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Clinical Exam

 

This test evaluates a behavioral response to a visual threat. As such it is not a reflex and involves integration of the visual pathways with cortical perception of a threat and a motor response in the form of a blink. Clinical Overview–This is a cortically mediated eyelid closure produced by a threatening or unexpected gesture or action suddenly appearing in the near visual field. It is present from about six to twelve weeks of age depending on the species and the breed. The animal's head is held still and the contralateral eye is covered with a hand. The free hand moves rapidly toward the open eye stopping prior to causing physical contact. The test is repeated for the other eye. With a cooperative patient the medial and lateral aspects of each eyeball (retina) can be tested. Care must be taken not to create too much air turbulence. In the stoic patient it may be necessary to tap the eyelids being tested so that the animal is aware of the test. The entire peripheral and central visual pathway must be intact for a response to occur. This is a learned response, not a reflex, to a perceived threat. Normal function is demonstrated by a blink or retraction of the globe in response to the threat or even an aversive head movement. Abnormal function is manifested by a reduced to absent blink or globe retraction. The afferent part of this response involves the same structures as the visual pathways. The information generated in the contralateral visual (occipital) cortex is forwarded to the motor cortex to initiate a motor response. The cortico-bulbar pathways to the facial nerve nucleus (CN VII) then transmit the motor information. This response requires intact ipsilateral facial nerve function as well as an intact ipsilateral cerebellum. The neuronal pathways through the cerebellum are however not known. To localize or isolate a lesion responsible for dysfunction, other cranial nerve tests (palpebral reflex; pupillary light reflex (PLR) would be required.

 

 

Anatomy

 

Neuroanatomical Structures Evaluated - The afferent or sensory visual pathway (optic nerve (CN II), the optic chiasm, the optic tract, lateral geniculate nucleus, the optic radiations are evaluated by the menace response. This test also evaluates the conscious perception of vision and facial nerve (CN VII) function.

Diagrammatic Representation of Anatomy
Clinical Stimulus – As one eye is covered, the other eye is tested by directing a hand in its direction in a threatening manner.
Clinical Response – In a normal animal the eyelids will close in response to the perceived threat.
Afferent Pathways – The hand movement or threat is initially detected by the retina and an induced nerve impulse travels down the optic nerve from the eye into the cranial cavity via the optic canal. It travels to the optic chiasm where the major portion of it will cross over to the other side.
Efferent Pathways – A normal response of closing the eyelids is mediated by impulses travelling via the motor portion of the facial nerve (CN VII) having left the brainstem and exiting the skull through the stylomastoid foramen. The facial nerve impulses cause contraction of the orbicularis oculi muscle closing the eyelids.
Pathway

 

An image of the hand is projected through the eye to the retina. Electrochemical receptors in the retina are excited and the generated impulses are projected into the optic nerve. Objects in each temporal visual field are projected upon the nasal retina. Objects in the nasal visual field are projected to the temporal retina. Image is next projected from the retina through the optic nerve to the optic chiasm where, in dogs, 75% of the optic nerve fibers cross over to enter the contralateral optic tract (65% in cats). The nasal retinal field makes up the majority of fibers that cross and the temporal retinal field makes up the majority of fibers that remain ipsilateral. After crossing at the chiasm, the image is projected through the optic tract to reach the lateral geniculate nucleus in the thalamus. From the lateral geniculate nucleus, fibers pass in the optic radiations to the visual cortex in the occipital lobe. The object is now recognized by the brain as present in the visual field. Association fibers running through the internal capsule transmit a stimulus from the visual cortex to the ipsilateral motor cortex. Projection fibers transmit a stimulus through the internal capsule to the crus cerebri in the ipsilateral pons (metencephalon). Stimulus crosses over in transverse fibers of pons to the contralateral middle cerebellar peduncle (ipsilateral to initial visual stimulus) and up into the cerebellar cortex. A stimulus exits the cerebellum toward the facial nucleus in the medulla oblongata (myelencephalon). The facial nerve transmits the stimulus arising in the nucleus to the orbicularis oculi muscles of the eye causing a blink response.

Diagrammatic Representation of Anatomy
Afferent Pathways - The stimulus necessary to generate a response in this test starts in the retina and causes impulses to be transmitted down the optic nerve crossing at the chiasm and synapsing in the lateral geniculate nucleus of the thalamus. At this point the impulse travels on to the visual cortex of the occipital lobe through the optic radiations.
Interneuron 1 - Once an impulse has arrived in the visual cortex where it is perceived, it travels to the ipsilateral motor cortex via association fibers and then projection fibers continue the pathway to the pontine nucleus
Interneuron 2 - This diagram illustrates the pathway from the frontal lobe down through the internal capsule to the pontine nucleus.
Total pathway - once the stimulus arrives in the pontine nucleus, it crosses the pons and enters the cerebellum which coordinates the efferent response through the facial nerve (CN VII).

 

 

 

Sections

Further Clinical Evaluation of the optic nerve – The optic nerve is the common part of the afferent pathways involved in the vision and is tested with the menace response, visual placing and pupillary light reflex (PLR).  These tests use different integration centres within the brain and different efferent pathways.  The integrity of the optic nerve can be determined by combining the results of these tests.  Vision in animals is mainly evaluated by observation of the animal within an obstacle course (animal walking into things or avoiding obstacles), a cotton drop test and by testing the menace response and visual placing.  The PLR involves the visual pathways up to the level of the lateral geniculate nucleus but does not test the animal’s central vision.  Fundic examination and evaluation of the appearance of the optic disc are also important parts of the evaluation of the optic nerve.

Diagrammatic Representation of Anatomy
Total Pathway – The entire pathway of the menace response can be seen with the important synapses illustrated in 2D sections. The crossing over of the pathway can be appreciated in this illustration.
Lateral Anatomy – The key gross components of the anatomy responsible for the menace are illustrated here.
Lateral Section – This illustration confirms where the 2D sections seen in the Total pathway above are taken from.
Sagittal Anatomy- – As for the lateral section, this cut away confirms where the 2D sections are taken from.