Interesting eye findings today:
Cranial Nerve III
- All extra ocular movements except those from the Superior Oblique (CN IV) and Lateral Rectus (CN VI).
- Innervates the Levator Palpebrae Superioris: this keeps your eyelid open. Many CN III lesions will result in ptosis.
- Efferent limb of the pupillary light reflex. Remember to look for a "direct" and then a "consensual" response to light.
- A Quick CN III Tip: Pupillary constriction is controlled by the outer fibers of CN III, and ocular movements/upper eyelids are controlled by the inner fibers. So lesions that compress the outer CN III fibers (eg. lesions like Posterior Communicating Artery Aneurysms) present initially with dilated pupils, while lesions affecting the inner portions of CN III (like infarction in diabetes) present with ptosis and a "down and out" position of the eye that spares the pupil.
Cranial Nerve IV
- Innervates the Superior Oblique muscle, which moves the eye "down and in". Lesions here result in difficulty looking down. Patients have trouble walking downs stairs.
Cranial Nerve VI
- Innervates the Lateral Rectus muscles, which moves the eye laterally.
shouldn't the oblique muscles turn laterally en the superior and inferior rectus muscles medially (so next to their elevation or depression)?
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Yes Bram, you are correct. The SO actually externally rotates as well as depresses the eyeball. However when you want to test the muscle you internally rotate the eyeball and ask the patient to then depress. So this diagram shows the directions which you 'test' each of the muscles (not what they actually do).
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