ORGAN OF VISION.

Clinical anatomy and physiology

(Lecture by M. Bezugly MD, Ph.D.)
Organ of vision:

1) visual analyzer
- peripheral part (eyeball)
- conduction tracts
(optic nerve, optic chiasma, optic tract)
- central part
(geniculate bodies, optic radiation (Graciole), occipital lobe cortex )

accessory ocular apparatus (adnexa)

- orbit,
- eyelids,
- lacrimal apparatus, external eyeball muscles

Eyeball

Weight 7-8 g

anteroposnerior diameter (Axial length) - 24 mm

consists of 3 main coats:

Outer (fibrous coat)

Middle (vascular coat)

Inner (nervous coat)

Fibrous coat

Dense strong wall which protects intraocular contents. Its anterior 1/6th is
transparent and called CORNEA. Posterior 5/6th opaque part is called
SCLERA. Cornea is set into sclera like a watch glass. Junction of the cornea
& sclera is called LIMBUS. Conjunctiva is firmly attached at the limbus

Cornea is anterior part of fibrous coat. Is a part of dioptric apparatus of the

eye

In normal:

avascular
 sensitive

transparent

smooth

glassy

spherical

Cornea

Nutrition sources:

1) Aqueous humor

2) Tears

3) Vessels of Limbus

4) Outer cornea gets oxygen from atmosphere

Sclera

Fibrous outer posterior protective coat

A few strands of scleral tissue pass across the anterior portion of optic nerve
as Lamina cribrosa

Episclera thin layer of fine elastic tissue covering outer surface of anterior
sclera. Contains numerous blood vessels that nourish the sclera

Vascular coat (uveal tract)

Supplies nutrition to the various structures of the eyeball. It consists of 3

parts which from anterior to posterior are:

Iris

Ciliary body

Choroid

Iris

Flat surface with a centrally situated aperture the pupil

Sphincter and dilator muscles within the stroma

Controls the amount of light entering the eye

 Ciliary body

Corrugated anterior zone pars plicata, ciliary processes

Flattened posterior zone pars plana

Ciliary muscle longitudinal, circular, radial fibers

FUNCTIONS:

Aqueous humor production

Accomodation

The drainage of aqueous humour

ciliary processes

Aqueous in the posterior chamber

(through the pupil)

anterior chamber

Trabecular ciliary body

meshwork

Schlemms suprachoroidal

canal space

Collector venous circulation

channels of ciliary body,

choroid and sclera

Episcleral veins

Trabecular Uveoscleral

outflow=80 - 90% outflow=10-20%

Coroid
 Functions:

Nutrition for outer layers of the retina

Features:

No sensory nerve endings

Different blood supply with anterior segment

Easily detaches from sclera

Tightly connected with retina

Due to great capillary amount has a vast their summary diameter that
enables causative agents settling

The eyeball can be divided into 2 segments: anterior & posterior

Anterior segment:

Crystalline lens (which is suspended from the cilliary body by zunules) &
structures anterior to it iris, cornea and 2 aqueous humor-filled spaces
anterior & posterior chamber

Posterior segment

Includes structures posterior to lens vitreous, retina, choroid & optic disc

Vitreous
Posterior to the lens

4 ml in volume

Inert, transparent gel

Functions:

Optical

Maintenance of globe volume

Nervous coat (RETINA)

Is concerned with visual functions

 Retina
Contains 3 of 5 neurons of visual analiser

1st neuron - photoreceptors (rods and cones),

2nd neuron - bipolar cells,

3rd - multipolar or ganglionic cells. Their axons form all parts of conduction
tracts: optic nerves, optic chiasm and visual tracts. They finish in lateral
geniculate bodies.

4th neuron geniculate bodies, their axons form Graciole radiation and
passing through the internal capsule finish in the occipital lobe cortex, where
the 5th neuron of the visual analyzer is located.

Visual pathway
Each eyeball acts as a camera: it perceives the images and relays the
sensations to the brain (occipital cortex) via visual pathway

Visual pathway comprises:

Optic nerve

Optic chiasma

Optic tract

Geniculate body

Optic radiation

Normal ocular fundus

Optic disc

Macula

Retinal vessels

Blood supply of eyeball

Ophthalmic artery,

branch of internal carotid

 Branches:

central retinal artery superior, inferior papillary branches (supply

internal retina and optic disc)

short posterior ciliary arteries (20) supply outer retina from

photoreceptors to outer plexiform layer, form coroid

long posterior ciliary arteries (2) supply cilliary body, and iris (Circulus
arteriosus major ) anastomosing with

Anterior ciliary arteries (muscular arteries) supply iris

Venous outflow 2 systems:

Inner retinal vein cavernous sinus

Outer (cilliary) 4 vortex veins superior & inferior ophthalmic veins

Venous outflow 2 systems:

Inner retinal vein cavernous sinus

Outer (cilliary) 4 vortex veins superior & inferior ophthalmic veins

The orbit

Superior orbital fissure

Between the body, the greater and lesser wings of the sphenoid bone

CONTAINS:

Superior ophthalmic vein

Lacrimal nerve

Frontal nerve

Nasociliary nerve

Oculomotor nerve

Trochlear nerve

Abducent nerve

External ocular muscles

Six muscles that move the globe medially

 (medial rectus), laterally (lateral rectus), upward (superior rectus and inferior
oblique), downward (inferior rectus and superior oblique), and torsionally
(superior and inferior obliques). These muscles are supplied by three cranial
nerves: cranial nerve IV, which innervates the superior oblique; cranial
nerve VI, which innervates the lateral rectus; and cranial nerve III, which
controls the remainder of the extraocular muscles

Lacrimal apparatus

1. Lacrimal gland

2. Lacrimal punctum

3. Lacrimal canaliculi

4. Lacrimal sac

5. Nasolacrimal duct

Eyelids

Skin layer

Orbicularis oculi Muscle

Areolar tissue

Tarsal Plates

Palpebral Conjunctiva

M.orbicularis oculi

1. Orbital part

2. Palpebral part

3. Lacrimal part (around canaliculi)

4. Lid Margins

Anterior margin:

Eyelashes

Glands of Zeis sebaceous glands

Glands of Moll sweat glands

 Posterior margin

Lacrimal punctum

EXAMINATION METHODS IN OPHTHALMOLOGY

1. HISTORY:

Present history (patients complains)

Past history (anamnesis)

Personal & professional history

Family history

2. GENERAL PHYSICAL & SYSTEMIC EXAMINATION

3. OCULAR EXAMINATION

Techniques of ocular examination

1. Loupe & lens examination

2. Slit-lamp examination

Methods:

Diffuse illumination

Direct illumination

Indirect illumination

Retroillumination

Specular reflection etc.

For examination of adnexa, anterior and posterior segments of the globe

Ophtalmoscopy

Examination Method for posterior segment of the globe

1. Direct ophthalmoscopy image is erect, virtual & magnified

2. Indirect ophthalmoscopy image real, inverted and magnified

3. Fundus examination by focal illumination (biomicroscopic, binocular

ophthalmoscope with fundus-lenses)