Although the pathways are uncertain, the supranuclear control for the near response likely arises from diffuse cortical locations. The near response consists of pupillary constriction, accommodation (change in the shape of the lens), and convergence of the eyes (see Chapter 2 ). The ciliary ganglion lies between the optic nerve and the lateral rectus muscle, receives fibers from the inferior branch of the IIIrd nerve, and issues short ciliary nerves to the orbit, orbital muscles, and lacrimal gland. Fibers to the ciliary body outnumber those to the iris sphincter muscle by 30 : 1.Ĭiliary ganglion depicted in a lateral view of a dissection of the orbit. The ciliary ganglion issues postganglionic cholinergic short ciliary nerves, which initially travel to the globe with the nerve to the inferior oblique muscle, then between the sclera and choroid, to innervate the ciliary body and iris sphincter muscle. The pupillary fibers follow the inferior division into the orbit, where they then synapse at the ciliary ganglion, which lies in the posterior part of the orbit between the optic nerve and lateral rectus muscle ( Fig. Within the anterior cavernous sinus, the third nerve divides into two portions. Within the subarachnoid portion of the third nerve, pupillary fibers tend to run on the external surface, making them more vulnerable to compression or infiltration and less susceptible to vascular insult. Efferent parasympathetic fibers, arising from the Edinger–Westphal nucleus, exit the midbrain within the third nerve (efferent arc). Since the afferent pupillary fibers leave the optic tract before the lateral geniculate nucleus, isolated lesions of the geniculate, optic radiations, and visual cortex generally do not affect pupillary size or reactivity. ![]() Although these connections are bilateral, the input into the Edinger–Westphal nuclei is predominantly from the contralateral pretectal nucleus. Interneurons then connect the pretectal nuclei to the Edinger–Westphal nuclei. Retinal ganglion cell axons activated by photoreceptors and ipRGCs together mediate the pupillary light reflex and travel through the optic nerve, chiasm, and optic tract to reach the pretectal nuclei (afferent arc). Light in one eye causes bilateral pupillary constriction. Postsynaptic cells innervate the pupillary sphincter, resulting in miosis. This structure connects bilaterally, but predominantly contralaterally, to the oculomotor nuclear complex at the Edinger–Westphal ( E-W ) nuclei, which issue parasympathetic fibers that travel within the third nerve (inferior division) and terminate at the ciliary ganglion ( CG ) in the orbit. Light entering one eye ( straight dark arrow, bottom right ) stimulates the retinal photoreceptors ( RET ), resulting in excitation of ganglion cells, whose axons travel within the optic nerve ( ON ), partially decussate in the chiasm ( CHI ), then leave the optic tract ( OT ) (before the lateral geniculate nucleus ( LGN )) and pass through the brachium of the superior colliculus ( SC ) before synapsing at the mesencephalic pretectal nucleus ( PTN ). Pupillary light reflex-parasympathetic pathway. The ipRGCs are most sensitive to blue light, and the preservation of circadian rhythms and the pupillary light reflexes in patients with severe photoreceptor diseases and Leber’s hereditary optic neuropathy can be explained by intact ipRGC function. Additionally, intrinsically photosensitive retinal ganglion cells (ipRGCs) containing melanopsin, a photopigment, can be activated by light without photoreceptor input. Light entering the eye causes retinal photoreceptors to hyperpolarize, in turn causing activation of retinal interneurons and ultimately the retinal ganglion cells. Normally, light directed at either eye leads to bilateral pupillary constriction, and this pupillary light reflex is mediated by a parasympathetic pathway (see Fig. The sphincter muscle wraps 360 degrees around the pupillary margin, and the dilator muscle similarly encircles the pupil but is more peripherally located. Contraction of the dilator muscle leads to pupillary enlargement (mydriasis), while sphincter muscle contraction causes pupillary constriction (miosis). ![]() The iris contains the two muscles that control the size of the pupil. Note the pupil is slightly nasal to the center of the cornea and iris.
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