PUPILLARY PATHWAY

By – Surbhi Bharti
Roll no -1690
 INTRODUCTION

Pupils are controlled by 2 muscles of ectodermal

origin- the sphincter and dilator pupillae.the
constrictor centre passes tone And is perpetually
sending out impulses To the sphincter which keep the
pupil slightly constricted . Abnormal enlargement of
pupil is called mydriasis and abnormal contraction is
called miosis
NERVE SUPPLY OF PUPILLARY
MUSCLES

The sphincter is supplied by cholinergic

nerves Through third cranial nerve.the
fibers start in edinger westphal nucleus
Near third nerve nucleus In the floor of
aqueduct of sylvius.the fibers run in trunk of
third nerve And relay in ciliary ganglion And
from there to short ciliary nerve of eye
 SYMPATHETIC PATHWAY

The dilator is supplied by Adrenergic fibers of

cervical sympathetic Nerve.the dilator tract
commences in hypothalamus.from hypothalamus the
dilator Fibers pass downward through medulla
oblongata Into lateral columns of cord.these fibers
leave the cord by ventral roots of first 3 dorsal and
last 2 cervical Nerves
 PUPILLARY REFLEXES

1. Light reflex
2. Near reflex
3. Psychosensory reflex
 LIGHT REFLEX

When light is shone in one eye, both the pupils

constrict. Constriction of the pupil to which light is
shone is called direct light reflex and that of the
other pupil is called consensual (indirect) light reflex.
Light reflex is initiated by rods and cones.
PATHWAY OF LIGHT REFLEX

1. Afferent fibres extend from retina to the

pretectal nucleus in the midbrain. These travel along
the optic nerve to the optic chiasma where fibres
from the nasal retina decussate and travel along the
opposite optic tract to terminate in the contralateral
pretectal nucleus. While the fibres from the temporal
retina remain uncrossed and travel along the optic
tract of the same side to terminate in the ipsilateral
pretectal nucleus.
2. Interneuronal fibres connect each pretectal nucleus with
Edinger-Westphal nuclei of both sides. This connection forms
the basis of consensual light reflex.
3. Efferent pathway consists of the parasympathetic fibres
which arise from the Edinger-Westphal nucleus in the midbrain
and travel along the third (oculomotor) cranial nerve. The
preganglionic fibres enter the inferior division of the third nerve
and via the nerve to the inferior oblique reach the ciliary
ganglion to relay. Post-ganglionic fibres travel along the short
ciliary nerves to innervate the sphincter pupillae
EXAMINATION OF DIRECT LIGHT
REFLEX

■Direct light reflex.To elicit this reflex the patient is

seated in a dimlylighted room.With the help of a
palm one eye is closed and a narrow beam of light is
shown to other pupil and its response is noted.The
procedure is repeated for the second eye.A normal
pupil reacts briskly and its constriction to light is
well maintained.
EXAMINATION OF CONSENSUAL
LIGHT REFLEX

Consensual light reflex. To determine consensual reaction to

light, patient is seated in a dimly lighted room and the two eyes
are separated from each other by an opaque curtain kept at the
level of nose (either hand of examiner or a piece of cardboard).
Then one eye is exposed to a beam of light and pupillary
response is observed in the other eye. The same procedure is
repeated for the second eye. Normally, the contralateral pupil
should also constrict when light is thrown on to one pupil.
 NEAR REFLEX

Near reflex occurs on looking at a

near object. It consists of two
components: (a) convergence
reflex, i.e., contraction of pupil on
convergence; and (b)
accommodation reflex, i.e.,
contraction of pupil associated with
accommodation.
PATHWAY OF CONVERGENCE
REFLEX
Its afferent pathway is still not elucidated. It
is assumed that the afferents from the medial
recti travel centrally via the third nerve to the
mesencephalic nucleus of the fifth nerve, to a
presumptive convergence centre in the tectal
or pretectal region. From this the impulse is
relayed to the Edinger-Westphal nucleus and
the subsequent efferent pathway of near
reflex is along the 3rd nerve. The efferent
fibres relay in the accessory ganglion before
reaching the sphincter pupillae
PATHWAY OF ACCOMMODATION
REFLEX

Pathway of accommodation reflex. The afferent

impulses extend from the retina to the parastriate
cortex via the optic nerve, chiasma, optic tract, lateral
geniculate body, optic radiations, and striate cortex.
From the parastriate cortex, the impulses are relayed
to the Edinger-Westphal nucleus of both sides via the
occipitomesencephalic tract and the pontine centre.
From the Edinger-Westphal nucleus the efferent
impulses travel along the 3rd nerve and reach the
sphincter pupillae and ciliary muscle after relaying in
the accessory and ciliary ganglions.
EXAMINATION OF NEAR REFLEX

. In it pupil constricts while looking at a near object. This

reflex is largely determined by the reaction to
convergence but accommodation also plays a role. To
determine the near reflex, patient is asked to focus on a
far object and then instructed suddenly to focus at an
object (pencil or tip of index finger) held about 15 cm
from patient’s eye. While the patient’s eye converges and
focuses the near object, observe the constriction of pupil.
PSYCHOSENSORY REFLEX

It refers to dilatation of the pupil in response to

sensory and psychic stimuli. It is very complex and
its mechanism is still not elucidated.
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