Huzaifah Ibrahim bin Adam Shah 12-4-43

Oculomotor Nerve
The oculomotor nerve is the third cranial nerve (III). It offers motor and parasympathetic
innervation to many of the ocular structures.

We will discuss about the anatomical course, functions and test of the oculomotor nerve.

Overview
Motor: Innervates a number of the extraocular muscles.

Parasympathetic: Supplies the sphincter pupillae and the ciliary muscles of the eye.

Sympathetic: No direct function, but sympathetic fibres run with the oculomotor nerve to
innervate the superior tarsal muscle.

Anatomical Course
The oculomotor nerve originates from the anterior aspect of the midbrain (oculomotor
nucleus and Edinger-Westphal nucleus) at the level of superior colliculus. It moves anteriorly,
passing below the posterior cerebral artery, and above the superior cerebellar artery. The
nerve pierces the dura mater and enters the lateral aspect of the cavernous sinus. Within the
cavernous sinus, it receives sympathetic branches from the internal carotid plexus. These
fibres do not combine with the oculomotor nerve they merely travel within its sheath.
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The nerve leaves the cranial cavity via the superior orbital fissure. At this point, it divides
into superior and inferior branches. Once within the orbital cavity, both branches innervate
accessory structures of the eye:

Superior branch: Motor innervation to the superior rectus and levator palpabrae
superioris. Sympathetic fibres run with the superior branch to innervate the superior
tarsal muscle.

Inferior branch: Motor innervation to the inferior rectus, medial rectus and inferior
oblique. Parasympathetic fibres to the ciliary ganglion, which ultimately innervates
the sphincter pupillae and ciliary muscles.

Motor Functions
The oculomotor nerve innervates the majority of the extra-ocular muscles. These muscles
move the eyeball and upper eyelid.

Superior branch:

Superior rectus Elevates the eyeball

Levator palpabrae superioris Raises the upper eyelid.

There are sympathetic fibres that run with the superior branch of the oculomotor nerve. They
innervate the superior tarsal muscle, which acts to keep the eyelid elevated after the levator
palpabrae superioris has raised it.

Inferior branch:

Inferior rectus Depresses the eyeball

Medial rectus Adducts the eyeball

Inferior oblique Elevates, abducts and laterally rotates the eyeball

Parasympathetic Functions
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There are two structures in the eye that receive parasympathetic innervation from the
oculomotor nerve:

Sphincter pupillae Constricts the pupil, reducing the amount of light entering the
eye.

Ciliary muscles Contracts, causes the lens to become more spherical, and thus more
adapted to short range vision.

The parasympathetic fibres travel in the inferior branch of the oculomotor nerve. Within the
orbit, they branch off and synapse in the ciliary ganglion. The fibres are carried from the
ganglion to the eye via the short ciliary nerves.

Examination
Cranial nerves III, IV, and VI are usually tested together as part of the cranial nerve
examination. . By observing the eye movement and eyelids, the examiner is able to obtain
more information about the extraocular muscles, the levator palpebrae superioris muscle, and
cranial nerves III, IV, and VI.

Extraocular muscles
The examiner typically instructs the patient to hold his head still and follow only with the
eyes a finger or penlight that circumscribes a large "H" in front of the patient. Loss of
function of any of the eye muscles results in ophthalmoparesis.

Since the oculomotor nerve controls most of the eye muscles, it may be easier to detect
damage to it. Damage to this nerve, termed oculomotor nerve palsy is also known by the
down and out symptoms, because of the position of the affected eye (lateral and downward
deviation of gaze).

Levator function
Levator function is measured by blocking the effect of the frontalis muscle, in this case with a
thumb on the eyebrow. Then a ruler is used to measure the extent of eyelid movement on
maximum down and up gaze. Failure of levator function will cause ptosis.

Accommodation
The oculomotor nerve also controls the thickening of the lens of the eye. By moving a finger
toward a person's face to induce accommodation, his pupils should constrict.

Loss of accommodation can indicate the presence of a lesion on the oculumotor nerve.

Pupillary reflex
The oculomotor nerve also controls the constriction of the pupils. Shining a light into one eye
should result in equal constriction of the other eye. The neurons in the optic nerve decussate
Huzaifah Ibrahim bin Adam Shah 12-4-43

in the optic chiasm with some crossing to the contralateral optic nerve tract. This is the basis
of the "swinging-flashlight test".

Continued pupillary dilation can indicate the presence of a lesion on the oculumotor nerve.

References
1. Ophthalmology text book

2. Ophthalmology practical book

3. http://teachmeanatomy.info/head/cranial-nerves/oculomotor/

4. http://www.healthline.com/human-body-maps/oculomotor-nerve

5. http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/h_n/cn/cn1/cn3.ht
m

6. https://en.wikipedia.org/wiki/Oculomotor_nerve