The superior branch of the oculomotor nerve or the superior division, the smaller, passes medially over the optic nerve. It supplies the superior rectus and levator palpebrae superioris.

Inferior branch

The inferior branch of the oculomotor nerve or the inferior division, the larger, divides into three branches.

All these branches enter the muscles on their ocular surfaces, with the exception of the nerve to the inferior oblique, which enters the muscle at its posterior border.

Nuclei

The oculomotor nerve (CN III) arises from the anterior aspect of the mesencephalon (midbrain). There are two nuclei for the oculomotor nerve:

Sympathetic postganglionic fibres also join the nerve from the plexus on the internal carotid artery in the wall of the cavernous sinus and are distributed through the nerve, e.g., to the smooth muscle of superior tarsal (Mueller's) muscle.

Function

The oculomotor nerve includes axons of type GSE, general somatic efferent, which innervate skeletal muscle of the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. (Innervates all the extrinsic muscles except superior oblique and lateral rectus.)

The nerve also includes axons of type GVE, general visceral efferent, which provide preganglionic parasympathetics to the ciliary ganglion. From the ciliary ganglion postganglionic fibers pass through the short ciliary nerve to the constrictor pupillae of the iris and the ciliary muscles.

Clinical significance

Disease

Paralysis of the oculomotor nerve, i.e., oculomotor nerve palsy, can arise due to:

In people with diabetes and older than 50 years of age, an oculomotor nerve palsy, in the classical sense, occurs with sparing (or preservation) of the pupillary reflex. This is thought to arise due to the anatomical arrangement of the nerve fibers in the oculomotor nerve; fibers controlling the pupillary function are superficial and spared from ischemic injuries typical of diabetes. On the converse, an aneurysm which leads to compression of the oculomotor nerve affects the superficial fibers and manifests as a third nerve palsy with loss of the pupillary reflex (in fact, this third nerve finding is considered to represent an aneurysm—until proven otherwise—and should be investigated). [3]

Examination

Eye muscles

Cranial nerves III, IV, and VI are usually tested together as part of the cranial nerve examination. The examiner typically instructs the patient to hold his head still and follow only with the eyes a finger or penlight that circumscribes a large "H" in front of the patient. By observing the eye movement and eyelids, the examiner is able to obtain more information about the extraocular muscles, the levator palpebrae superioris muscle, and cranial nerves III, IV, and VI. Loss of function of any of the eye muscles results in ophthalmoparesis.

Since the oculomotor nerve controls most of the eye muscles, it may be easier to detect damage to it. Damage to this nerve, termed oculomotor nerve palsy, is known by its down and out symptoms, because of the position of the affected eye (lateral, downward deviation of gaze).

Pupillary reflex

The oculomotor nerve also controls the constriction of the pupils and thickening of the lens of the eye. This can be tested in two main ways. By moving a finger toward a person's face to induce accommodation, their pupils should constrict.

Shining a light into one eye should result in equal constriction of the other eye. Fibers from the optic nerves cross over in the optic chiasm with some fibers passing to the contralateral optic nerve tract. This is the basis of the "swinging-flashlight test".

Loss of accommodation and continued pupillary dilation can indicate the presence of a lesion on the oculomotor nerve.

Additional images

See also

Related Research Articles

<span class="mw-page-title-main">Cranial nerves</span> Nerves that emerge directly from the brain and the brainstem

Cranial nerves are the nerves that emerge directly from the brain, of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and from regions of the head and neck, including the special senses of vision, taste, smell, and hearing.

<span class="mw-page-title-main">Abducens nerve</span> Cranial nerve VI, for eye movements

The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve.

Articles related to anatomy include:

<span class="mw-page-title-main">Trochlear nerve</span> Cranial nerve IV, for eye movements

The trochlear nerve, also known as the fourth cranial nerve, cranial nerve IV, or CN IV, is a cranial nerve that innervates a single muscle - the superior oblique muscle of the eye. Unlike most other cranial nerves, the trochlear nerve is exclusively a motor nerve.

<span class="mw-page-title-main">Pupillary light reflex</span> Eye reflex which alters the pupils size in response to light intensity

The pupillary light reflex (PLR) or photopupillary reflex is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retinal ganglion cells of the retina in the back of the eye, thereby assisting in adaptation of vision to various levels of lightness/darkness. A greater intensity of light causes the pupil to constrict, whereas a lower intensity of light causes the pupil to dilate. Thus, the pupillary light reflex regulates the intensity of light entering the eye. Light shone into one eye will cause both pupils to constrict.

<span class="mw-page-title-main">Superior oblique muscle</span> Part of the eye

The superior oblique muscle or obliquus oculi superior is a fusiform muscle originating in the upper, medial side of the orbit which abducts, depresses and internally rotates the eye. It is the only extraocular muscle innervated by the trochlear nerve.

<span class="mw-page-title-main">Oculomotor nucleus</span>

The fibers of the oculomotor nerve arise from a nucleus in the midbrain, which lies in the gray substance of the floor of the cerebral aqueduct and extends in front of the aqueduct for a short distance into the floor of the third ventricle. From this nucleus the fibers pass forward through the tegmentum, the red nucleus, and the medial part of the substantia nigra, forming a series of curves with a lateral convexity, and emerge from the oculomotor sulcus on the medial side of the cerebral peduncle.

<span class="mw-page-title-main">Accommodation reflex</span> Reflex action of the human eye

The accommodation reflex is a reflex action of the eye, in response to focusing on a near object, then looking at a distant object, comprising coordinated changes in vergence, lens shape (accommodation) and pupil size. It is dependent on cranial nerve II, superior centers (interneuron) and cranial nerve III. The change in the shape of the lens is controlled by ciliary muscles inside the eye. Changes in contraction of the ciliary muscles alter the focal distance of the eye, causing nearer or farther images to come into focus on the retina; this process is known as accommodation. The reflex, controlled by the parasympathetic nervous system, involves three responses: pupil constriction, lens accommodation, and convergence.

<span class="mw-page-title-main">Eye movement</span> Movement of the eyes

Eye movement includes the voluntary or involuntary movement of the eyes. Eye movements are used by a number of organisms to fixate, inspect and track visual objects of interests. A special type of eye movement, rapid eye movement, occurs during REM sleep.

<span class="mw-page-title-main">Levator palpebrae superioris muscle</span> Muscle in orbit that elevates upper eyelid

The levator palpebrae superioris is the muscle in the orbit that elevates the upper eyelid.

<span class="mw-page-title-main">Lateral rectus muscle</span> Muscle on lateral side of the eye

The lateral rectus muscle is a muscle on the lateral side of the eye in the orbit. It is one of six extraocular muscles that control the movements of the eye. The lateral rectus muscle is responsible for lateral movement of the eyeball, specifically abduction. Abduction describes the movement of the eye away from the midline, allowing the eyeball to move horizontally in the lateral direction, bringing the pupil away from the midline of the body.

<span class="mw-page-title-main">Inferior oblique muscle</span> Part of the eye

The inferior oblique muscle or obliquus oculi inferior is a thin, narrow muscle placed near the anterior margin of the floor of the orbit. The inferior oblique is one of the extraocular muscles, and is attached to the maxillary bone (origin) and the posterior, inferior, lateral surface of the eye (insertion). The inferior oblique is innervated by the inferior branch of the oculomotor nerve.

<span class="mw-page-title-main">Extraocular muscles</span> Seven extrinsic muscles of the eye

The extraocular muscles, or extrinsic ocular muscles, are the seven extrinsic muscles of the eye in humans and other animals. Six of the extraocular muscles, the four recti muscles, and the superior and inferior oblique muscles, control movement of the eye. The other muscle, the levator palpebrae superioris, controls eyelid elevation. The actions of the six muscles responsible for eye movement depend on the position of the eye at the time of muscle contraction.

<span class="mw-page-title-main">Edinger–Westphal nucleus</span> One of two nuclei of the oculomotor nerve

The Edinger–Westphal nucleus is one of two nuclei of the oculomotor nerve and is located in the midbrain. It receives afferents from both pretectal nuclei. It contains parasympathetic pre-ganglionic neuron cell bodies that synapse in the ciliary ganglion. It contributes the autonomic, parasympathetic component to the oculomotor nerve, ultimately providing innervation to the iris sphincter muscle and ciliary muscle to mediate the pupillary light reflex and accommodation, respectively.

<span class="mw-page-title-main">Ciliary ganglion</span> Bundle of nerves, parasympathetic ganglion

The ciliary ganglion is a parasympathetic ganglion located just behind the eye in the posterior orbit. It is 1–2 mm in diameter and in humans contains approximately 2,500 neurons. The ganglion contains postganglionic parasympathetic neurons. These neurons supply the pupillary sphincter muscle, which constricts the pupil, and the ciliary muscle which contracts to make the lens more convex. Both of these muscles are involuntary since they are controlled by the parasympathetic division of the autonomic nervous system.

<span class="mw-page-title-main">Short ciliary nerves</span> Nerves of the orbit around the eye

The short ciliary nerves are nerves of the orbit around the eye. They are branches of the ciliary ganglion. They supply parasympathetic and sympathetic nerve fibers to the ciliary muscle, iris, and cornea. Damage to the short ciliary nerve may result in loss of the pupillary light reflex, or mydriasis.

<span class="mw-page-title-main">Cranial nerve examination</span> Type of neurological examination

The cranial nerve exam is a type of neurological examination. It is used to identify problems with the cranial nerves by physical examination. It has nine components. Each test is designed to assess the status of one or more of the twelve cranial nerves (I-XII). These components correspond to testing the sense of smell (I), visual fields and acuity (II), eye movements and pupils, sensory function of face (V), strength of facial (VII) and shoulder girdle muscles (XI), hearing and balance, taste, pharyngeal movement and reflex, tongue movements (XII).

<span class="mw-page-title-main">Oculomotor nerve palsy</span> Medical condition

Oculomotor nerve palsy or oculomotor neuropathy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. As the name suggests, the oculomotor nerve supplies the majority of the muscles controlling eye movements. Damage to this nerve will result in an inability to move the eye normally. The nerve also supplies the upper eyelid muscle and is accompanied by parasympathetic fibers innervating the muscles responsible for pupil constriction. The limitations of eye movement resulting from the condition are generally so severe that patients are often unable to maintain normal eye alignment when gazing straight ahead, leading to strabismus and, as a consequence, double vision (diplopia).

<span class="mw-page-title-main">Corticomesencephalic tract</span>

In neuroanatomy, corticomesencephalic tract is a descending nerve tract that originates in the frontal eye field and terminate in the midbrain. Its fibers mediate conjugate eye movement.

<span class="mw-page-title-main">Roots of the ciliary ganglion</span>

The ciliary ganglion is a parasympathetic ganglion located just behind the eye in the posterior orbit. Three types of axons enter the ciliary ganglion but only the preganglionic parasympathetic axons synapse there. The entering axons are arranged into three roots of the ciliary ganglion, which join enter the posterior surface of the ganglion.

References

PD-icon.svgThis article incorporates text in the public domain from page 884 of the 20th edition of Gray's Anatomy (1918)

  1. 1 2 Vilensky, Joel; Robertson, Wendy; Suarez-Quian, Carlos (2015). The Clinical Anatomy of the Cranial Nerves: The Nerves of "On Olympus Towering Top". Ames, Iowa: Wiley-Blackwell. ISBN   978-1-118-49201-7.[ page needed ]
  2. "sulcus of the oculomotor nerve". TheFreeDictionary.com. Retrieved 2022-08-08.
  3. Oculomotor Nerve Palsy at eMedicine