Further observations on the sympathetic pathways to the pupil

The clinical disturbance resulting from section of the sympathetic in the neck; miosis, decreased sweating, increased vascularity and narrowing of the palpebral fissure is universally recognized while the definitive sympathetic pathways remain unknown. Most current texts depict a plexus along the surface of the parasellar carotid as part of that pathway although a previous review leaves the large connection of the carotid sympathetic to the sixth and then to the first division of the fifth cranial nerve as a putative pathway. Recent reports of complete tears of the parasellar carotid without sympathetic changes tend to further discount a carotid plexus as a pathway and focus attention on the direct carotid sympathetic nerve connections to the sixth and fifth cranial nerves as probable but unproven pathways, the interruption of which, result in Bernard, Mitchell, Horner Syndrome. (Parkinson '79).