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The Sense of Sight / All About the Eyes
Page: 18
Accommodation is an involuntary reflex act, and the ciliary muscle belongs to the smooth involuntary class. Appropriate to this, the innervation is through the autonomic system, the parasympathetic nerve cells belonging to the oculomotor nerve (the third cranial nerve) occupying a special region of the nucleus in the midbrain called the Edinger-Westphal nucleus; the fibres have a relay point in the ciliary ganglion in the eye socket, and the postganglionic fibres enter the eye as the short ciliary nerves. The stimulus for accommodation is the nearness of the object, but the manner in which this nearness is translated into a stimulus is not clear. Thus, the fact that the image is blurred is not sufficient to induce accommodation; the eye has some power of discriminating whether the blurredness is due to an object being too far away or too close, so that something more than mere blurredness is required.
The amount of light entering the eye is restricted by the aperture in the iris, the pupil.
When a person is in a dark room his pupil is large, perhaps eight millimetres (0.3 inch) in diameter, or more. When the room is lighted there is an immediate constriction of the pupil, the light reflex; this is bilateral, so that even if only one eye is exposed to the light both pupils contract to nearly the same extent. After a time the pupils expand even though the bright light is maintained, but the expansion is not large. The final state is determined by the actual degree of illumination; if this is high, then the final state may be a diameter of only about three to four millimetres (about 0.15 inch); if it is not so high, then the initial constriction may be nearly the same, but the final state may be with a pupil of four to five millimetres (about 0.18 inch). During this steady condition, the pupils do not remain at exactly constant size; there is a characteristic oscillation in size that, if exaggerated, is called hippus.
A pupillary constriction will also occur when a person looks at a near object—the near reflex. Thus, accommodation and pupillary constriction occur together reflexly and are excited by the same stimulus. The function of the pupil is clearly that of controlling the amount of light entering the eye, and hence the light reflex. The constriction occurring during near vision suggests other functions, too; thus, the aberrations of the eye (failure of some refracted rays to focus on the retina) are decreased by reducing the aperture of its optical system. In the dark, aberrations are of negligible significance, so that a person is concerned only with allowing as much light into the eye as possible; in bright light high visual acuity is usually required, and this means reducing the aberrations. The depth of focus of the optical system is increased when the aperture is reduced, and the near reflex is probably concerned with increasing depth of focus under these conditions.
Dilation of the pupil occurs as a result of strong psychical stimuli and also when any sensory nerve is stimulated; dilation thus occurs in extreme fear and in pain.
The muscles of the iris have been described earlier. It is clear from their general features that constriction of the pupil is brought about by shortening of the circular ring of fibres—the sphincter; dilation is brought about by shortening of the radially oriented fibres. The sphincter is innervated by parasympathetic fibres of the oculomotor nerve, with their cell bodies in the Edinger-Westphal nucleus, as are the nerve cells controlling accommodation; thus, the close association between the accommodation and pupillary reflexes is reflected in a close anatomical contiguity of their motor nerve cells.
The sensory pathway in the light reflex involves the rods and cones, bipolar cells, and ganglion cells. As indicated earlier, a relay centre for pupillary responses to light is the pretectal nucleus in the midbrain. There is a partial crossing-over of the fibres of the pretectal nerve cells so that some may run to the motor nerve cells in the Edinger-Westphal nucleus of both sides of the brain, and it is by this means that illumination of one eye affects the other. The Edinger-Westphal motor neurons have a relay point in the ciliary ganglion, a group of nerve cells in the eye socket, so that its electrical stimulation causes both accommodation and pupillary constriction; similarly, application of a drug, such as pilocarpine, to the cornea will cause a constriction of the pupil and also a spasm of accommodation; atropine, by paralyzing the nerve supply, causes dilation of the pupil and paralysis of accommodation (cycloplegia).
The dilator muscle of the iris is activated by sympathetic nerve fibres. Stimulation of the sympathetic nerve in the neck causes a powerful dilation of the iris; again, the influx of adrenalin into the blood from the adrenal glands during extreme excitement results in pupillary dilation.
Many involuntary muscles receive a double innervation, being activated by one type of nerve supply and inhibited by the other; modern experimentation indicates that the iris muscles are no exception, so that the sphincter has an inhibitory sympathetic nerve supply, while the dilator has a parasympathetic (cholinergic) inhibitor. Thus, a drug like pilocarpine not only activates the constrictor muscle but actively inhibits the dilator. A similar double innervation has been described for the ciliary muscle. In general, any change in pupillary size results from a reciprocal innervation of dilator and constrictor; thus, activation of the constrictor is associated with inhibition of the dilator and vice versa.
In general, as has been indicated, pupillary constriction and accommodation occur together, in response to the same stimulus; a third element in this near response is, of course, the convergence (turning in) of the eyes, mediated by voluntary muscles, the medial recti. Experimentally, it is often possible to separate these activities, in the sense that one may cause convergence without accommodation by placing appropriate prisms in front of the eyes; or one may cause accommodation without convergence by placing diverging lenses in front of the eyes. There are many experiments that show that accommodation and convergence are neurologically linked to some extent, however. Take this preliminary to see if your condition could respond to treatment.
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Additional information regarding conditions of the eyes can be found here.
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