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Ciliary muscle
The choroid and iris. (Ciliary muscle is labeled near top.)
Latin musculus ciliaris
Gray's subject #225 1011
Origin: 1) longitudinal fibers → scleral spur; 2) circular fibers → encircle root of iris[1]
Insertion: 1) longitudinal fibers → ciliary process, 2) circular fibers → encircle root of iris[1]
Blood: long posterior ciliary arteries
Nerve: short ciliary
Action: 1) accommodation, 2) regulation of trabecular meshwork pore size
Dorlands/Elsevier m_22/12548589

The ciliary muscle /ˈsɪli.ɛəri/ is a ring of striated smooth muscle[2] in the eye's middle layer (vascular layer) that controls accommodation for viewing objects at varying distances and regulates the flow of aqueous humour into Schlemm's canal. It changes the shape of the lens within the eye, not the size of the pupil which is carried out by the sphincter pupillae muscle.

EtymologyEdit

The word ciliary had its origins around 1685–1695.[3] The term cilia originated a few years later in 1705–1715, and is the Neo-Latin plural of cilium meaning eyelash. In Latin, cilia means upper eyelid and is perhaps a back formation from supercilium, meaning eyebrow. The suffix -ary originally occurred in loanwords from Middle English (-arie), Old French (-er, -eer, -ier, -aire, -er), and Latin (-ārius); it can generally mean "pertaining to, connected with," "contributing to" and "for the purpose of."[4] Taken together, cili(a)-ary pertains to various anatomical structures in and around the eye, namely the ciliary body and annular suspension of the lens of the eye.[5]

Embryologic developmentEdit

The ciliary muscle develops from the mesoderm within the choroid[6] and is considered a cranial neural crest derivative.

Mode of actionEdit

AccommodationEdit

Main article: accommodation of the eye

The ciliary fibers have circular (Ivanoff),[7] longitudinal (meridional) and radial orientations.[8]

According to Hermann von Helmholtz's theory, the circular ciliary muscle fibers affect zonular fibers in the eye (fibers that suspend the lens in position during accommodation), enabling changes in lens shape for light focusing. When the ciliary muscle contracts, it pulls itself forward and moves the frontal region toward the axis of the eye. This releases the tension on the lens caused by the zonular fibers (fibers that hold or flatten the lens). This release of tension of the zonular fibers causes the lens to become more spherical, adapting to short range focus. The other way around, relaxation of the ciliary muscle causes the zonular fibers to become taut, flattening the lens, increasing the focal distance,[9] increasing long range focus. Although Helmholtz's theory has been widely accepted since 1855, its mechanism still remains controversial. Alternative theories of accommodation have been proposed by others, including L. Johnson, M. Tscherning, and Ronald A. Schachar.[2]

Trabecular meshwork pore sizeEdit

Contraction and relaxation of the longitudinal fibers, which insert into the trabecular meshwork in the anterior chamber of the eye, cause an increase and decrease in the meshwork pore size, respectively, facilitating and impeding aqueous humour flow into the canal of Schlemm.[10]

InnervationEdit

The ciliary muscle receives both parasympathetic and sympathetic fibers from the ciliary ganglion called short ciliary nerves. These postganglionic fibers are part of cranial nerve III (Oculomotor nerve).[11]

Ciliary ganglion pathways
Ciliary ganglion with sympathetic and parasympathetic fibers of ciliary nerves.
Dr Joe KiffAdded by Dr Joe Kiff

Postsynaptic sympathetic signals that originate in the superior cervical ganglion are carried by the nasociliary nerve or directly extend from the internal carotid plexus and pass through the ciliary ganglion. Sympathetic (adrenergic) activation of the muscle's beta-2 receptors result in relaxation and increase in ciliary body size. This tautens the zonule fibers and the lens is stretched flat, thereby decreasing its refractive power appropriately for far distance vision.

Presynaptic parasympathetic signals that originate in the Edinger-Westphal nucleus are carried by cranial nerve III (the oculomotor nerve) and travel through the ciliary ganglion. Parasympathetic activation of the M3 muscarinic receptors causes ciliary muscle contraction, the effect of contraction is to decrease the diameter of the ring of ciliary muscle. The zonule fibers relax and the lens becomes more spherical, increasing its power to refract light for near vision.

The adrenergic tone is dominant over the parasympathetic tone.[9]

Role in the treatment of glaucomaEdit

Open-angle glaucoma (OAG) and closed-angle glaucoma (CAG) may be treated by muscarinic receptor agonists (e.g., pilocarpine), which cause rapid miosis and contraction of the ciliary muscles, opening the trabecular meshwork, facilitating drainage of the aqueous humour into the canal of Schlemm and ultimately decreasing intraocular pressure.[12]

Additional imagesEdit

See alsoEdit

ReferencesEdit

  1. 1.0 1.1 Gest, Thomas R; Burkel, William E. "Anatomy Tables - Eye." Medical Gross Anatomy. 2000. University of Michigan Medical School. January 5, 2010 Umich.edu
  2. 2.0 2.1 Kleinmann, Guy MD; Kim, Hee Joon MD; Yee, Richard W. MD (2006). "Scleral Expansion Procedure for the Correction of Presbyopia." (article) International Ophthalmology Clinics. 46(3):1-12, Lippincott Williams & Wilkins, Inc.. ISSN: 0020-8167.
  3. "cilia", Unabridged. Source location: Random House, Inc. Reference.com, Accessed: January 16, 2010
  4. Dictionary.com, "-ary," in The American Heritage Dictionary of the English Language, Fourth Edition. Source location: Houghton Mifflin Company, 2004. Reference.com, Accessed: January 16, 2010.
  5. "ciliary," in Dictionary.com Unabridged. Source location: Random House, Inc. Reference.com, Accessed: January 16, 2010.
  6. Dudek RW, Fix JD (2004). "Eye" (chapter 9). Embryology - Board Review Series (3rd edition, illustrated). Lippincott Williams & Wilkins. p. 92. ISBN 0-7817-5726-6, ISBN 978-0-7817-5726-3. Books.Google.com, Retrieved January 17, 2010.
  7. Sampaolesi R, Sampaolesi JR, Zárate G (2009). "Ocular Embryology with Special Reference to Chamber Angle Development" (chapter 8). The Glaucomas - Pediatric Glaucomas (volume 1). Springer Berlin Heidelberg. pp. 61–69. ISBN 978-3-540-69146-4. Springerlink.com
  8. Riordan-Eva Paul, "Chapter 1. Anatomy & Embryology of the Eye" (Chapter). Riordan-Eva P, Whitcher JP (2008). Vaughan & Asbury's General Ophthalmology, 17th, McGraw-Hill. AccessMedicine.com
  9. 9.0 9.1 Hardman JG, Limbird LE, Gilman AG (2006). "Table 6-1" Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th Edition, 143–145, New York: McGraw-Hill.
  10. Salmon John F, "Chapter 11. Glaucoma" (Chapter). Riordan-Eva P, Whitcher JP (2008). Vaughan & Asbury's General Ophthalmology, 17th, McGraw-Hill. AccessMedicine.com
  11. Moore KL, Dalley AF (2006). "Head (chapter 7)" Clinically Oriented Anatomy, 5th, Lippincott Williams & Wilkins.
  12. Le, Tao T.; Cai, Xumei; Waples-Trefil, Flora. "QID: 22067". USMLERx. MedIQ Learning, LLC. 2006–2010. 13 January 2010 Usmlerx.com

External linksEdit

Sensory system - Visual system - Eye - edit
Anterior chamber | Aqueous humour | Blind spot | Choroid | Ciliary body | Conjunctiva | Cornea | Iris | Lens | Macula | Optic disc | Optic fovea | Posterior chamber | Pupil | Retina | Schlemm's canal | Sclera | Tapetum lucidum | Trabecular meshwork | Vitreous humour
Sensory system - Visual system - edit
Eye | Optic nerve | Optic chiasm | Optic tract | Lateral geniculate nucleus | Optic radiation | Visual cortex
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