PUPILLARY DISORDERS

Lesions at different sites within the visual pathways. The corresponding visual
field defects are represented on the right side of the drawing

1.Central retinal artery (sup. temporal

branch)
2. Central retinal vein (sup. Temporal
branch)
3. Fovea
4. Optic cup
5. Lamina cribrosa

Papil atrophy

Anisocoria flowchart. (Reproduced from Thompson HS,

Pilley SEJ. Unequal pupils. A flowchart for sorting out the anisocorias.
Surv Ophthalmol

 Terima Kasih

Laminar and cellular organization of the retina

 A rod and a cone. Each rod (or cone) consists of an

outer segment and an inner segment connected by a
cilium. The outer segment of the rod is rod shaped and
that of the cone is cone shaped. In both, the receptor
disks are specialized structures of the plasma membrane
that contain the photopigments (integral proteins). The
new disks of a rod are continuously formed by repeated
infolding of the plasma membrane at the base of the
outer segment. The disks of the cones are not
continuously replaced. The inner segment contains
biosynthetic organelles and synaptic terminals

 The pathway of light from visual fields to the retina to

lateral geniculate bodies and to primary visual cortex.
The macular field projects to the posterior aspect of
primary visual cortex (solid black). The area just rostral
to this receives the rest of the binocular field, and still
more rostral is the area for the monocular visual field.
The upper half of the visual field projects to cortex below
the calcarine sulcus (lingual gyrus). The lower half of the
visual field projects to cortex above the sulcus (cuneate
gyrus).

The pupillary light reflex and the accommodation reflex pathways

and the pathway for pupillary dilatation. The light reflex pathway is
mediated by axons from photopigment containing ganglion cells that
terminate bilaterally in the midbrain pretectum, located immediately
in front of the superior colliculus. The pretectal nuclei are a relay to
the EdingerWestphal (E-W) nucleus on both sides. The latter gives
rise to parasympathetic preganglionic fibers in the oculomotor nerve
that terminate in the ciliary ganglion whose postganglionics elicit
pupillary constriction. Although not classified as part of the light
reflex, the diameter of the pupil is controlled by interaction between
the parasympathetic and sympathetic nervous systems. The E-W
nucleus also gives rise to fibers that descend through the brainstem
to the sympathetic outflow in the upper thoracic spinal cord.
Preganglionics ascend to the superior cervical ganglion whose
postganglionics elicit pupillary dilatation. Accommodation is
mediated via (1) the ascending visual pathway, (2) descending
corticocollicular fibers from the occipital (area 19), and frontal (area
8) lobes, (3) a relay in the superior colliculus to the E-W nucleus, (4)
the preganglionic parasympathetic outflow through the oculomotor
nerve to the ciliary ganglionic, which gives rise to (5) postganglionic
fibers that activate the ciliary muscles.

1. Temporal retina
2. Nasal retina
3. Medial rectus muscle
4. Short ciliary nerve (postganglionic fibers for the
iris sphincter)
5. Optic nerve
6. Oculomotor branch for the medial rectus muscle
7. Ciliary ganglion
8. Frontal eye field
9. Oculomotor root (preganglionic fibers for the iris
sphicter)
10. Optic chiasma
11. Optic tract
12. Oculomotor nerve
13. Accessory oculomotor nucleus (of Edinger and
Westphal)
14. Superior quadrigeminal brachium
15. Oculomotor nuclei and premotor area
16. Lateral geniculate nucleus
17. Pretectal nucleus
18. Superior longitudinal fasciculus
19. Optic radiation
20. Visual cortex