"Blow out" fractures Gunshot wounds Penetrating trauma Trauma of the orbit Traumatic optic neuropathy

Diagnosis Diagnosis is based on X-ray, CT, or MRI imaging, visual function and color discrimination tests, ophthalmoscopic exam, visual evoked potentials (VEP), and electroretinogram (ERG).

Differential diagnosis Other causes of papilledema should be considered, including increased intracranial pressure (ICP) and pseudotumor cerebri.

Treatment depends upon the cause of the lesion.

Depending on the etiology.

Acheson J (2000) Optic nerve and chiasmal disease. J Neurol 247: 587-596 Lee AG, Brazis PW (2000) Neuro-ophthalmology. In: Evans RW, Baskin DS, Yatsu FM (eds) Prognosis of neurological disorders. Oxford University Press, New York Oxford, pp 97-108

Lowitsch K (1986) Nervus opticus. In: Schmidt D, Malin JC (eds) Erkrankungen der Hirnnerven. Thieme, Stuttgart, pp 11-53

Wilson-Pauwels L, Akesson EJ, Stewart PA (1988) Cranial nerves. Anatomy and clinical comments. Decker, Toronto Philadelphia




Oculomotor nerve

Genetic testing





Lee screen


+ (Diabetes)



Abducens Nerve Function
Fig. 2. 1 Oculomotor nerve, 2 Abducens nerve, 3 Trochlear nerve, 4 Cross section through brainstem, 5 Internal carotid artery
Testing Oculomotor Nerve

Fig. 3. Oculomotor nerve paresis: A Complete ptosis; B Upon lifting of the lid lateral deviation of left bulbus. Pupillary dilatation (mydriasis) signals the parasympathetic fibers for the sphincter pupillae are affected

Extraocular eye muscles except superior oblique muscle and lateral rectus muscle.

Parasympathetic to the constrictor pupillae and ciliary muscles.

The nucleus of the oculomotor nerve is located in the midbrain, ventral to the cerebral aqueduct. The nerve fibers course ventrally in the tegmentum, through the red nucleus and the medial aspect of the peduncles, emerging in the fossa interpeduncularis. The nerve passes the posterior cerebral and superior cerebellar arteries as it courses anteriori. It pierces through the dura and enters the cavernous sinus, where it runs along the lateral wall superior to the trochlear nerve. The nerve then passes the superior orbital fossa and through the tendinous ring. In the orbit, it divides into a superior portion (innervating the superior rectus and levator palpebrae superioris) and inferior portion (innervating the inferior rectus, inferior oblique, and medial rectus). The visceral fibers (originating in the Edinger-Westphal nucleus of the oculomotor nucleus complex) are also found in the inferior portion and terminate in the ciliary ganglion (see Fig. 2).

Topographical location of Nuclear lesions:

lesions Nuclear lesions are rare, and usually of vascular etiology.

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