Physiology Faculty of

CNS-222 Module medicine

Practical 3

Corneal reflex
Light reflex
Visual field

Staff members of
Medical Physiology
 Objectives
After studying this section, you should be able to:

 Identify functions of the cornea and iris

Describe Corneal reflex

Describe Pupillary light reflex

Describe Visual field

 Corneal reflex
What are the layers of the eye?

Outer coat: Sclera & cornea

Middle coat: choroid, ciliary body & iris

N.B. Ciliary body consists of ciliary muscle,

ciliary processes & suspensory ligaments

Inner coat: Retina “the queen of the eye”

 And now, what is the corneal reflex??
Touching the cornea → bilateral blinking

• A superficial reflex
• Tested by a piece of cotton.
• Used to test the integrity of trigeminal nerve & the
depth of anesthesia

• Pathway:
Receptors: free nerve endings in the cornea
Afferent: V nerve (ophthalmic division)
Center: pons
Efferent: VII nerve (bilateral)
Effector organ: orbicularis occuli muscles
Response: bilateral blinking
 Light reflex
You must know at first the functions of the iris:

1- It regulates the entry of light rays through the pupil.

2- It prevents chromatic and spherical aberrations.

3- It protects the retina (by preventing the ultraviolet

rays from falling on it)

4- Pupillary light reflex which is very important in

diagnosis of many nervous lesions)

 And now, what is pupillary light reflex?

Exposure of one eye to light → miosis of the same eye

(direct reflex) and miosis of the contralateral eye
(indirect or consensual light reflex)

The importance of this reflex is to:

1- localize the site of lesion in the visual pathway
2- Diagnose of certain nervous diseases.
3- Determine the depth of anesthesia
Pathway of pupillary light reflex:
Receptors: Rods & cones in the retina
Afferent: optic nerve (II)→ optic chiasma →optic
tract →collaterals from optic tract
Center: pretectal nucleus (in the midbrain), which will Optic tract
III nerve Optic chiasma
send impulses to Edinger-Westphal nucleus on both
sides.
Efferent: oculomotor nerve (III) through its
parasympathetic fibers, → relay in the ciliary
ganglion → short ciliary nerves.
Effector organ: constrictor pupillae muscles (bilateral)
Response: bilateral miosi
Abnormal Pupillary light reflex:
1- Encephalitis & alcoholism: the reflex is lost due to block of transmission of impulses from
the retina to the EWN
2- Argyll Robertson pupil: which means that the pupil doesn’t constrict in response to light
but constricts in response to accomodation. This is due to lesion in the pretectal nucleus
which may occur in neurosyphilis.
3- Reverse Argyll Robertson pupil: which means that the pupil doesn’t constrict in response
to accomodation but constricts in response to light. This is due to lesion in the occipito-tectal
tract.
4- Horner’s syndrome: the pupil is persistently constricted due to lesion in the sympathetic
supply to the eye.
Visual field
• Visual field is the maximum space that can be seen by one eye when it is fixed
on a point in the space.
• It is not circular. Why?
because it is cut off medially by the nose, superiorly by the supra-orbital ridge and
inferiorly by the cheeks)
• It is measured by an apparatus called perimeter
Why do we measure the visual field?
1- To localize of the sites of lesion in the visual pathway.
2- To lacalize the sites of scotomas (blind spots in the
retina)
3- To diagnose some retinal diseases as retinitis
pigmentosa which has a characteristic visual field loss.

Retinitis pigmentosa scotoma

• Oxford Handbook of Medical Sciences ,third edition 2021,
• Robert Wilkins, Simon Cross, Ian Megson, David Meredith, OXFORD university press.
(Handbook)
Lippincott Illustrated Reviews: Integrated Systems.
• Sandra K. Leeper-Woodford, MS, Macon, Georgia Linda R. Adkison, MS Copyright ©
2015 Wolters Kluwer. (Student book)
• Guyton and Hall Textbook of Medical Physiology 14th edition
• John E. Hall, PhD and Michael E. Hall, MD, MS.
• Copyright © 2021 by Elsevier, Inc. All rights reserved
• http://evolve.elsevier.com/Hall/physiology/ (Text book)