II. Definitions

  1. Conjugate Gaze
    1. Movement of both eyes in the same direction at the same time
  2. Ophthalmoplegia
    1. Weakness or paralysis of one or more Extraocular Movement muscles
    2. Results from either a muscle disoder or nerve palsy

III. Anatomy: Innervation

  1. Cerebral Cortex
    1. Voluntary Conjugate Gaze (Brodmann's Area 8)
    2. Involuntary Conjugate Gaze (Areas 17-19)
  2. Cranial Nerves
    1. CN 3 (nucleus in Midbrain)
    2. CN 4 (nucleus in Midbrain)
    3. CN 6 (nucleus in pons)
  3. Nucleii and Pathways
    1. Lateral Gaze Center (Pontine Paramedian Reticular Formation, Paraabducens Nucleus)
      1. Responsible for horizontal gaze and saccade eye movements
      2. Facilitates Conjugate Gaze by synapsing with contralateral fibers for coordinated eye movements
    2. Medial Longitudinal Fasciculus (MLF)
      1. Transmits signals between CN 3 and CN 6 to coordinate eye movements (Conjugate Gaze)
      2. Dysfunctional in Internuclear Ophthalmoplegia (e.g. Multiple Sclerosis, esp. if bilateral)
      3. Example of normal Conjugate Gaze pathway via Medial Longitudinal Fasciculus
        1. Cortical signal from voluntary gaze center directs left eye to look left
        2. Left eye CN 6 (lateral rectus) fires for the left eye to look left
        3. CN 6 signals Synapse with the Lateral Gaze Center
        4. Signals are transmitted via Medial Longitudinal Fasciculus across midline to contralateral CN 3
        5. Medial rectus directs the right eye to also look left (adduct to look medially)

IV. Anatomy: Extraocular Muscles: Innervated by CN 3 with 2 exceptions

  1. Medial Range of Motion
    1. Medial Rectus (Cranial Nerve III)
  2. Lateral Range of Motion
    1. Lateral Rectus (Cranial Nerve VI)
  3. Upward Range of Motion
    1. Superior Rectus (Cranial Nerve III)
    2. Inferior Oblique (Cranial Nerve III)
  4. Downward Range of Motion
    1. Inferior Rectus (Cranial Nerve III)
    2. Superior Oblique (Cranial Nerve IV)

V. Anatomy: Images

  1. See Neurologic Anatomy of the Eye
  2. eye_eom.png
  3. eyeOculomotorGrayBB785.gif Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  4. eyeOculomotorGrayBB889.gif Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)

VI. Pathophysiology

VII. References

  1. Goldberg (2014) Clinical Neuroanatomy, Medmaster, p. 40-53
  2. Netter (1997) Atlas Human Anatomy, ICON Learning, p. 114, 126

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Oculomotor nerve structure (C0028864)

Definition (FMA) Cranial nerve which connects the midbrain to the extra-ocular and intra-ocular muscles.
Definition (UWDA) Cranial nerve which connects the midbrain to the extra-ocular and intra-ocular muscles.
Definition (NCI_CDISC) The third cranial nerve.
Definition (MSH) The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain.
Definition (CSP) third cranial nerve; sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye; sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation; motor fibers originate in the oculomotor nuclei of the midbrain.
Concepts Body Part, Organ, or Organ Component (T023)
MSH D009802
SnomedCT 56193007
English Nerve, Oculomotor, Nerves, Oculomotor, Oculomotor Nerve, Oculomotor Nerves, Cranial Nerve III, Cranial Nerve, Third, Cranial Nerves, Third, Nerve, Third Cranial, Nerves, Third Cranial, Third Cranial Nerve, Third Cranial Nerves, cranial nerve III, Oculomotor nerve [III], Nervus oculomotorius [III], Oculomotor nerve tree, cranial nerve iii, oculomotor nerves, cranial iii nerve, Cranial Nerve IIIs, third cranial nerve, 3n, oculomotor nerve, Nervus oculomotorius, OCULOMOTOR NERVE, Nervus Oculomotorius, Nerve IIIs, Oculomotorius, Nervus, Nerve III, Third cranial nerve, Oculomotor nerve, Cranial nerve III, Oculomotor nerve structure (body structure), Oculomotor nerve structure, Oculomotor nerve, NOS
French Troisième paire crânienne, Nerf oculomoteur, Nerf crânien III, Nerf moteur oculaire commun, Troisième nerf crânien, Nerf oculo-moteur, Nerf crânien 3
Swedish Ögonrörelsenerv
Czech nervus oculomotorius, okohybný nerv, III. hlavový nerv
Finnish Silmän liikehermo
German DRITTER HIRNNERV, Hirnnerv III, III. Hirnnerv, Nervus oculomotorius
Italian Nervo cranico III, Terzo nervo cranico, Nervo oculomotore
Latvian Acs kustību nervs
Polish Nerw okoruchowy, Nerw III
Japanese 動眼神経, 眼球運動神経, 第3脳神経
Norwegian 3. hjernenerve, Nervus oculomotorius, Øyets bevegelsesnerve, Okulomotorisk nerve, Hjernenerve 3
Spanish III Par Craneal, Nervio Craneal III, III par craneal, estructura del nervio oculomotor (estructura corporal), estructura del nervio oculomotor, nervio craneal III, nervio motor ocular, nervio oculomotor, tercer par craneal, tercer par craneano, III Nervio Craneal, Nervio Oculomotor, Tercer Nervio Craneal
Portuguese III Par Craniano, III Nervo Craniano, Nervo Craniano III, Nervo Oculomotor, Terceiro Nervo Craniano
Dutch IIIe hersenzenuw, Nervus cranialis III, Nervus oculomotorius

Ontology: Ophthalmoplegia (C0029089)

Definition (MSHCZE) Oftalmoplegie – ochrnutí očních svalů (vnitřních či zevních). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Weakness or paralysis of at least one of the muscles controlling the movement of the eye. It results from degeneration of the muscles or the neural pathways involved in the eye movement. Representative disorders causing ophthalmoplegia include ocular myopathies and multiple sclerosis.
Definition (MSH) Paralysis of one or more of the ocular muscles due to disorders of the eye muscles, neuromuscular junction, supporting soft tissue, tendons, or innervation to the muscles.
Concepts Sign or Symptom (T184)
MSH D009886
SnomedCT 155196009, 267745004, 16110005
English Oculomotor Paralysis, Ophthalmoplegias, EYE MUSCLE PARALYSIS, OCULOMOTOR PARALYSIS, OPHTHALMOPLEGIA, Paralysis, Oculomotor, oculomotor paralysis, Oculomotor paralysis, Extraocular muscle paralysis, ophthalmoplegia, ophthalmoplegia (diagnosis), Paralysis extraocular muscle (s), Eye muscle paralysis, Muscle paralysis eye, Paralysis oculomotor, Ophthalmoplegia (NOS), Ophthalmoplegia NOS, Ophthalmoplegia [Disease/Finding], eye muscles paralysis, eye muscle paralysis, Ophthalmoplegia (disorder), eye muscle; paralysis, paralysis; eye muscle, Ophthalmoplegia, NOS, Ophthalmoplegia
French OPHTALMOPLEGIE, PARALYSIE OCULOMOTRICE, Paralysie musculaire d'un oeil, Paralysie du muscle oculaire, Ophtalmoplégie SAI, Paralysie de muscles extraoculaires, Ophtalmoplégie, Paralysie oculomotrice, Paralysie oculo-motrice
Portuguese OFTALMOPLEGIA, PARALISIA OCULOMOTORA, Oftalmoplegia NE, Paralisia de nervo oculomotor comum, Paralisia de músculo ocular, Paralisia de músculo(s) extrínseco(s) do olho, PARALISIA DA MUSCULATURA OCULAR, Oftalmoplegia, Paralisia Oculomotora
Spanish OFTALMOPLEJIA, PARALISIS OCULOMOTORA, Parálisis del músculo (s) extraocular, Parálisis de la músculatura ocular, Parálisis oculomotora, Parálisis de músculo ocular, Oftalmoplejia NEOM, Oftalmoplejia (NEOM), PARALISIS MUSCULATURA OCULAR, oftalmoplejía (trastorno), oftalmoplejía, Oftalmoplejia, Oftalmoplejía, Parálisis Oculomotora
German OPHTHALMOPLEGIE, Laehmung Okulomotorius, Okulomotorius-Laehmung, Augenmuskellaehmung, Laehmung der aeusseren Augenmuskeln, Muskellaehmung, Auge, Ophthalmoplegie NNB, Ophthalmoplegie (NNB), AUGENMUSKELLAEHMUNG, OKULOMOTORIUSLAEHMUNG, Ophthalmoplegie, Augenmuskellähmung
Dutch paralyse extra-oculaire spier(en), oftalmoplegie (NAO), spier paralyse oog, oogspier paralyse, paralyse oculomotorisch, oculomotorische paralyse, oftalmoplegie NAO, oogspier; paralyse, paralyse; oogspier, oftalmoplegie, Oftalmoplegie, Paralyse, oculomotorische
Italian Paralisi di muscolo oculare, Oftalmoplegia (NAS), Oftalmoplegia NAS, Paralisi di muscolo/i extraoculare/i, Paralisi dell'oculomotore, Paralisi oculomotoria, Oftalmoplegia
Japanese 眼筋麻痺NOS, 外眼筋麻痺, 眼筋麻痺(NOS), ドウガンシンケイマヒ, ガンキンマヒNOS, ガイガンキンマヒ, ガンキンマヒ, 眼筋麻痺, 動眼神経麻痺
Swedish Ögonförlamning
Czech oftalmoplegie, Paralýza očního svalu, Svalová paralýza oka, Oftalmoplegie NOS, Okulomotorická obrna, Extraokulární svalová paralýza, Obrna okulomotoriu, Oftalmoplegie (NOS), Oftalmoplegie, ophthalmoplegia
Finnish Oftalmoplegia
Polish Oftalmoplegia
Hungarian Oculomotorius bénulás, Ophthalmoplegia (K.m.n.), Szem izom paralysis, Ophthalmoplegia k.m.n., Szemizom paralysis, Paralysis, extraocularis izom/izmok, Ophthalmoplegia, Oculomotorius paralysis
Norwegian Oftalmoplegi, Okulomotorisk paralyse, Øyemuskellammelse

Ontology: Medial longitudinal fasciculus (C0152373)

Concepts Body Part, Organ, or Organ Component (T023)
SnomedCT 28390009
English medial longitudinal fasciculus, medial longitudinal bundle, medial longitudinal fascicle, Fasciculus longitudinalis dorsalis (Riley), Fasciculus longitudinalis posterior (posticus), Tractus longitudinalis medialis, Fasciculus longitudinalis medialis, Fasciculus commissurae posterioris, Medial longitudinal fasciculus structure (body structure), Medial longitudinal fasciculus structure, Medial longitudinal fasciculus, NOS, Medial longitudinal fasciculus, MLF-Medial longitudinal fasciculus
Spanish estructura del fascículo longitudinal medio (estructura corporal), estructura del fascículo longitudinal medio, fascículo longitudinal medio

Ontology: Conjugate gaze (C0522329)

Concepts Organ or Tissue Function (T042)
SnomedCT 103255006
English Conjugate gaze, Conjugate gaze (finding)
Spanish mirada conjugada (hallazgo), mirada conjugada

Ontology: Paramedian nucleus of pons (C2332972)

Concepts Body Part, Organ, or Organ Component (T023)
English Paramedian nucleus of pons, Nucleus paramedianus pontis