So we've talked about amblyopia,
which is where the central processing
of the input coming from the
eye and the brain gets turned off
and that can be for the causes that
we talked about, including cataracts
and abnormal kind of rotation of the eye.
We talked about strabismus
so that the eye is not there,
the axes are not aligned in the
various reasons that that happens.
Now we're going to talk about how we
actually have extraocular movement,
how the muscles actually make
the eye go and the consequences
of having injury to the nerves
that innervate the specific muscles
and what that does in terms
of malrotation of the eye.
We've seen this briefly before.
And again, we're going to have some creative
redundancies, so you're going to see it again.
So eye muscles, you can see where the nose is,
you can see where the medial canthus would be.
And you're looking at the green
arrow indicating the medial rectus.
And when the medial rectus pulls,
tugs on its insertion into the sclera,
turns the eye towards the
nose, that's the medial rectus.
The superior rectus will make
the eye look up, pulling it up.
The inferior rectus pulls it down, the
lateral rectus points it, pulls it laterally.
The superior oblique pulling from the top
and kind of rotating it will actually make it
the eye look down and out.
And the inferior oblique will make it look up and out.
Okay, so those are the muscles, let's talk
about the nerves that are innovating these.
The oculomotor nucleus, oculomotor nerves, cranial
nerve number III is going to innervate as shown here,
the superior rectus, the inferior rectus,
the medial rectus and the inferior obliques.
So four muscle bundles are going
to be innovated by the oculomotor
The superior oblique is innervated by the
trochlear nucleus, cranial nerve number IV.
And the lateral rectus is going to be innervated
by the abducens or the cranial nerve number VI.
So let's look at what happens if we start
injuring either the nucleus or the nerve fibers
running from that nucleus to those muscles.
If we injure the oculomotor nucleus,
so cranial nerves III, we're going to affect
4 muscle bundles, right?
The superior rectus, medial rectus,
the inferior rectus, and inferior oblique.
All of those are going to be affected.
So that means that we can't pull inwards.
We can't pull up, but we can pull
laterally and down, down and out.
So the abducens is still going to
be acting on the lateral rectus
and the trochlear nerve is still going to
be acting on the superior oblique.
So in patients that had cranial nerve palsies
where one eye is looking straight ahead,
the other one can only be pulled down and out.
And that's typical for a cranial nerve III palsy.
Perfect. Okay, let's injure another one separately.
So now the trochlear nerve or the
trochlear nucleus, cranial nerve number IV,
that's going to be innervating the superior oblique.
Remember, the superior oblique's
job is to pull the eye down and out
so we have a little X down
there, it cannot go that direction.
It can only go the other green arrows
because those muscles are all intact.
Now, normally, you wouldn't see much of an effect.
So if the patient were to stare directly ahead
at you, then both eyes would probably work
appropriately in the middle.
But if we have lateral gaze on the non-affected
eye and we have the eye trying to rotate
towards the medial canthus, it's incomplete.
In fact, because I cannot pull down and
out, there's excess force going up and in.
So the eye deviates up and in when
you have a cranial nerve IV palsy.
And the last one, so the lateral rectus, if it
cannot work, we cannot pull the eye laterally.
Okay, so injury to the abducens nucleus,
cranial nerve number VI will give us
an inward deviation of the
eye and that's what happens.
So when we're staring straight ahead, now,
the affected eye cannot be pulled outwards,
it goes inward.
With that, we've covered some
interesting motion abnormalities
and some interesting processing
abnormalities of the eye.