Dr Tahzeen’s

Optics of Vision
nd
The optic nerve is the 2 nerve of the 12 cranial nerves. There are four properties considered when
checking the optic nerve. These are;

 Visual acuity
 Visual field
 Color vision
 Color of the choroid/retina

Visual acuity:
Visual acuity (VA) commonly refers to the clarity/sharpness of vision. Visual acuity is checked using
Snellen’s chart. For checking far vision, the subject is kept at a distance of 6m away from the chart
whereas for near vision, the distance is reduced to 10in.

Visual field:
Visual field refers to the ability to view in periphery. The scientific method to check visual field is called
perimetry test. While the individual test is called confrontation test. Confrontation visual field testing
involves having the patient looking directly at your eye or nose and testing each quadrant in the
patient's visual field by having them count the number of fingers that you are showing. This is a test of
one eye at a time (uniocular field of vision).

Color vision:
Color vision refers to the ability to perceive different colors. Color vision is checked using Ishihara test.

Structure & Functions of the Eye:

Optic nerve: The bundle of nerve fibers at the back of the eye that carry visual messages from the retina
to the brain.

Sclera: The tough outer coat that protects the entire eyeball.
Cornea: The outer, transparent structure at the front of the eye that covers the iris, pupil and anterior
chamber; it is the eye's primary light-focusing structure.

Iris: The colored ring of tissue behind the cornea that regulates the amount of light entering the eye by
adjusting the size of the pupil.

Lens: The transparent structure suspended behind the iris that helps to focus light on the retina; it
primarily provides a fine-tuning adjustment to the primary focusing structure of the eye, which is the
cornea.

Pupil: The adjustable opening at the center of the iris through which light enters the eye.

Retina: The light sensitive layer of tissue that lines the back of the eye.

Choroid: Layer of the eye behind the retina, contains blood vessels that nourish the retina.

Under normal circumstances, the upper edge of the cornea is not visible. Exophthalmos (also called
exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit.
Enophthalmos is the posterior displacement of the eye.

The palpebral fissure is the area between the open eyelids. A drooping eyelid is called ptosis or
blepharoptosis. In this condition, the border of the upper eyelid falls to a lower position than normal. In
severe cases, the drooping eyelid can cover all or part of the pupil and interfere with vision. Ptosis can
affect one or both eyes.

The conjunctiva is the clear, thin membrane that covers part of the front surface of the eye and the
inner surface of the eyelids.

There are 3 layers of the eye;

 Fibrous tunic
 Vascular tunic
 Nervous tunic

Fibrous Tunic:
Fibrous tunic consists of the sclera and the cornea.

Vascular Tunic:
The middle layer is called the vascular tunic. It is responsible for the nourishment of the eye. It consists
of the iris, the choroid, and the ciliary body.

Nervous Tunic:
The inner layer of photoreceptors and neurons called the nervous tunic, which consists of the retina.
The purpose of the retina is to receive light that the lens has focused, convert the light into neural
signals, and send these signals on to the brain for visual recognition. The color of retina is dusky.
Fundoscopy is used to check the functioning of the retina.
Visual Pathway:

In retina, the image is formed on the Fovea Centralis. The image travels from the optic disc to the optic
nerve. At a point called the optic chaisma, the optic nerves divide into two optic tracts.

Visual Pathway Lesions:

Damage to the optic nerve causes permanent and severe loss of vision and pupillary reflex
abnormalities. According to the localization of lesion, different type of visual field defect can occur. In
general

 If the optic nerve is damaged anterior to the optic chiasm, it causes loss of vision on the same
side as the damage
 If the optic nerve is damaged in the optic chiasm level, it causes bitemporal hemianopia.
 If optic nerve is damaged posterior to the optic chiasm (optic tract, optic radiation), it causes a
visual field defect on the opposite side to the damage.
Clinical Correlation:

Heminopia:
Loss of vision in one half of the visual field is termed as heminopia.

Homonymous Heminopia:
Loss of vision in the same halves of the visual fields.

Heteronymous Heminopia:
Loss of vision in different halves of the visual fields.

Refractive Principles of a Lens

Convex lens focuses light rays
whereas concave lens diverges light
rays.
Emmetropia
Emmetropia refers to an eye that has no visual defects. Image formed on an emmetropic eye is focused,
clear and precise. Parallel light rays from distant objects are focused on retina when cillary muscles are
relaxed. When a person has emmetropia in both eyes, the person is described as haing ideal vision.

Ametropia
An abnormal refractive condition of the eye in which images fail to focus upon the retina.

Errors of Refraction
 Myopia (Short sightedness)
 Hyperopia (Far sightedness)
 Astigmatism

Myopia
Image of a far object is focused in front of the retina, giving rise to a blurred image. Far objects cannot
be focused on retina even with accommodation. The symptoms of myopia are

 Person unable to see far objects clearly

 Person can see near objects clearly
 Watering of the eyes or headaches

By concave lens, myopia is corrected.

Hyperopia
Image of a near object is focused behind the retina, giving rise to a blurred image. Near objects cannot
be focused on retina even with accommodation. This is the opposite problem to myopia. The causes of
hyperopia maybe that the eye ball is short or the lens system is too weak. The symptoms of hyperopia
are

 Person unable to see near objects clearly

 Person can see far objects clearly
 May give rise to eye strain and headaches

Hyperopia is corrected by use of convex lens.

Astigmatism
Astigmatism is a common vision condition that causes blurred vision. It occurs when the cornea (the
clear front cover of the eye) is irregularly shaped or sometimes because of the curvature of the lens
inside the eye. Light rays are refracted to 2 different points. The cause of astigmatism is that the
curvature of cornea is not uniform which results in rays failing to focus on a single point. Images appear
blurred.
Tears
 Is a hypertonic fluid spread over eye by blinking.
 Contains bactericidal enzyme called lysozyme, protects eye from infection and kills bacteria.

 Secretion is controlled by Facial N.

Functions:
 Cleaning
 Wetting ocular surface
 Bacteriostasis
 Supporting the cornea (oxygen supply)

Lacrimal Apparatus
Lacrimal Glands:
 Located at outer upper corner of each eyelid.
 Produces tears
 Tears wash and lubricate anterior surface of eyeball.

Lacrimal Canal:
 Located in inner corner of eye socket
 Collects tears and open into lacrimal sac
 Drain into nasolacrimal duct

 Ultimately drain into nasal cavity.