CHAPTER 1
Anatomy of the Visual Pathways
Carlos Gustavo De Moraes, MD*w
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Abstract: The axons of the retinal ganglion cells form the optic
nerve. The two optic nerves meet at the optic chiasm, where the
nerve fibers originating in the nasal retina of each eye decussate to
join the temporal fibers of the fellow eye. From the chiasm, the
same axons continue on as the optic tract. These axons travel to
and synapse in the lateral geniculate nucleus, the cells of which send
their axons through the optic radiations to the visual cortex. The
main blood supply to visual cortex is provided by the posterior
cerebral arteries and their branches (the calcarine, posterior tem-
poral, and parieto-occipital arteries). At the occipital pole, how-
ever, there may be a dual blood supply to the area subserving
central vision, with anastomoses between branches of the posterior
cerebral arteries and the superior temporo-occipital branch from
the middle cerebral artery.
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T he visual cortex corresponds to approximately 55% of
the entire cortical area of the primate brain. For com-
parison purposes, 3% is associated with the auditory sys-
tem and 11% with the somatosensory system.1,2 Given that
structure and function are correlated, this suggests that
over 50% of all the information stored in the brain is
directly or indirectly related to vision. Unlike other organs
and systems, the anatomy of the central nervous system
remains poorly understood. In the past two decades, how-
ever, there has been a massive increase in research in
neurosciences, which may lead to more accurate and
sophisticated methods to detect and treat disorders of the
visual system. This brief review provides a basic description
of the main structural components of the visual system.
RETINA
The first neurons of the visual pathway are the retinal
ganglion cells (RGC) which are located in the innermost
retinal layers (Fig. 1). First, light needs to cross all inner
layers before it reaches the photoreceptors, which are
neurons specialized on the reception and conduction of
visual stimuli. The two types of photoreceptors, rods and
cones, contain a photopigment which is composed of opsin,
a membrane protein and 11-cis-retinal, a chromophore. A
photon can cause conformational changes in this photo-
pigment, leading to a cascade of chemical reactions that
convert electromagnetic energy into an electrical stimulus.
This stimulus travels to other retinal layers through neu-
rotransmitters. From the photoreceptors the impulse is
transmitted to the bipolar cells and then reaches the RGCs.
From the *Department of Ophthalmology, New York University
School of Medicine; and wEinhorn Clinical Research Center, New
York Eye and Ear Infirmary, New York, NY.
Disclosure: The author declares no conflict of interest.
Copyright r 2013 by Lippincott Williams & Wilkins
DOI: 10.1097/IJG.0b013e3182934978
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Their axons reach the retinal nerve fiber layer (RNFL)
where they converge to the optic nerve head.3
The arterial blood supply to the outer 1/3 of the retina
comes from the posterior ciliary arteries, whereas that to
the inner 2/3 comes from the central retinal artery, both
branches of the ophthalmic artery.4
OPTIC NERVE
The optic nerve head is composed of four main regions
(Fig. 1):
 Nerve fiber layer
 Prelaminar region
 Lamina cribrosa
 Retrolaminar region
After passing through the lamina cribrosa, the optic
nerve becomes invested with meninges (pia- and dura-
mater) and also becomes myelinated by oligoden-
drocytes.2,3 The cerebrospinal fluid (CSF) fills the
subarachnoid space. Within the intraocular portion of the
optic nerve (3–4 mm), the compartment between the sub-
arachnoid space and the scleral tissue form a virtual space
that produces a pressure gradient between the intraocular
compartment and the CSF space (Fig. 2). The arterial circle
of Zinn-Haller, which is composed of anastomotic branches
of the posterior ciliary arteries, the pial arteriole plexus, and
the peripapillary choroid, provides blood supply to the
optic nerve head.4
Outside the globe, the optic nerve is divided into three
portions: intracranial (25 mm), intracanalicular (within the
optic canal and inside the lesser wing of the sphenoid bone,
6–7 mm), and intracranial portions (18–20 mm) before it
reaches the optic chiasm. The distal and proximal portions
of the optic nerve are supplied by branches of the oph-
thalmic artery and the circle of Willis.5
OPTIC CHIASM
The two optic nerves travel toward, and meet at the
optic chiasm, which lies in the subarachnoid space of the
suprasellar cistern, above the sella turcica and the pituitary
gland. Above the optic chiasm is the hypothalamus and
behind it lies the infundibulum. Another important ana-
tomical relation is the cavernous sinus, which lies below the
chiasm and around the pituitary gland. The following
structures cross through the cavernous sinus: internal car-
otid artery, oculomotor nerve (CN III), trochlear nerve
(CN IV), abducens nerve (CN VI), ophthalmic nerve (the
V1 branch of the trigeminal nerve, CN V), and the maxil-
lary nerve (the V2 branch of CN V).3,6
In the chiasm, the nerve fibers originating in the nasal
retina of each eye decussate to join the temporal fibers of
the fellow eye (Fig. 3). The distribution of nerve fibers
within the optic nerve and chiasm maintains a retinotopic
organization. The blood supply to the optic chiasm comes
from anastomotic arteries comprising the circle of Willis.2,3
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FIGURE 1. Retinal layers and the optic nerve head.
OPTIC TRACT
From the optic chiasm, the same axons that originate
in the RGC layer continue through the optic tract until they
synapse with neurons situated in the lateral geniculate
nucleus (LGN). A retinotopic organization is also main-
tained in the tract. Its blood supply is variable but typically
arises from anastomotic branches of the posterior com-
municating and internal carotid artery.2,3
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Anatomy of the Visual Pathways
LATERAL GENICULATE NUCLEUS
Most axons from the optic tract synapse in the LGN,
the cells of which are the second neurons of the visual
pathway, and are distributed into 6 layers. Ganglion cell
axons from the ipsilateral eye (temporal retina) synapse in
layers 2, 3, and 5, while axons from the contralateral eye
(nasal retina) synapse in layers 1, 4, and 6. Two main types
of neurons can be identified in the LGN: large neurons
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De Moraes
FIGURE 2. The intrascleral portion of the optic nerve and the subarachnoid space.
located in layers 1 and 2 (magnocellular layers) and small
neurons in layers 3, 4, 5, and 6 (parvocellular layers)
(Fig. 4). There is a third cell layer distributed irregularly
between the parvocellular and magnocellular layers called
the koniocellular layer.2,3
Notably, only 5%–10% of the synapses in the LGN
come from RGC axons. The majority comes from up-down
modulating connections from the thalamic reticular
nucleus, pulvinar nucleus, and the visual cortex.7 The reti-
notopic organization of the LGN is such that the central
portion (hilum) receives macular fibers, whereas the lateral
and medial horns receive fibers from the inferior retina and
superior retina, respectively.8 The blood supply to the LGN
arrives via branches of the internal carotid artery and
posterior cerebral arteries.2,3
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SUPERIOR COLLICULI, PRETECTAL NUCLEI, AND
SUPRACHIASMATIC NUCLEUS
Not all fibers from the optic tract synapse in the LGN.
Some fibers connect with other nuclei located in the mid-
brain and which are related to autonomic functions.
The superior colliculi are responsible for coordinat-
ing eye and head movements to sudden visual and other
sensory stimuli, as well as saccadic gaze. Their neu-
rons also receive input from other sensory organs (e.g.:
labyrinth, somatosensory system) as well as the visual
cortex.
The pretectal nuclei receive afferent input from the
RGC, which travel via dual connections to each Edinger-
Westphal nucleus. From the Edinger-Westphal nuclei,
parasympathetic fibers travel through the oculomotor
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FIGURE 3. The afferent visual pathway and the optic chiasm.
nerves to the ciliary ganglion and are responsible for the
control of pupil size and consensual reflex.2
Some RGC containing melanopsin send axons to the
suprachiasmatic nucleus at the base of the anterior hypo-
thalamus. This center is sensitive to changes in ambient
light and sends fibers to the pineal gland. It is responsible
for the regulation of physiologic functions related to cir-
cadian rhythms.9
FIGURE 4. The lateral geniculate nucleus.
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Anatomy of the Visual Pathways
OPTIC RADIATIONS
From the LGN, the second neurons send axons to the
visual cortex through the optic radiations. These fibers
initially project anteriorly and then turn posteriorly toward
the occipital lobe (Fig. 5). The anterior portion of the optic
FIGURE 5. Inferior view of the dissected visual pathway. The
optic radiations are shown in number 5.
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De Moraes
FIGURE 6. Histological and macroscopic view of the human visual cortex.
radiations receives its blood supply from branches of the
circle of Willis and middle cerebral artery, whereas distal
(posterior) portions are supplied by anastomotic branches
of the posterior cerebral artery.10
VISUAL CORTEX
Axons from the six layers of the LGN travel along the
optic radiations and synapse in the primary visual cortex,
named V1 (Fig. 6). These axons make connections in the
cortical layer IV (‘stripe of Gennari’). Axons from the
parvocellular layers of the LGN synapse at layer IV-C-b,
while those from the magnocellular layers synapse at layer
IV-C-a. Notably, there is a 300-400-fold increase in the
number of neurons in V1 as compared to the RGC layer.11
The corresponding representation of the vertical meridian
of the visual field lies medially within the calcarine lips,
whereas the horizontal meridian is represented deep within
the calcarine fissure. Macular projections representing the
central field synapse in the posterior pole of calcarine cor-
tex. The macular representation is greatly magnified in the
visual cortex retinotopic map. For instance, connections
from 1 mm2 around the fovea, representing the central 10
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degrees (which corresponds to approximately 2% of the
total visual field) represent roughly 60% of the striate
cortex.12,13
Most of the blood supply to the visual cortex comes
from the posterior cerebral arteries and its branches. At the
occipital pole, however, there is a dual blood supply to the
area corresponding to the central vision, with anastomoses
between branches of the posterior cerebral artery and
branches of the middle cerebral artery (Fig. 7).14
FEEDBACK MECHANISMS AND THE HIGHER-
ORDER VISUAL CORTEX
Despite reaching the visual cortex, stimuli from the
retina still need regulation and processing before they can
be perceived as images. Up-down connections between
thalamic and higher-order cortical levels provide an accu-
rate perceptual interpretation of light stimuli.15 Some of
these loops were described above, such as the connections
between V1 and the LGN and between the different mes-
encephalic nuclei.16,17 From V1 the information travels to
extrastriate areas responsible for different features of vision,
such as color, motion, depth, contrast, and memory. From
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FIGURE 7. Arterial blood supply to the visual cortex.
V4 and V5, then, the information is conducted and/or
stored in different areas which are related with other
functions (e.g.: somatosensory, speech, and hearing sys-
tems), motor activity, and emotions.17–19
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