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And The: Reflexes
And The: Reflexes
From the Royal Victorian Eye and Ear Hospital, 32 Gisbome Street, East Melbourne, victoria 3002.
*Ophthalmology Registrar.
Reprint: Dr Alex Paul Hunyor.
Edinger-Westphal nucleus
’ optic nerve
Figure 2 Schematic diagram of the pathway for the pupillary light reflex.
taining homeostasis. Autonomic reflex control nerve, to the trigeminal nerve, thence to the
occurs at different levels. trigeminal spinal nucleus which projects to the
1. Local reflexes such as bladder contraction, reticular formation in the area of the visceral
where pelvic sensory nerves form the afferent motor nuclei of the vagus nerve, and vagal
limb, relaying in the spinal cord at S2-S4 with efferent outflow results in nausea, bradycardia
parasympathetic preganglionic fibres, which in and faintness (via muscarinic cholinergic recep-
turn synapse in pelvic parasympathetic ganglia tors). Syncope and even cardiac arrest have been
with postganglionic fibres which innervate the described with this reflex, which may be
detrusor muscle. prevented by prior muscarinic blocking (with
2. Brainstem reflexes such as the pupillary reflex intravenous atropine) or by retrobulbar or
(see below) and vital reflexes, e.g., vagal afferents peribulbar anaesthesia. Thus, it may still occur
from the lungs influence the output from pontine during general anaesthesia.
respiratory centres (pneumotaxic and apneustic
centres). Pupillary reflexes
3 . Higher control of autonomic activity by the
The main pupillary reflexes are the light and dark
hypothalamus includes integration with
reflexes (which share a common afferent
endocrine and immune systems and higher cere-
pathway) and miosis associated with the near
bral functions, and maintenance of chemical,
triad or synkinesis. The pupil has opposing
thermal and nutritional homeostasis.
dilator and sphincter muscles, innervated
predominantly by sympathetic and parasympa-
Autonomic reflexes and the eye thetic fibres respectively.
Oculocardiac rejex The pathway for the light reflex (Figure 2) is
This reflex occurs with pressure on the eye or from the retina via optic nerve, hemi-decussating
orbit, or stretching of extraocular muscles, as in the optic chiasm, to the optic tract, leaving in
may occur during ophthalmic surgery. Stimuli its proximal third, and passing between the
such as pain or pressure are transmitted via affer- medial and lateral geniculate bodies, via the
ents in the nasociliary branch of the ophthalmic brachium of the superior colliculus to the