1、Z.Wang,MD 2004Anatomy and Physiology of the Eye2OphthalmologypPathogenesis,development,prevention and treatment for diseases of the eye and its appendicespOver 90%information comes from visionpUnique anatomical and physiological featurespComplex physiological functionsnSense of light,color,shape,etc
2、.nBinocular visionpRelation with general medicine3Ophthalmic ExaminationspBasic toolsnSlit LampnOphthalmoscopepAdvanced techniquesnComputernLasernUltrasound4Anatomy of the Eye and AppendicespEyeball Receive visual informationpVisual pathway Transmit visual informationpAppendices-Protection5Mechanism
3、 of VisionLight rays from an objectImage on retinaElectric impulsesVisual center in occipital cortexRefractionAccommodationEnergy conversionVisual pathway6The EyeballpMeasurementsnVertical dia.=23mm,Horizontal dia.=23.5mmnAxial length=21 to 26 mmlLonger in myopialShorter in hyperopial1mm 3D7The Wall
4、 of the EyeballpOuter layernCorneanScleranLimbuspMiddle layer nIrisnCiliary bodynChoroidpInner layer nRetina8Precorneal Tearfilmp3 layersnLipid(Meibomian glands)nWater(Lacrimal glands)nMucin(Goblet cells)pFunctionsnMoistening cornea and conjunctivanSmoothing out epithelial irregularitiesnInhibiting
5、growth of microorganismpDry eyenDeficiency in any components9The CorneapMeasurementn12 x 11 mm in dia.n0.5 1mm thickp5 layerspRich in nerve fiber endingspTransparentnNo blood vesselsnUniform collagen fibril alignmentnNa K pump in endotheliumEpitheliumBowmans layerStromaDescemets membraneEndothelium1
6、0The CorneapImmunologically privileged sitenCorneal transplantation(keratoplasty)lLamellar keratoplastylPenetrating keratoplastypSlow healing responsepMajor refractive median+43 diopters(D)n of total refractive powerpCorneal refractive surgeriesnRadial keratotomy(RK)nPhotorefractive keratectomy(PRK)
7、nLaser in situ keratomileusis(LASIK)11The SclerapAvascular,tough fibrous tissuepThicknessn0.3 to 1.0 mmpOpaque,collagen fibrills irregular in size and alignmentpAnterior part covered by bulbar conjunctivapConnected to 6 extraocular musclespThinner and translucent in children12The LimbuspJunction of
8、the cornea and scleranAnterior border End of Bowmans layernPosterior border End of Descemets membranepSurgical landmark of important structuresnTrabecular meshworknCanal of Schlemm13The IrispAnterior to the lenspRegulate the amount of lightnSphincter musclenDilator musclepAnt.&Post.ChamberspUnique c
9、olor,texture and pattern14The Ciliary BodypSecrete Aqueous humornMaintenance of normal intraocular pressure(IOP)nNutrition of cornea and lens,etc.Ora SerrataAccommodation15AccommodationpCiliary muscle zonule lenspAge-elasticity of lens capsule-hardness of lens nucleus gradual loss of accommodation(p
10、resbyopia)Ciliary muscle at restCiliary muscle contracts16The Flow of Aqueous HumorNonpigmented epithelial cells Ciliary body Posteror Chamber Pupil Anterior Chamber Trobecular meshwork Schlemm canal Anterior ciliary vein17The ChoroidpThree layerspHigh blood flow from long and short posterior ciliar
11、y arteriesnNutrition to outer layers of retinapRich in blood vessels and pigmentsnAbsorption of excessive light18The RetinapHistologically 10 layerspRetinal detachmentnRetinal pigmented epithelium(RPE)nNeurosensory retinaRPENeurosensory r.19PhotoreceptorspHighly specialized neuroepithelial cellspCon
12、es&rodsn6 million cones Central,bright&color visionn125 million rods Peripheral,dark visionpBipolar,horizontal&amacrine cellspGanglion cellsnAxons to form optic nervePhotoreceptorBipolor c.Ganglion c.Inner segmentOuter segment20The MaculapThe center of retina,temporal to optic discpFovea foveola ava
13、scular zone pOnly cones,no rodspFor detailed central visionpHighly sensitive area21Optic DiscpOptic nerve headpNo photoreceptorsp“Blind Spot”in visual field22The Contents of the EyepContentsnAqueous humornLensnVitreous bodypRefractive mediumpMaintain IOP23The Crystalline LenspBiconvex,avascular,colo
14、rlesspCapsule,lenticular fibers,and nucleuspEpithelium beneath ant.capsule&equatorpSubepithelial lamellar fibers produced and squeezed towards the centerpFunctionsnFocusing naccommodationpChanges with agenLarger&hardernLess elasticnCataract24VitreouspConsists mainly of waterp2/3 of the eyes volumepV
15、iscousitypImportant for metabolism of intraocular tissuespAttached to retinapAging changesnThinner&more liquidn“floaters”25Blood SupplypCentral systempCiliary systempOriginate from ophthalmic artery26Central Retinal Artery SystempOriginate from ophthalmic arterypPenetrate optic nervep4 branchespNour
16、ish the inner 5 layers of retinapRetinal artery occlusion EMERGENCYnCRAO&BRAOpRetinal vein occlusionnCRVO&BRVO27Ciliary Artery SystempAnterior ciliary arteries Ciliary body&limbuspLong posterior ciliary arteries Iris&ciliary bodypShort posterior ciliary arteries Choroid pVortex veins ophthalmic vein
17、 cavernous sinuses28Appendices of the EyepEyelidspConjunctivapLacrimal apparatuspExtraocular musclespOrbit29The Eyelidp5 layersnSkinnSubcutaneousnMusclenTarsusnPalpebral conjunctivap2 musclesnLevator PalpebraenOrbicularis OculipFunctionsnProtectionnDistribution of tearsnLimiting light entering the e
18、ye30The EyelidpGlandsnMeibomian nZeisnMoll31The ConjunctivapTransparent mucous membranepThree partsnPalpebralnBulbarnFornicalpConjunctivitisBulbar conjunctivaPalpebral conjunctivaFornical conjunctiva32Lacrimal ApparatuspTears drainage systemnLacrimal glandnLacrimal punctanCanaliculusnLacrimal sacnNa
19、solacrimal ductpDacryocystitis33Extraocular MusclespRectus musclesnSuperiornInferiornMedialnLateral Abducens n.pOblique musclesnSuperior Trochlear n.nInferior Oculomotor n.pStrabismusOculomotor n.34The OrbitpProtective functionpBonesnFrontal b.nSphenoid b.nZygomatic b.nEthmoid b.nPalatine b.nMaxilla
20、 b.nLacrimal b.pSinusesnFrontal s.nMaxillary s.nEthmoid&Sphenoid s.35Important openingspOptic foramen cranial cavitypSuperior&inferior orbital fissuresOptic Foramen36Visual PathwaypOptic nervepOptic chiasmpOptic tractpLateral geniculate bodypOptic radiationpOccipital cortex37Patterns of Visual Field
21、 Defect Caused by Lesions at Different LevelsRight half of visual field Left optic tract Left cerebral hemisphere 38The Light ReflexpDirectpIndirect39Review(1)pThe middle layer of the wall of eye ball includes:nIrisnCiliary bodynChoroid pWhich part(s)of the cornea is(are)unable to regenerate after i
22、njury?nBowmans layernEndotheliumpAqueous humor is secreted by:nNon-pigmented ciliary epithelial cellspThe lipid layer of the tears is secreted by:nThe meibomian glands in the eyelidpWhat is the main refractive media?nCornea 40Review(2)pThe reasons for the corneas transparency?nNo blood vesselsnUnifo
23、rm size and alignment of collagen fibrilsnActive Sodium-Potassium pumps in endotheliumpWhich nucleus is mainly involved in the light reflex?nThe E-W nucleuspWhich kind of photoreceptor is for color vision?nThe conepWhat are the aging changes in the lens?nLarger nHarder&less compressiblenLess elastic
24、pWhat vein(s)drain(s)the blood from the ciliary arteries?nThe vortex veins41Review(3)pWhich part of the nerve fibers cross at the optic chiasm?nNerve fibers from the nasal half of the retinapWhat make up the left optic tract?nFibers receiving the impulses from the right half of visual fieldornFibers
25、 receiving the impulses from the left half of retinapWhat is retinal detachment?nSeperation of the retinal pigment epithelium and the neurosensory retinapWhats the common origin of the central retinal artery and the ciliary arteries?nThe ophthalmic arteryMedical Terms of TodayConjunctiva结合膜Cornea角膜S
26、clera巩膜Limbus角巩膜缘Iris虹膜Choroid脉络膜Retina视网膜Aqueous humor房水Bowmans layer前弹力层Descemets layer后弹力层Keratoplasty角膜移植术Trabecular meshwork小梁网Ciliary body睫状体Zonule悬韧带Accommadation调节Glaucoma青光眼Cataract白内障Photoreceptor光感受器Macula黄斑Fovea中心凹Vitreous玻璃体Presbyopia老视Myopia近视Hyperopia远视Astigmatism散光Strabismus斜视Orbicularis Oculi眼轮匝肌Levator Palpebrae提上睑肌Lacrimal apparatus泪器Canaliculus泪小管Meibomian gland睑板腺Tarsus睑板Optic Chiasm视交叉Slitlamp裂隙灯Ophthalmoscope检眼镜Vortex vein涡静脉Ora Serrata锯齿缘Pars Plana扁平部
