BINDURA UNIVERSITY OF SCIENCE EDUCATION

P. BAG 1020 Tel. (263) 712 842 712-4

Bindura, 066 210 6505

Zimbabwe

FACULTY OF SCIENCE AND ENGINEERING

OPTOMETRY DEPARTMENT

NAME : RUSERE SUCCESS KUDZAI

REG NUMBER : B213298B

LEVEL : 2.1(CONVENTIONAL) YEAR: 2022

PROGRAMME : BACHELOR OF SCIENCE HONOURS DEGREE IN OPTOMETRY

MODULE CODE : OPTC 201

MODULE TITLE : OCULAR ANATOMY AND PHYSIOLOGY

LECTURER : DR. MASHOKO

DUE DATE : 01 NOVEMBER 2022

QSN. Discuss physiology of aqueous formation and its drainage and relate it to
how intraocular pressure is controlled. [25 marks]

Aqueous humor is a transparent fluid contained in the anterior and posterior

chambers of the eye and is formed by the ciliary epithelium of the ciliary processes
projecting from the ciliary body. It is secreted into the posterior chamber of the eye
by the ciliary epithelium, a double layer of cells located on the surface of the
ciliary processes. The various constituents of aqueous humour have to pass three
tissue layers of ciliary processes capillary wall, stroma and two layers of
epithelium. It then circulates through the pupil into the anterior chamber. A large
portion of anterior chamber leaves the eye through the trabecular meshwork into
Schlemm’s canal and the episcleral venous system. The remainder escapes via the
uveoscleral route by simple percolation though the interstitial tissue spaces of the
ciliary muscle into the suprachoroid and out through the sclera.

Aqueous humor formation is a complex process. Basically, it can be subdivided

into four stages: There must be blood flow to the vascular bed of the ciliary
processes, an ultrafiltrate is passed through the fenestrated capillaries of the ciliary
processes, which have high protein permeability, into the interstitial spaces
between the vessels and the ciliary epithelium. A number of solutes are transported
from the ultrafiltrate in the posterior chamber across the ciliary epithelium. Lastly
the osmotic gradient established by the solutes facilitates the passive flow of water
into the eye by osmosis.

The movement of solutes across the ciliary epithelium can be achieved by three
interdependent mechanisms. The first one is diffusion contributing about 10%,
which is defined as the passive movement of solutes across the CE in response to a
concentration gradient. Lipid-soluble substances are transported through the lipid
portions of the cell membrane. The second one is ultrafiltration 20%, which is
defined as the passive movement of water- and water-soluble substances across
cell membranes as a result of the hydrostatic and oncotic pressures between the
ciliary stroma and the aqueous humour. Only limited by size and charge. Diffusion
and ultrafiltration are both passive mechanisms, with lipid- and water-soluble
substances from the capillary core traversing the stroma and passing between
pigmented epithelial cells and limited by the tight junctions of the non-pigmented
epithelial cells.
The third is active transport accounts for the majority of aqueous production about
70%, which is an energy consuming process involving the movement of solutes
across the ciliary epithelium against their concentration gradients. Water-soluble
substances of larger size or greater charge are actively transported across the cell
membrane, requiring the expenditure of energy; Na-K ATPase and glycolytic
enzymes are present in nonpigmented epithelial cells facilitating this process.

Regulation of aqueous humor outflow is important for intraocular pressure

maintenance. The drainage path for aqueous humor starts in the posterior chamber
of the eye. Further, aqueous humor flows into the area between the posterior iris
and the anterior lens and then through the pupil and enters the anterior chamber.
From the anterior chamber, aqueous humor leaves the eye through the trabecular
meshwork and flows into Schlemm’s canal. The flow from the anterior chamber
into Schlemm's canal is pressure dependent. Further, there is also a drainage of
fluid through the interstitial tissue spaces of the ciliary muscle into the supraciliary
and supra-choroidal spaces. From these spaces fluid may pass through the sclera
via spaces between the collagen fibrils in the sclera and through loose connective
tissue along nerves and blood vessels piercing the sclera. The greatest resistance to
aqueous humor outflow is contained at the trabecular meshwork. Intraocular
pressure is the intraocular fluid pressure inside the eyeball that depends on the
balance between the production and drainage of aqueous humor mainly through the
trabecular meshwork and if unchecked it can damage the optic nerve in cases such
as glaucoma.
REFERENCE
 Clinical Anatomy of the Eye, Snell,Richard, Wiley

 Fundamentals of Anatomy and Physiology, Martini, Frederic H, Pearson

 B. Phillipson, Invest. Ophthalmol. 8, 281 (1969)