The oculomotor nerve
is the third of twelve paired cranial nerves
. It controls most of the eye's movements, constriction of the pupil, and maintains an open eyelid. (Note: cranial nerves IV
also participate in control of eye movement
The oculomotor nerve arises from the anterior aspect of mesencephalon
(midbrain). There are two nuclei for the oculomotor nerve:
Emergence from brain
On emerging from the brain, the nerve is invested with a sheath of pia mater
, and enclosed in a prolongation from the arachnoid
It passes between the superior cerebellar (below) and posterior cerebral arteries (above), and then pierces the dura mater in front of and lateral to the posterior clinoid process, passing between the free and attached borders of the tentorium cerebelli.
It runs along the lateral wall of the cavernous sinus, above the other orbital nerves, receiving in its course one or two filaments from the cavernous plexus of the sympathetic, and a communicating branch from the ophthalmic division of the trigeminal.
Superior and inferior rami
It then divides into two branches, which enter the orbit through the superior orbital fissure, between the two heads of the lateral rectus
Here the nerve is placed below the trochlear nerve and the frontal and lacrimal branches of the ophthalmic nerve, while the nasociliary nerve is placed between its two rami:
Testing the oculomotor nerve
Cranial nerves III, IV and VI are usually tested together. 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. By observing the eye movements
, the examiner is able to obtain more information about the extraocular muscles
, the levator palpebrae superioris muscle
, and cranial nerves III, IV, and VI.
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 n' out symptoms, because of the position of the affected eye.
The oculomotor nerve also controls the constriction of the pupils
. This can be tested in two main ways. By moving a finger towards a person's face to induce accommodation
, as well as them going cross-eyed, their pupils should constrict.
Shining a light into their eyes should also make their pupils constrict. Both pupils should constrict at the same time, independent of what eye the light is actually shone on.
- - "Oculomotor nerve palsy"