Ophthalmology

Dr. Jihan abdallah

Anatomy of the eye and surrounding structures.

Anatomy of the eyeball. Ocular adnexae. Bony orbits.

Anatomy of the eye and surrounding structures.

1- Anatomy of the eyeball.

Anatomy of the eyeball

The eyeball is nearly spherical in shape with a diameter of about 24 mm. The outer most layer is divided into anterior 1/6 called the cornea. It is transparent to allow the light rays into the eye. The posterior 5/6 is whitish and called the sclera.

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 The intermediate layer is highly vascular and pigmented ---> Uveal tract. It is composed of 3 parts => iris, ciliary body and choroid. The iris is a circular disc with an aperture at the center => pupil. It can change in size to control the amount of light entering the eye.
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The ciliary body has 2 functions:

1- Secretion of aqueous humour by ciliary processess. 2- Modifying the power of the lens according to the distance of vision. => Accommodation and occurs by contraction of the ciliary ms.

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 The choroid lines the sclera and covers the retina. The retina is the innermost layer of the eyeball. It is a very thin layer which contains the receptors for vision=> rods& cones.

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 Rods lying at periphery & responsible for vision in dim light. cones lying at center & responsible for vision in bright light. The most important part for vision is =>macula. The nerve fibers of the retina collect to form the optic nerve & carries visual impulses from the retina to the brain.
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 The lens lies behind the iris & is kept in place by the suspensory ligament which connects the edge of lens to ciliary processes. The lens is biconvex in shape & transparent to collect the light rays onto the retina. The lens divides the cavity of the eye ball into small anterior one & big posterior one. Anterior=>A H. Posterior=> vitreous.

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2- Ocular adnexae
Two eye lids Conjunctiva Lacrimal system Extra ocular muscles

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 The two eye lids are mobile mucocutaneous folds which protect the eye from different sources of injury.

The two eye lids are closed by orbicularis oculi muscle supplied by the facial nerve and are opened by the levator supplied by oculomotor nerve.
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 Conjunctiva : Transparent mucous membrane covering the outer surface of the eyeball except the cornea, and lining the inner surfaces of the eyelids.

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Lacrimal system
The lacrimal gland secretes the tears which washes the surface of the eye & keeps it moist & clear. The tears are drained through the lacrimal drainage system into the nasal cavity.

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Anatomy of the lacimal drainage system

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EOM is =>6. 4 recti. 2 obliques. Supplied by 3rd cranial nerve Except SO =>Trochlear n. L R=> Abducent n. They move the eye ball in all directions of gaze.
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Extraocular muscles :Six muscles that move the eyeball

4 recti. 2 obliques. Supplied by 3rd cranial nerve Except SO =>Trochlear n. L R=> Abducent n. They move the eye ball in all directions of gaze.

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1_levator__CN3 2_S.RECTUS__CN3

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3-The orbital cavities:

They are pyramidal in shape with the base looking forwards & the apex backward. Each orbit has 4 walls: Roof => related to anterior cranial fossa Medial wall => related to nose, ethmoidal air sinuses & sphenoid sinus. Lateral wall=> related to temporal fossa. Floor=> related to maxillary sinus and the upper jaw. The apex of the orbit is connected to the middle cranial fossa where the vessels and nerves of the eye ball arise.
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Eye lid problems with relation to dentistry.

1. Recurrent styes of the eye lids: Stye is an acute suppurative inflammation of hair follicles and glands related to it. It is localized inflammation to root of one lashes with yellow pus, head pointing at lid margin Ttt: -antibiotic ED& Oint. -Surgical drainage.

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Blepharitis:
Chronic inflammation of skin of lid margin. Infective=> bad hygiene. Ttt:- good hygeine. - antibiotic ED& Oint.

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Bell's palsy
Lower motor facial palsy . Inability to close the eye . Deviation of the angle of the mouth to the healthy side. Dryness corneal ulcer & opacities. Loss of vision. Ttt:- E D, O & cover. Physiotherapy.
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Jaw winking reflex

The eye lid is ptosed & elevates with jaw movement. Abnormal association bet 3rd &5th ns . Supplying ms for lid elevation & mastication.

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Problems of the conjunctiva

Conjunctivitis : Inflammation of the conjunctiva. Characterized by discharge, grittiness, redness, and swelling.

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Anatomy of the conjunctiva.

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Mucopurulent discharge in bacterial conjunctiva.

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Conjunctival papillae involving the upper (tarsal conjunctiva.( =(lid)_________cause : allergy

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The cornea
Diseses of the cornea: Cogenital. Traumatic. Inflammmatory.

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 Cornea :Transparent, dome-shaped front part of the eye that covers the iris, pupil, and anterior chamber and provides most of an eye's optical power.

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Munson sign in keratoconus

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Nipple cone in keratoconus

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 The cornea should be stained with fluorescein eye drops. If this is not done, many lesions, including large corneal ulcers, may be missed.

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Small dendritic ulcer stained with fluoresein

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Larg dendritic ulcer stained with fluoresein

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