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eye movements

Normal Eye Movements. Objective: FoveationExtraocular musclesMuscle innervation

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eye movements

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    1. Eye Movements Donna L. Hill, MD Neuro-ophthalmology Departments of Neurology and Ophthalmology UF&Shands Jacksonville

    2. Normal Eye Movements Objective: Foveation Extraocular muscles Muscle innervation CNs III, IV, and VI Cranial nerve nuclei Three primary types of movements Pathologic eye movements

    3. Objective: foveation fovea most sensitive portion of retina we need to orient, either voluntarily or reflexively, to important stimuli accomplished by directing our eyes to a target so that it is projected onto the fovea to maintain foveation, we depend on visual feedback as the primary source of information on eye movement accuracy

    4. Extraocular muscles Superior rectus moves eye up Inferior rectus moves eye down Medial rectus moves eye in (a-d-duction) Lateral rectus moves eye out (a-b-duction) Inferior oblique moves eye up when it is in an adducted position; also extorts the eye. Superior oblique moves eye down when it is adducted; also intorts the eye.

    5. Isolating Extraocular Muscles

    6. CN III

    7. CN III

    8. CN IV CN VI

    9. CN VI

    10. Coordination of Eye Movements Separate systems exist to control each different subtype of eye movement: saccades, smooth pursuit, and vergence May be nuclear or supranuclear control May be reflexive or voluntary Separate systems exist to govern vertical and horizontal eye movements

    11. Targeting Eye Movements Saccades: Quick, darting conjugate movements which direct the eyes to a new target. Smooth pursuit: A slower conjugate movement which allows for tracking of a moving object, or of a stationary object while we are moving. Convergence: A dysconjugate movement of both eyes toward the midline to allow for focusing on a near object by adjusting the angle between the eyes.

    12. Variety of pathways contribute to saccadic control and smooth pursuit

    13. Saccades Under the control of three different areas in the brain: voluntary saccades - frontal eye fields (Brodmanns area 8) reflexive saccades to complex stimuli - parietal lobes (Brodmanns area 7) reflexive saccades to elementary stimuli - superior colliculi

    14. Voluntary Saccades (horizontal)

    15. Voluntary Horizontal Saccades

    16. Yoking Mechanism

    17. Reflexive Saccades

    18. Smooth Pursuit Two types: Voluntary (actually termed smooth pursuit) movements - originate in the temporo-parietal lobe Reflexive - which are under vestibular nuclear control alone and constitute what is called the vestibulo-ocular reflex (VOR).

    19. Voluntary Smooth Pursuit originates near the angular gyrus - Area 39 at the temporal parietal occipital junction cells in this region are able to compute the speed and direction of a moving object results in ipsilateral smooth pursuit

    20. Optokinetic Reflex Combination of saccades and smooth pursuit that allow tracking of targets in turn (e.g. counting sheep as they jump over a fence). smoothly pursue one target, then saccade in the opposite direction to pick up the next target parieto-temporal junction (smooth pursuit area) projects down to ipsilateral vestibular nucleus, inhibits it allowing ipsilateral smooth pursuit then, the FEF of the same hemisphere generates a saccade back (contralateral) to the next target

    21. Reflexive Smooth Pursuit - VOR maintains gaze on a target despite head movement reflex arc semicircular canal opposite the head turn detects motion and activates the ipsi vestibular n. which deactivates its inhibitory input on the ipsilateral VI results in eyes turning opposite to the head turn

    22. Convergence When areas of the occipital cortex detect a discrepancy in the retinal projection from each eye and amount of blur, a signal is sent to initiate convergence. To bring a near object into focus actually involves convergence, accomodation (lens curvature increases) and pupillary constriction. Together, these 3 movements are called the near triad.

    23. Pathologic eye movements Muscle Trauma, entrapment, inflammation, infiltrating diseases Neuromuscular Junction myasthenia gravis, botulism, organophosphate poisoning Cranial nuclei or nerve Brainstem: stroke, hemorrhage, multiple sclerosis, tumor, trauma Subarachnoid space: Increased intracranial pressure, aneurysm, meningitis, sarcoidosis, autoimmune Cavernous sinus: Tumor, sinus thrombosis, pituitary apoplexy, sphenoid sinusitis, carotid-cavernous fistula, Tolosa-Hunt syndrome Orbit: Trauma, tumor, infection

    24. right cranial nerve III palsy

    25. right cranial nerve VI palsy

    27. Gaze Palsy inability to look in a particular direction (ie. neither eye can look right) lesion in the FEF, the PPRF, or the CN VI nucleus Lesion in the FEF unable to look contralaterally, eyes deviate toward the lesion, can be overcome with VOR Lesion in PPRF or CN VI nucleus inability to look ipsilaterally with either eye

    28. Voluntary Horizontal Saccades

    30. Yoking Mechanism

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