The ciliary ganglion is a tiny parasympathetic ganglion, only about 2 mm across, lying near the back of the orbit between the optic nerve and the lateral rectus muscle. Preganglionic fibres from the oculomotor nerve synapse here, and the postganglionic fibres travel in the short ciliary nerves to the muscles that constrict the pupil and focus the lens. Sympathetic and sensory fibres pass through it without synapsing.
| Origin | Parasympathetic root from the inferior division of the oculomotor nerve (CN III), with a sensory root from the nasociliary nerve and a sympathetic root from the internal carotid plexus |
|---|---|
| Course | Lies near the orbital apex between the optic nerve and lateral rectus and sends postganglionic fibres forward in the short ciliary nerves to pierce the sclera around the optic nerve |
| Motor |
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| Sensory |
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Damage to the ciliary ganglion or short ciliary nerves produces a tonic (Adie) pupil: a dilated pupil that reacts poorly to light but slowly to near effort (light-near dissociation). Because the denervated sphincter becomes supersensitive, dilute pilocarpine (0.1%) constricts the tonic pupil but not a normal one, which is a useful diagnostic test. The ganglion can be damaged by orbital trauma, orbital surgery, viral infection and retrobulbar injection.
Usually idiopathic and most common in young women, it causes a unilateral dilated pupil with poor light reaction and blurred near vision. When combined with reduced tendon reflexes it is called Holmes-Adie syndrome.
Blunt orbital trauma or surgery near the orbital apex can injure the ganglion, leaving a persistently dilated pupil and reduced accommodation in that eye.
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