NCM 114: EENT - lacrimal

Lecture: Anatomy and Physiology of the Eye - zygomatic

- maxillary
The Eye and Vision - palatine
 Vision
 Considered by many as the most Internal Parts of the Eye
important special sense
 Begins with the eye and fully Anterior Chamber
perceived by the brain - cornea
 Eyes - anterior chamber
- iris
 Two spherical organs located in
- lens
bony cavities (orbits) in front of the
- zonules
head
- ciliary body
 Eyeball
o Round ball-shaped organ about 2.5
Posterior Chamber
cm long and 2.3 cm in diameter - vitreous chamber/body
 Visual System - sclera
 Eyes and accessories/surrounding - choroid
structures - retina
- optic nerve
External/Accessory Structures
 Eyelids Anterior Chamber
 Eyebrows
 Eyelashes Cornea
 dome-shaped “window” at the front of the
Lacrimal Apparatus eye (where contact lens rests)
 Lacrimal gland  provides 85% of the light bending
 Superior and anterior lacrimal punctum (focusing) power of the eye
and canaliculi  clear, no blood vessels
 Lacrimal sac  1mm thick but tough
 Nasolacrimal duct  Made of 5 distinct layers:
 Nose - corneal epithelium (microvillae)
- bowman’s layer
Eye Muscle - stroma (substantia propia)
 Intrinsic muscle  type I and V collagen
- Iris - Descemet’s membrane
- Ciliary body - Endothelium
- Innervated by CN III (occulomotor)
 Extrinsic muscle Endothelium
- Superior rectus  Pumps water out of the cornea keeping it
- Inferior rectus transparent
- Lateral rectus  Does not regenerate
- Medial rectus  10% normally lost per decade of life
- Superior and inferior oblique
muscles  Too much corneal fluid will cause opacity
and epithelium may become blistered
- Superior oblique innervated by
(bullous keratopathy)
CN IV
- Lateral rectus innervated by CN Anterior Chamber
VI  Fluid filled space (aqueous humor)
- The rest, CN III
- produced by the ciliary body
(located in the posterior chamber)
Orbit
and bathes the whole of the
 bony socket which encloses and protects anterior segment
the eye along with the attached muscles,
 provides nourishment and removal of
nerves, vessels and glands
breakdown products to the lens and
 composed of 7 bones cornea
- frontal
- sphenoid Iris
- ethmoid
  colored structure which rests behind the
cornea and in front of the natural lens
 thin elastic tissue with and opening in the
center (pupil), surrounded by a circular
muscle called a sphincter
 the place where the iris meets the cornea
is called the angle
 The front layer of the tissue varies in
thickness; the thicker it is, the bluer the
eyes appear to be when seen through the
clear cornea
 The backside is made up of cells
containing brown pigment which acts to
absorb light as well as prevent its
scattering within the eye
Iris Sphincter
 Circular (constrictor) muscle at the
papillary border
- Innervated by the parasympathetic
fibers of CN III (Oculomotor)
- Contraction decreases
circumference of the ring and causes
papillary constriction (miosis)
 Radial (Dilator) muscle fibers
- Innervated by sympathetic fibers
from the superior cervical ganglion of
the neck (mydriasis)
Lens
 Normally clear, the lens sits behind the iris
and in front of the virtreous humor
 Focuses light rays on the back of the eye
 Provides near vision in our youth and
which gets gradually stiffer as we age
 It is the lens that gradually becomes more
and more cloudy with age (cataract)
Zonules
 The fiber-like processes extending from
the ciliary body to the capsule of the lens
of the eye
 Responsible for holding the lens of the eye
in its normal position
Ciliary Body
 Located just behind the iris
 Produces the nutrient fluid called
aqueous humor
 Controls focusing of the eye
 Contraction of the ciliray muscles affects
the shape of the lens, thereby changing its
focus (accommodation)
 Contraction of muscles in the ciliray ring
narrows the diameter
Ciliary
Body
Iris through the angle
Trabecular Meshwork
(normally open 30°)
Veins
Posterior Segment
Vitreous Chamber
 Filled with gel-like structure called the
vitreous body, vitreous humor, vitreous
gel, or hyaloids
 However, it is neither a humor nor a gel
 Composed of mucopolysaccharides and
hyaluronic acids
 Maintain the shape of the eye keeping the
retina pressed against the inner surface of
the eye
 Cushion the contents of the eye from
shocks such as from running or turning of
the head
Sclera
 Avascular, white outer protective wall of
the eye
 Extends from the cornea onto the optic
nerve where it serves as a sheath up to
and through the bony optic canal
 When seen from the front, it is commonly
(but incorrectly) referred to as the “white
of the eye” (conjunctiva)
Choroid
 Vascular and pigmented layer situated
between the retina and the sclera of the
eye
 Supplies the inner retinal sensory cells
with nutrients and oxygen
 The movement of nutrients into the
sensory cells is done by active transfer
across cell membranes; that’s why vision
deteriorates when retina is detached and
no longer in contact with the choroids
Retina
 Layer of tissue lining the inside of the back
of the eye
 Contains millions of photoreceptor cells
which convert light into images
  Contains ten layers and is responsible for
gathering light focused upon it by the
cornea and lens
 It converts the light to electrical signals
which it amplifies and sends on to the
brain for interpretation and construction of
images
2 General Zones or Areas
1. Central Area
 Macular area
- central part that receives the most
sharply formed images
- responsible for daylight and color
vision
 Fovea/Fovea Centralis
- Very center of the macula where
best vision occurs
2. Peripheral Area
 Provides side vision, night vision and
also detects motion
 The sum total of the extent of the vision
– both central and peripheral – is called
the visual field(VF)
 Optic disc (optic nerve head) – a
depressed white area in the retina; seen
in the optic fundus upon opthalmoscopy
Optic Nerve
 Collection of the retinal nerve fiber layer
which transmits visual information from
the eye to the brain
 Covered by a very tough, flexible
extension of the sclera as far as the optic
chiasm
 The central artery and vein (which supply
the internal layers of the retina) run up the
center of this nerve
Sensory Pathway for Vision
 Rod and Cone receptors
 Optic nerves (left and right)
 Optic chiasm
 Optic tracts
 Occipital lobe
Uvea
 Choroid, cilirary body, and iris
 Pigmented and continuous with one
another
Physiology of Vision
 Light waves from an object (such as a
tree) first enter the eye through the
cornea
 The light then progresses through the
pupil and crystalline lens
 Initially, the light waves are bent or
converged by the cornea, and then further
by the crystalline lens, to a point located
immediately behind the back surface of
the lens
 At that point, the image becomes reversed
(turned backwards) and inverted (turned
upside down)
 The light continues through the vitreous
humor and then, ideally, to a focus on the
retina behind the vitreous
 Within the layers of the retina, light
impulses are changed into electrical
signals and then sent through the optic
nerve, along the visual pathway, to the
occipital lobe
Accomodation:
 For focusing near objects
 Papillary constriction
 Lens become rounder
 Convergence of eyeballs
Age-related Changes
 Arcus senilis
- whitish-bluish arcs at margin of the iris
- fat deposits
- does not affect vision
 Presbyopia
- Loss of lens elasticity
- Uses bifocal lenses
 Hyperopia
- Farsightedness
- Uses biconcave lenses
 Myopia
- Nearsightedness
- Uses biconvex lenses
 Astigmatism
- Abnormal curvature of the cornea
- Uses cylindrical lenses