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The pupillary light reflex (PLR) is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retinal ganglion cells of the eye, thereby assisting in adaptation to various levels of lightness/darkness.he pupillary reflex pathway begins with the photosensitive retinal ganglion cells, which convey information to the optic nerve (via the optic disc). The optic nerve connects to the pretectal nucleus of the upper midbrain, bypassing the lateral geniculate nucleus and the primary visual cortex.
The ciliospinal reflex response is mainly mediated by second-and third-order sympathetic nerves to the dilatator muscle of the iris.As the pupillary response to various pharmacological agents indicates a sympathetic dysfunction in patients with cluster headache, the ciliospinal reflex was studied in 25 patients.n 18 (72%) of our 25 patients, an asymmetric and lower ciliospinal reflex response on the symptomatic side was seen. In 3 (12%) patients, there was no difference in the response. In 4 patients (16%), the incorrect side was indicated by an asymmetric reflex response.