ANATOMY OF

VISUAL PATHWAY,FIELD
DEFECTS
AND
ITS LESIONS.

By-Dr. Ruchi Pherwani

Visual field

Each eye sees a part of the visual space

that defines its visual field.
The visual fields of both eyes overlap
extensively to create a binocular visual
field. The total visual field is the sum of
the right and left hemifields and consists
of a binocular zone and two monocular
zones.
Visual Pathway
Each eyeball act as
camera ;it
perceives the
images & relay the
sensations to the
brain(occipital
cortex) via the
VISUAL PATHWAY.
VISUAL PATHWAY
Vision is produced by photoreceptors in the
retina, a layer of cells behind the eye. The
information leaves the eye by manner of the optic
nerve, and there is partly crossing of axons at the
optic chiasm.
Afterward the chiasm, the axons are termed as
the optic tract. The optic tract wraps about the
midbrain to acquire to the lateral geniculate
nucleus (LGN), where all axons should synapse.
From there, the LGN axons fan out via the deep
white matter of the brain as the optic
radiations, that will ultimately travel to primary
visual cortex, at behind the brain.
 VISUAL
PATHWAY
comprises of:

Optic Nerve
Optic Chiasma
Optic Tract
Lateral
Geniculate
Body
Optic
Radiations
Visual cortex
OPTIC NERVE
2nd cranial nerve.
47-50 mm in length.
Starts from optic disc & extends upto optic chiasma
where the two nerves meet.
Backward continuation of nerve fibre layer of retina
which consist of axons originating from ganglion cells.
Contains the afferent fibres of light reflex

Has 4 parts : 1)intraocular (1mm)

2)intraorbital (30mm)
3)intra canalicular (6-9mm)
4)intracranial (10mm)
Morphologicaly & Embryologicaly optic nerve is
compared to sensory tract of Brain(white
matter) :
Optic nerve is an
outgrowth of brain.
Not covered by
neurilemma so does
not regenerate when
cut.

Fibres of optic nerve

are very thin(2-10 um
in diameter)& are
million in number.

surrounded by
meninges unlike other
peripheral nerves.

Both primary &

secondary neurons are
in retina.
1)Intra ocular Part :
About 1mm in size, passes through sclera ,
choroid & finally appears in eye as optic disc.

Divided in 4 portions from anterior to

posterior :a)surface nerve fibre layer.
b) prelaminar region.
c) lamina cribrosa.
d) retrolaminar region.
 2) Intraorbital part :
Extends from back of eyeball to
optic foramina.
This part slightly sinuous to give
play for the eye movements.
Here optic nerve is surrounded
by all 3 layers of meninges &
subarachnoid space.
The central retinal artery along
with enters the subarachnoid
space to enter the nerve on its
inferomedial aspect.
Near optic foramina,optic nerve
is closely surronded by annulus
of zinn & the origin of four recti
muscles.
Some fibres of superior &
medial rectus are adherent to
its sheath & account for painful
occular movements in
retrobulbar neuritis.
 3) Intracanalicular Part
This part is closely
related to ophthalmic
artery.
it crosses the nerve
from medial to lateral
side in dural sheath.
Sphenoid &
posterior ethmoidal
sinuses lie medial to it
& seperated by thin
bony lamina, this
relation accounts for
retrobulbar neuritis
following infection of
sinuses.
4) Intracranial part

About 10mm

Lies above cavernous sinus & converges with

its fellow to form chiasma.

Ensheathed in pia mater.

Internal carotid artery runs below then

lateral to it.
 OPTIC CHIASMA
Flattened structure,12 mm
horizontally & 8mm
anteroposteriorly.
Ensheathed by pia & surrounded by
CSF.
Lies over diaphragma sellae so
visual field defects seen in patient
with pituitary tumor having
suprasellar extension.
Posteriorly chiasma continous with
the optic tracts & form the
anterior wall of 3rd ventricle.
Nerve fibres arising from nasal half
of two retina decussate at the
chiasma.
Anatomical variation in position of
normal optic chiasma:
a)central : lies directly
over sella, expanding
pituitary tumor involves
chiasma first.
b)pre-fixed : lies more
anteriorly over
tuberculum
sellae,pituitary tumor
involves optic tract first.
c) post-fixed : lies more
posterior over dorsum
sellae,pituitary tumor
damage optic nerve
first.
Relations of chiasma :
Anterior - anterior cerebral
arteries & its communicating
arteries.
Posterior- tuber cinereum,
infundibulum ,pitutary body
,posterior perforated
substance.
Superior- third ventricle.
Inferior- hypophysis
Lateral- extra cavernous
part of internal carotid
artery& anterior perforated
substance.
 OPTIC TRACTS
Cylindrical bundle of nerve
fibres.

Run outwards & backwards

from posterolateral aspect
of optic chiasma ,between
tuber cinereum & anterior
perforated substance to
unite with cerebral
peduncle.

Fibres from temporal half of

retina of same eye & nasal
half of opposite eye.

Posteriorly each ends in

Lateral Geniculate Body.
LATERAL GENICULATE BODY

Oval structures situated at termination of the

optic tracts.
Each consist of 6 layers of neurons(grey matter)
alternating with white matter (optic fibres)
Fibres of 2nd order neuron coming via optic
tract relay here.
OPTIC RADIATIONS (Geniculo-
Calcarine Pathway)
From LGB to the occipital cortex.
Pass forwards then laterally through the area of
wernicke as optic peduncles.
Anterior to lateral ventricle ,traversing the
retrolenticular part of internal capsule,medial to
auditory tract.
Its fibres then spread out fanwise to form
medullary optic lamina.
Inferior fibres subserve upper visual fields &
sweep anteroinferiorly in meyers loop &
temporal lobe to visual cortex.
Superior fibres subserve inferior visual field
proceed posteriorly through parietal lobe to
visual cortex.
VISUAL CORTEX
Located on the medial aspect of occipital lobe,
in & near calcarine fissure.

Peristriate
area 18
Visuopsychic
area
Parastriate
Visual cortex area 19

Visuosensory Striate area

area 17
Modified nomenclature recognizing
five visual areas :
Blood supply of Visual Pathway

Arterial
Circle of
Willis

Carotid Vertebral
arterial arterial
system system
Circle of Willis :
Blood supply of Optic Nerve:
A. Intraocular part

Peripapillary choroidal vessels

Prelaminar

Lamina
Posterior choroidal vessels
cribrosa
region

Centrifugal branches from central

Retrolaminar retinal artery
Centripetal branches from pial vessels
B . Intraorbital part :

Periaxial Derived from 6 branches of internal

carotid artery: ophthalmic, long &
short posterior ciliary artery.

system Lacrimal artery.

Central artery of retina.

of vessels

Axial Intraneural b/o central retinal artery.

Central collateral b/o central retinal
artery.
system Central artery of optic nerve.

of vessels
C .Intracanalicular part :
periaxial system of vessels.

D . Intracranial part :
Pial system of vessels

B/o internal B/o anterior

carotid artery cerebral artery

Twigs from
B/o ophthalmic anterior
artery communicating
artery
Venous drainage :

Optic nerve Intracranial

Orbital part
head part
Central Peripheral Pial plexus
retinal vein pial plexus which ends
Central in anterior
retinal vein cerebral &
basal vein
Blood supply of Optic Chiasma
Arterial :
Superior B/o anterior cerebral & anterior
communicating artery

aspect
Inferior B/o internal carotid artery ,posterior
communicating artery ,anterior superior
hypophyseal artery
aspect
Venous:
Superior Superior chiasmal vein drains
into anterior cerebral vein
aspect
Inferior Pre-infundibular vein draining
into basilar vein.
aspect
Blood supply of optic tract:
Arterial: Pial plexus receiving contribution
from posterior communicating artery,
anterior choroidal artery & middle
cerebral artery.

Venous drainage: anterior cerebral vein &

basal vein.
 Blood supply of lateral geniculate
body:
Supply fibres coming from superior
homonymous quadrant of retina.
Posterior cerebral
artery

Supply fibres coming from inferior

homonymous quadrant of retina.
Anterior choroidal
artery

Supplied by anastomosis from posterior

Macular fibres
cerebral & anterior choroidal artery.
over region of
hilum
Blood supply of Optic radiations

Anterior Anterior choroidal artery

part
Middle Deep optic artery b/o middle
part cerebral artery.

Posterior Calcarine branches from posterior

cerebral artery.
part
Blood supply of visual cortex

Visual cortex

Terminal b/o middle

Calcarine artery b/o cerebral artery &
Posterior cerebral anastomosis between
artery middle& posterior
cerebral artery.
 Venous drainage of visual cortex

Internal cerebral vein

drains in great cerebral
Medial aspect vein of galen & straight
sinus

Inferior cerebral vein

drains in cavernous sinus.
Superolateral
aspect
LESIONS OF VISUAL PATHWAY
1) LESIONS OF OPTIC NERVE :
Causes:
optic atrophy
indirect optic neuropathy
acute optic neuritis
traumatic avulsion of optic nerve.
Characterised by: complete blindness in
affected eye with loss of both direct on
ipsilateral & concensual light reflex on
contralateral side. Near reflex is preserved.
Eg. Right optic nerve
involvement
2)Lesions through proximal part of optic
nerve :
ipsilateral blindness.
contralateral hemianopia
abolition of direct light reflex on affected
side & concensual light reflex on
contralateral side.
near reflex intact.

Eg. Rt optic nerve

Involvement in
Proximal part
3)Central lesions of chiasma (sagittal)
causes:
suprasellar aneurysm
tumors of pituitary gland
craniopharyngioma
suprasellar meningioma & glioma of 3rd ventricle.
third ventricular dilatation due to obstructive
hydrocephalus.
chronic chiasmal arachnoiditis.

Characterised by:
Bitemporal hemianopia
Bitemporal hemianopic
paralysis of pupillary reflex. (usually lead to partial
descending optic atrophy)
4)Lateral chiasmal lesions :
causes:
Distension of 3rd ventricle causing pressure on
each side of optic chiasma
Atheroma of carotids & posterior
communicating artery.
Characterised by
Binasal hemianopia
Binasal hemianopic
parallysis of pupillary reflex (usually lead to
partial descending optic atrophy)
5)Lesions of optic tract :
Causes:
Syphiliticmeningitis/ gumma.
Tuberculosis
Tumors of optic thalamus
Aneurysm of superior cerebellar or posterior
cerebral arteries.
Characterised by :
Incongruous homonymous hemianopia with C/L
hemianopic pupillary reaction( wernickes reaction)
These lesions usually lead to partial descending
optic atrophy & may be associated with C/L 3rd
nerve paralysis & ipsilateral hemiplegia.
6)Lesions of lateral geniculate body :

leads to homonymous hemianopia with

sparing of pupillary
reflexes & may end in
partial optic atrophy.
7)Lesions of optic radiations :
Causes:
Vascularocclusion
Primary & secondary tumors
Trauma
Characterised by :
COMPLETE
TOTAL OPTIC HOMONYMOUS
RADIATION HEMIANOPIA(
INVOLVEMENT sometimes sparing
macula)
 LESIONS OF
PARIETAL LOBE INFERIOR
(involving superior QUADRANTIC
fibres of optic HEMIANOPIA( PIE
radiations) ON THE FLOOR)

LESIONS OF
SUPERIOR
TEMPORAL LOBE
QUADRANTIC
(involving inferior
HEMIANOPIA( PIE
fibres of optic
ON THE ROOF)
radiations)
 Pupillary reactions are normal as fibres of
light reflex leave the optic tracts to
synapse in the superior colliculi.

Lesions of optic radiations do not

produce optic atrophy as the 1st order
neurons (optic nerve fibres) synapse in
LGB.
8)Lesions of visual cortex : pupillary light
reflex is normal & optic atrophy does not occur
following visual cortex lesions.
Congruous
Congruous
homonymous
homonymous
hemianopia(sparing
macular defect
macula)

Occlusion of
Head injury/gun shot
posterior cerebral
injury leading to
artery supplyin
lesions of tip of
anterior part of
occipital cortex+
occipiatl cortex
Thank you