The Pupil.
The Pupil.
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DOI：
10.1212/con.0000000000000771
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发表时间：
2019-10-01
期刊：
影响因子：
--
通讯作者：
Bouffard, Marc A
中科院分区：
文献类型：
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作者：
Bouffard, Marc A
综述目的：本文的目的是回顾瞳孔功能的解剖学和生理学，然后利用这些信息来建立一个全面的框架来理解和诊断瞳孔疾病。最近的发现：视杆细胞和视锥细胞对瞳孔光反射的作用早已为人所知。最近发现了第三种光敏细胞类型，即固有光敏视网膜神经节细胞。这种细胞利用黑视素介导部分独立于杆状细胞和锥状细胞的瞳孔光反射（即光后瞳孔反应）和昼夜节律的光调节。摘要：自主神经系统通过对刺激的反应调节瞳孔大小。副交感神经系统在对光和近视觉刺激的反应中引起瞳孔缩小。这些刺激激活投射到Edinger-Westphal核的核上通路。交感神经系统对各种唤醒因素（生理性（清醒）和病理性（疼痛））的反应引起瞳孔肿大。生理功能异常引起瞳孔大小、形状和对刺激的反应紊乱。瞳孔异常的临床方法应侧重于对不同刺激下瞳孔预期反应的临床和药理学评估。
PURPOSE OF REVIEW: The goal of this article is to review the anatomy and physiology of pupillary function and then employ that information to develop a comprehensive framework for understanding and diagnosing pupillary disorders.RECENT FINDINGS: The contribution of rods and cones to the pupillary light reflex has long been known. A third photosensitive cell type, the intrinsically photosensitive retinal ganglion cell, has recently been discovered. This cell type employs melanopsin to mediate a portion of the pupillary light reflex independent of rods and cones (the postillumination pupillary response) and photic regulation of circadian rhythm.SUMMARY: The autonomic nervous system regulates pupil size in response to stimuli. The parasympathetic nervous system causes miosis in response to light and near visual stimuli. These stimuli activate supranuclear pathways that project to the Edinger-Westphal nuclei. The sympathetic nervous system causes mydriasis in response to a variety of arousing factors, both physiologic (wakefulness) and pathologic (pain). Abnormalities of physiologic function cause disturbances of pupil size, shape, and response to stimuli. The clinical approach to pupillary abnormalities should focus on the clinical and pharmacologic assessment of the pupil's expected response to diverse stimuli.