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Updated: Jan 25 2022

Eye Movement

  • Introduction
    • The forebrain controls eye movement via
      • frontal eye fields (FEF) which
        • are involved in generating
          • contralateral saccades via
            • the contralateral paramedian pontine reticular formation (PPRF)
        • clinical correlate
          • right-way eyes
            • lesions at the cerebral hemispheres (e.g., stroke) that affects the FEF results in the eyes looking
              • toward the side of the lesion
          • wrong-way eyes
            • a seizure at the FEF will result in the eyes looking
              • away from the side of seizure activity
            • thalamic hemorrhages
              • for unknown reasons
    • Cranial nerves involved in eye movements
      • oculomotor nerve (CN III)
        • innervates all of the extraocular muscles except
          • superior oblique muscle
          • lateral rectus muscle
        • medial rectus → adducts eye
        • superior rectus → elevates and intorts
        • inferior rectus → depresses and extorts
          • may become entraped during orbital floor fractures, leading to limited vertical eye movement
        • inferior oblique → elevates and extorts
        • a lesion results in
          • horizontal and vertical diplopia
            • in cases of complete one-sided CN III palsy results in
              • ptosis
              • mydriasis
              • inability to
                • adduct, elevate, and depress the eye
              • the eye resting in an
                • down-and-out and intorted position
      • trochlear nerve (CN IV)
        • superior oblique muscle → depresses and intorts
        • a lesion results in
          • vertical diplopia that worsens with downgaze
            • can reduce diplopia by tilting head away from the side of the lesion
      • abducens nerve (CN VI)
        • lateral rectus → abducts the eye
        • a lesion results in
          • horizontal diplopia
    • Clinical correlate
      • medial longitudinal fasciculus (MLF)
        • function
          • these are heavily myelinated fibers that interconnects the
            • oculomotor nuclei
            • trochlear nuclei
            • abducens nuclei
            • vestibular nuclei
        • lesion
          • internuclear ophthalmoplegia
            • a lesion affecting the ipsilateral MLF will impair adduction of the
              • ipsilateral medial rectus (and thus a horizontal gaze palsy)
                • notes can have nystagmus of the opposite eye for unknown reasons
            • bilateral MLF lesions are commonly found in multiple sclerosis
              • causes impaired adduction of both eyes during gaze towards the opposite side
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