ganglion ciliare

毛様体神経節

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/05/29 21:47:22」(JST)

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Ciliary ganglion
Detailed view of nerves of lateral orbit showing the ciliary ganglion immediately behind the globe of the eye.
Details
From	nasociliary nerve
To	Parasympathetic root of ciliary ganglion, Sympathetic root of ciliary ganglion, Sensory root of ciliary ganglion
Identifiers
Latin	ganglion ciliare
TA	A14.3.02.003
FMA	6964
Anatomical terms of neuroanatomy

The ciliary ganglion is a parasympathetic ganglion located just behind the eye in the posterior orbit. It measures 1–2 millimeters in diameter and in humans contains approximately 2,500 neurons. The oculomotor nerve coming into the ganglion contains preganglionic axons from the Edinger-Westphal nucleus (a part of the brainstem) which form synapses with the ciliary neurons. The postganglionic axons run in the short ciliary nerves and innervate two eye muscles:

• the sphincter pupillae constricts the pupil, a movement known as Miosis. The opposite, Mydriasis, is the dilation of the pupil.
• the ciliaris contracts, releasing tension on the Zonular Fibers, making the lens more convex, also known as accommodation.

Both of these muscles are involuntary – they are controlled by the autonomic nervous system.

It is one of four parasympathetic ganglia of the head and neck. (The others are the submandibular ganglion, pterygopalatine ganglion, and otic ganglion).

Anatomy

Scheme showing sympathetic and parasympathetic innervation of the pupil and sites of lesion in a Horner's syndrome.

Pathways in the Ciliary Ganglion. Green = parasympathetic; Red = sympathetic; Blue = sensory

Three types of nerve fibers run through the ciliary ganglion:

• a 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

Main article: Adie syndrome

Diseases of the ciliary ganglion produce a tonic pupil. This is a pupil that does not react to light (it is “fixed”) and has an abnormally slow and prolonged response to attempted near vision (accommodation).

When a patient with an Adie pupil attempts to focus on a nearby object, the pupil (which would normally constrict rapidly) constricts slowly. On close inspection, the constricted pupil is not perfectly round. When the patient focuses on a more distant object (say the far side of the room), the pupil (which would normally dilate immediately) remains constricted for several minutes, and then slowly dilates back to the expected size.

Tonic pupils are fairly common – they are seen in roughly 1 out of every 500 people. A patient with anisocoria (one pupil bigger than the other) whose pupil does not react to light (does not constrict when exposed to bright light) most likely has Adie syndrome – idiopathic degeneration of the ciliary ganglion.

Physiology

The strange behavior of tonic pupils was first explained by Irene Loewenfeld in 1979. The ciliary ganglion contain many more nerve fibers directed to the ciliary muscle than nerve fibers directed to the constrictor pupillae – roughly twenty times more. The ciliary muscle is also more massive than the constrictor pupillae, again by a factor of twenty. Based on these observations, Loewenfeld proposed an explanation of the tonic pupil. She noted that pathological destruction of nerve cells in the ciliary ganglion that is found in all cases of Adie pupil. In her own words:

Let’s say that in a given fresh Adie’s pupil, a random 70% of the cells in the ciliary ganglion stop working; and that, in a couple of months, these neurons re-grow and randomly re-innervate both intraocular sphincters (the ciliary muscle and the iris sphincter). Some parasympathetic light-reaction neurons that were originally destined for the iris sphincter will end up innervating the ciliary muscle. But there will not be enough of them to budge that big muscle, so there will be no detectable accommodation with exposure to light. The other way around, it is a different story. There will be plenty of accommodative neurons re-growing into the iris sphincter, and it won’t take very many of them to make a little muscle like the iris sphincter contract. This means that every time the patient accommodates her gaze to a near object, some of the innervation to the ciliary muscle will spill over into the iris and constrict the pupil.

Loewenfeld’s theory is now generally accepted. It explains the defining features of a tonic pupil:

(1) The pupil does not react to light. The original light-reaction neurons have been destroyed.

(2) Tonic constriction with attempted near vision. Aberrant regeneration of nerve fibers intended for the ciliary muscle causes abnormal, tonic contraction of the pupil with accommodation.

(3) Segmental iris constriction. When carefully examined under magnification, the iris does not constrict uniformly with attempted near vision. Only the re-innervated segments contract, producing a slightly irregular contour to the pupil.

(4) Denervation supersensitivity. Like any denervated muscle, the iris becomes supersensitive to its normal neurotransmitter (in this case, acetylcholine). Very weak solutions of cholinergic substances such as pilocarpine (that have no effect on the normal iris) cause the denervated iris to constrict.

Tonic pupils are usually due to Adie syndrome, but other diseases can denervate the ciliary ganglion. Peripheral neuropathies (such as diabetic neuropathy) occasionally produce tonic pupils. Herpes zoster virus can attack the ciliary ganglion. Trauma to the orbit can damage the short ciliary nerves. Anything that denervates the ciliary ganglion will produce a tonic pupil due to aberrant nerve regeneration.

Adie syndrome

Adie syndrome is tonic pupil plus absent deep tendon reflexes. Adie syndrome is a fairly common, benign, idiopathic neuropathy that selectively affects the ciliary ganglion and the spinal cord neurons involved in deep tendon reflex arcs. It usually develops in middle age, although it can occur in children. A variant of Adie syndrome, Ross syndrome, affects sweating as well.

Early in the course of Adie syndrome (when the cells of the ciliary ganglion have been destroyed, but before regeneration has occurred) the pupil will be fixed and dilated. The sphincter pupillae will be paralyzed. There will be no response to accommodation – the ciliary muscle is also paralyzed.

With aberrant nerve regeneration, the pupil will remain fixed, but it will constrict with attempted near vision. The constriction will be abnormal (“tonic”).

Late in the course of Adie syndrome, the pupil becomes small (as all pupils do with old age). It will still be “fixed” (it will not constrict to bright light) and it will continue to show abnormal, tonic constriction with attempted near vision.

Light-near dissociation

In some neurological disorders, the pupil does not react to light, but it does react to accommodation. This is called “light-near dissociation”.

In Adie syndrome, damage involving the ciliary ganglion manifests light-near dissociation and a tonically dilated pupil (usually unilateral).

Other causes of light-near dissociation involve damage to the brainstem, where a tonic pupil is not produced. Brainstem causes of light-near dissociation include Argyll Robertson pupil and Parinaud syndrome.

Irene Loewenfeld is generally credited for being the first physiologist to make this distinction.

Additional images

• Plan of oculomotor nerve.

• The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses.

• Diagram of efferent sympathetic nervous system.

External links

• Anatomy figure: 29:03-04 at Human Anatomy Online, SUNY Downstate Medical Center - "A deeper dissection of the right orbit from a superior approach."
• Atlas image: n2a4p2 at the University of Michigan Health System - "Branches of Trigeminal Nerve, Lateral View"
• Cell Centered Database - Ciliary ganglion
• lesson3 at The Anatomy Lesson by Wesley Norman (Georgetown University) (orbit5)
• cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (III, V)

UpToDate Contents

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• 1. 手首および手のガングリオン嚢胞ganglion cysts of the wrist and hand [show details]
  … recurrent ganglia, another five improved with repeat aspirations. There were no complications from ganglia aspirations. Adjunctive techniques such as performing multiple punctures of the ganglion walls or …
• 2. 超音波内視鏡下の腹腔神経叢および神経節への介入endoscopic ultrasound guided celiac plexus and ganglia interventions [show details]
  … abdominal pain or malignancy had no bearing on the identification or number of ganglia identified. The high rate of ganglion visualization and the lack of correlation with other pathologic processes suggested …
• 3. 舞踏病の概要overview of chorea [show details]
  …reveals abnormal deposition of iron in the basal ganglia with gradient echo (T2*) signal loss, as well as cystic changes and necrosis in basal ganglia . A distinct imaging pattern of iron deposition, termed …
• 4. 成人における慢性膝痛の放射線評価radiologic evaluation of the chronically painful knee in adults [show details]
  …types that are commonly found in this location are ganglion cysts and meniscal cysts. A ganglion is a cystic benign tumor of unknown origin. Ganglion cysts may be juxtaarticular, intraarticular, intraosseous …
• 5. 急性の手首の疼痛を有する成人患者の評価evaluation of the adult with acute wrist pain [show details]
  …questionable cases. Ganglion cyst – A ganglion is a soft cystic swelling overlying a joint or tendon sheath that commonly develops at the dorsum of the wrist . Ganglions can cause pain and their …

English Journal

• Herpes Simplex Virus 2 in Autonomic Ganglia: Evidence for Spontaneous Reactivation.

• Pieknik JR, Bertke AS, Krause PR.
• Journal of virology. 2019 Jun;93(11).
• Herpes simplex virus 2 (HSV-2) can be transmitted in the presence or absence of lesions, allowing efficient spread among the general population. Recurrent HSV genital lesions are thought to arise from reactivated latent virus in sensory cell bodies of the dorsal root ganglia (DRG). However, HSV-2 ha
• PMID 30894469

• Extrinsic Primary Afferent Neurons Link Visceral Pain to Colon Motility Through a Spinal Reflex in Mice.

• Smith-Edwards KM, Najjar SA, Edwards BS, Howard MJ, Albers KM, Davis BM.
• Gastroenterology. 2019 Apr;().
• Proper colon function requires signals from extrinsic primary afferent neurons (ExPANs) located in spinal ganglia. Most ExPANs express the vanilloid receptor TRPV1 and a dense plexus of TRPV1-positive fibers is found around myenteric neurons. Capsaicin, a TRPV1 agonist, can initiate activity in myen
• PMID 31075226

• Identification of peripheral neural circuits that regulate heart rate using optogenetic and viral vector strategies.

• Rajendran PS, Challis RC, Fowlkes CC, Hanna P, Tompkins JD, Jordan MC, Hiyari S, Gabris-Weber BA, Greenbaum A, Chan KY, Deverman BE, Münzberg H, Ardell JL, Salama G, Gradinaru V, Shivkumar K.
• Nature communications. 2019 04;10(1)1944.
• Heart rate is under the precise control of the autonomic nervous system. However, the wiring of peripheral neural circuits that regulate heart rate is poorly understood. Here, we develop a clearing-imaging-analysis pipeline to visualize innervation of intact hearts in 3D and employed a multi-techni
• PMID 31028266

Japanese Journal

• 人胎児脳神経の発生学的研究補遺

• 鈴木 良映
• 日本医科大学雑誌 26(10), 1012-1029, 1959
• … facialis with ganglion geniculi.<BR>3) Chorda tympani reaches mandibular arch in the horizon XIV, but it does not unifie with N. … The ganglion submandibulare appears soon after this unification in the earlier stage of the horizon XVII<BR>4) In the developmental stage of the human embryo, in which the gangl. …
• NAID 130003917085

• On the Innervation of the Pupil of the Dog:II. Destruction of the Ganglion Ciliare of One Side

• 笠 潤一郎
• The Tohoku Journal of Experimental Medicine 37(6), 530-540, 1940
• NAID 130003408216

• 睡眠時縮瞳ニ關スル知見補遺 : 特ニソノ成立機制ニ就テノ實驗的研究

• 篠田 坦
• 京都府立医科大学雑誌 10(1/2/3/4), 121-147, 1934
• … 2) Wenn man bei einem Kaninchen auf einer Seite des Ganglion ciliare durchschneidet und das auf der anderen Seite nicht, so zeigt die bis auf eine gewisse Weite erweiterte Pupille auf der ganglionlosen Seite wahrend des Schlafes keine Veranderung, auf der anderen Seite dagegen ist die Miosis eingetreten. …
• NAID 110007114218

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★リンクテーブル★

リンク元	「毛様体神経節」
関連記事	「cilia」

「毛様体神経節」

　　[★]

英

ciliary ganglion (KH)

ラ

ganglion ciliare

• ゴマ粒大で動眼神経からの副交感性節前線維がニューロンを変えるところ
• ニューロンを変えたあと短毛様体神経となる (KH.324)

「cilia」

　　[★]

• n.

• 繊毛、線毛