3. AFFERENT FIBRES- these fibres extend from retina to
pretectal nucleus in midbrain
RODS AND CONES
GANGLION CELLS
OPTIC NERVE
CHIASMA
PRETECTAL NUCLEUS
INTERNUNCIAL FIBRES
Pretectal nucleus to EWN.
4.
5.
6.
7. parasympathetic ganglion.
The oculomotor nerve coming into the ganglion contains
= preganglionic axons from the EWN which form synapses with the
ciliary neurons.
=The postganglionic axons run in the short ciliar nerves and
innervate two muscles:
sphicter pupliae, ciliaris( accommodation) muscles
are involuntary – they are controlled by the ANS.
HAS THREE ROOTS
parasympathetic root of ciliary ganglion originating from Edinger
westphal nucleus (or motor root)
a sympathetic root of ciliary ganglion from internal carotid
plexus
a sensory root of ciliary ganglion
DISEASES
Adie tonic pupil
Adie syndrome[ (tonic pupil plus absent deep tendon reflexes).
Light-near dissociation(no reaction of pupil to light but reaction to
accomodation present)
8. AFFERENT FIBRES- these fibres extend from retina to
pretectal nucleus in midbrain
RODS AND CONES
GANGLION CELLS
OPTIC NERVE
CHIASMA
PRETECTAL NUCLEUS
INTERNUNCIAL FIBRES
Pretectal nucleus to EWN.
9. Consists of parasympathetic fibres which
arise from EWN and travel along 3RDnerve.
Preganglionic fibres enter the inferior
division of 3RD nerve and via the nerve to IO
and relay in ciliary ganglion.
Postganglionic fibres travel along short ciliary
nerves and supply sphincter pupillae
10. Difference between the size of two pupil.
TYPE OF ANISOCORIA
1.PHYSIOLOGIC ANISOCORIA:-
1. Simple/central/essential
2. Minimal anisocoria [<0.4mm]
3. Both pupils react well to light
4. No dilatation lag
5. Isolated condition
11. 2.MIOSIS OF ONE PUPIL
Effect of local miotic
drug
Effect of systemic
morphine
Iridocyclitis
Horner’s syndrome
Head injury
Effect of strong light
3.MYDRIASIS OF ONE PUPIL
Effect of topical
sympathomimetic drug
Effect of topical
parasympatholytic drug
Sphincter damage
Internal ophthalmoplegia
Third nerve paralysis
Belladona poisoning
12. Difference in pupil size >2mm is considered
pathological and warrants further evaluation.
Anisocoria is not caused by optic nerve or
afferent pupil pathway dysfunction.
Assuming sphincter is structurally normal on slit
lamp examination, anisocoria is a sign of
autonomic dysfunction.
A pupil with a brisk sustained light reflex is a
normal pupil whether or not it appears larger or
smaller than its fellow
In case pupil which is constricted or
dilated,check for consensual reflex in the other
pupil.presence of consensual reflex indicates
integrity of afferent system in that eye is normal
13.
14.
15. POSTGANGLIONIC-
postganglionic
fibres in the head
Causes- benign
vascular
headache
syndrome , head
trauma, intraaural
or retro parotid
trauma and
cavernous sinus
lesion
CENTRAL-
hypothalamus to
the ciliospinal
centre of budge
at C8-T2
Causes-
brainstem
vascular
lesions,demyeli
nation and
tumors,syringo
myelia and
spinal cord
lesions at C8-T2
PREGANGLIONIC-
C8-T2 of spinal cord
to the course of
preganglionic fibres
to the superior
cervical ganglion
Causes- pancoast’s
tumor , carotid and
aortic aneurysm,
malignant cervical
lymph nodes ,
congenital (birth
trauma)
Oculosympathetic paresis
3 TYPES
16. CLINICAL FEATURES
1. Ptosis
2. Apparent enopthalmos
3. Miosis
4. Dilatation lag
5. Facial anhydrosis
6. Heterochromia iridis
17.
18.
19.
20. Tonicity caused by damage to ciliary ganglion or
short ciliary nerves (postganglionic
parasympathetic nerve injury)
Characterised by-
Sectoral iris sphincter palsy
Poor reaction to light
Denervation cholinergic supersensitivity
Strong and tonic response to near vision i.e light
–near dissociation followed by slow redilation
Idiopathic tonic pupil-adies pupil
70% patients are female
22. Neurosurgical emergency
Complete/partial palsy with or without pupil
involvement
Complete/partial ptosis which may mask
diplopia
Clinical presentation depends on location of
dysfunctionalong pathway between 3rd nerve
nucleus in midbrain and its branches of 3rd
nerve
Diagnosis is critical if pupil is involved