THE EYE

THE IMAGE-FORMING MECHANISM

The eyes convert energy in the visible spectrum into action potentials in the optic
nerve. The wavelengths of visible light range from approximately 397 nm to 723
nm. The images of objects in the environment are focused on the retina. The light
rays striking the retina generate potentials in the rods and cones. Impulses initiated
in the retina are conducted to the cerebral cortex, where they produce the sensation
of vision.
Principles of Optics

Light rays are bent (refracted) when they pass from a medium of one density into a
medium of a different density, except when they strike perpendicular to the
interface. Parallel light rays striking a biconvex lens (Figure 8–9) are refracted to a
point (principal focus) behind the lens. The principal focus is on a line passing
through the centers of curvature of the lens, the principal axis. The distance
between the lens and the principal focus is the principal focal distance. For
practical purposes, light rays from an object that strike a lens more than 6 m (20 ft)
away are considered to be parallel. The rays from an object closer than 6 m are
diverging and are therefore brought to a focus farther back on the principal axis
than the principal focus (Figure 8–9). Biconcave lenses cause light rays to diverge.
The focal point F and focal length f of a positive (convex) lens, a negative
(concave) lens, a concave mirror, and a convex mirror.
Figure 8–9.
Refraction of light rays by lenses: A: Biconvex lens. B: Biconvex lens of greater
strength than A. C: Same lens as A, showing effect on light rays from a near
point. D: Biconcave lens. The center line in each case is the principal axis. X is
the principal focus.

The greater the curvature of a lens, the greater its refractive power. The refractive
power of a lens is conveniently measured in diopters, the number of diopters
being the reciprocal of the principal focal distance in meters. For example, a lens
with a principal focal distance of 0.25 m has a refractive power of 1/0.25, or 4
diopters. The human eye has a refractive power of approximately 60 diopters at
rest.
 Principal Focal Length

For a thin double convex lens, refraction acts to focus all parallel rays to a point referred
to as the principal focal point. The distance from the lens to that point is the principal
focal length f of the lens. For a double concave lens where the rays are diverged, the
principal focal length is the distance at which the back-projected rays would come
together and it is given a negative sign. The lens strength in diopters is defined as the
inverse of the focal length in meters. For a thick lens made from spherical surfaces, the
focal distance will differ for different rays, and this change is called spherical
aberration. The focal length for different wavelengths will also differ slightly, and this is
called chromatic aberration.

The principal focal length of a lens is determined by the index of refraction of the glass,
the radii of curvature of the surfaces, and the medium in which the lens resides. It can
be calculated from the lens-maker's formula for thin lenses.

This shows parallel beams from two helium-neon lasers converging to the principal
focal point of a 30 cm double convex lens. The rays then enter a diverging lens of focal
length -10cm on the right. The laser beams were made visible with a spray can of
artificial smoke.
 Focal Length and Lens Strength

The most important characteristic of a lens is its principal focal length, or its
inverse which is called the lens strength or lens "power". Optometrists usually
prescribe corrective lenses in terms of the lens power in diopters. The lens power
is the inverse of the focal length in meters: the physical unit for lens power is
1/meter which is called diopter.

Spherical aberration Chromatic aberration

Accommodation

When the ciliary muscle is relaxed, parallel light rays striking the optically normal
(emmetropic) eye are brought to a focus on the retina. As long as this relaxation is
maintained, rays from objects closer than 6 m from the observer are brought to a
focus behind the retina, and consequently the objects appear blurred. The problem
of bringing diverging rays from close objects to a focus on the retina can be solved
by increasing the distance between the lens and the retina or by increasing the
curvature or refractive power of the lens. In bony fish, the problem is solved by
increasing the length of the eyeball, a solution analogous to the manner in which
the images of objects closer than 6 m are focused on the film of a camera by
moving the lens away from the film. In mammals, the problem is solved by
increasing the curvature of the lens.
The process by which the curvature of the lens is increased is called
accommodation. At rest, the lens is held under tension by the lens ligaments.
Because the lens substance is malleable and the lens capsule has considerable
elasticity, the lens is pulled into a flattened shape. When the gaze is directed at a
near object, the ciliary muscle contracts. This decreases the distance between the
edges of the ciliary body and relaxes the lens ligaments, so that the lens springs
into a more convex shape (Figure 8–10). The change is greatest in the anterior
surface of the lens. In young individuals, the change in shape may add as many as
12 diopters to the refractive power of the eye. The relaxation of the lens ligaments
produced by contraction of the ciliary muscle is due partly to the sphincter-like
action of the circular muscle fibers in the ciliary body and partly to the contraction
of longitudinal muscle fibers that attach anteriorly, near the corneoscleral junction.
When these fibers contract, they pull the whole ciliary body forward and inward.
This motion brings the edges of the ciliary body closer together.
Figure 8–10.

Accommodation. The solid lines represent the shape of the lens, iris, and ciliary
body at rest, and the dashed lines represent the shape during accommodation.

Near Point

Accommodation is an active process, requiring muscular effort, and can therefore

be tiring. Indeed, the ciliary muscle is one of the most used muscles in the body.
The degree to which the lens curvature can be increased is, of course, limited, and
light rays from an object very near the individual cannot be brought to a focus on
the retina even with the greatest of effort. The nearest point to the eye at which an
object can be brought into clear focus by accommodation is called the near point
of vision. The near point recedes throughout life, slowly at first and then rapidly
with advancing age, from approximately 9 cm at age 10 to approximately 83 cm at
age 60. This recession is due principally to increasing hardness of the lens, with a
resulting loss of accommodation (Figure 8–11) due to the steady decrease in the
degree to which the curvature of the lens can be increased. By the time a normal
individual reaches age 40–45, the loss of accommodation is usually sufficient to
make reading and close work difficult. This condition, which is known as
presbyopia, can be corrected by wearing glasses with convex lenses.
Figure 8–11.

Decline in the amplitude of accommodation in humans with advancing age. The

different symbols identify data from different studies. (Reproduced, with
permission, from Fisher RF: Presbyopia and the changes with age in the human
crystalline lens. J Physiol 1973;228:765.)

The Near Response

In addition to accommodation, the visual axes converge and the pupil constricts
when an individual looks at a near object. This three-part response—
accommodation, convergence of the visual axes, and pupillary constriction—is
called the near response.

Other Pupillary Reflexes

When light is directed into one eye, the pupil constricts (pupillary light reflex).
The pupil of the other eye also constricts (consensual light reflex). The optic
nerve fibers that carry the impulses initiating these pupillary responses leave the
optic nerves near the lateral geniculate bodies. On each side, they enter the
midbrain via the brachium of the superior colliculus and terminate in the pretectal
nucleus. From this nucleus, the second-order neurons project to the ipsilateral
Edinger–Westphal nucleus and the contralateral Edinger–Westphal nucleus. The
third-order neurons pass from this nucleus to the ciliary ganglion in the oculomotor
nerve, and the fourth-order neurons pass from this ganglion to the ciliary body.
This pathway is dorsal to the pathway for the near response. Consequently, the
light response is sometimes lost while the response to accommodation remains
intact (Argyll Robertson pupil). One cause of this abnormality is CNS syphilis,
but the Argyll Robertson pupil is also seen in other diseases producing selective
lesions in the midbrain.

Retinal Image

In the eye, light is actually refracted at the anterior surface of the cornea and at the
anterior and posterior surfaces of the lens. The process of refraction can be
represented diagrammatically, however, without introducing any appreciable error,
by drawing the rays of light as if all refraction occurs at the anterior surface of the
cornea. Figure 8–12 is a diagram of such a "reduced," or "schematic," eye. In this
diagram, the nodal point (n, optical center of the eye) coincides with the junction
of the middle and posterior third of the lens, 15 mm from the retina. This is the
point through which the light rays from an object pass without refraction. All other
rays entering the pupil from each point on the object are refracted and brought to a
focus on the retina. If the height of the object (AB) and its distance from the
observer (Bn) are known, the size of its retinal image can be calculated, because
AnB and anb in Figure 8–12 are similar triangles. The angle AnB is the visual
angle subtended by object AB. It should be noted that the retinal image is inverted.
The connections of the retinal receptors are such that from birth any inverted
image on the retina is viewed right side up and projected to the visual field on the
side opposite to the retinal area stimulated. This perception is present in infants
and is innate. If retinal images are turned right side up by means of special lenses,
the objects viewed look as if they are upside down.

Figure 8–12.

Reduced eye. n, nodal point. AnB and anb are similar triangles. In this reduced
eye, the nodal point is 15 mm from the retina. All refraction is assumed to take
place at the surface of the cornea, 5 mm from the nodal point, between a medium
of density 1.000 (air) and a medium of density 1.333 (water). The dotted lines
represent rays of light diverging from A and refracted at the cornea so that they are
focused on the retina at a.

Common Defects of the Image-Forming Mechanism

In some individuals, the eyeball is shorter than normal and the parallel rays of light
are brought to a focus behind the retina. This abnormality is called hyperopia or
farsightedness (Figure 8–13). Sustained accommodation, even when viewing
distant objects, can partially compensate for the defect, but the prolonged muscular
effort is tiring and may cause headaches and blurring of vision. The prolonged
convergence of the visual axes associated with the accommodation may lead
eventually to squint (strabismus) (see below). The defect can be corrected by
using glasses with convex lenses, which aid the refractive power of the eye in
shortening the focal distance.
Figure 8–13.

Common defects of the optical system of the eye. In hyperopia, the eyeball is too
short and light rays come to a focus behind the retina. A biconvex lens corrects
this by adding to the refractive power of the lens of the eye. In myopia, the eyeball
is too long and light rays focus in front of the retina. Placing a biconcave lens in
front of the eye causes the light rays to diverge slightly before striking the eye, so
that they are brought to a focus on the retina.
In myopia (nearsightedness), the anteroposterior diameter of the eyeball is too
long. Myopia is said to be genetic in origin. However, in experimental animals it
can be produced by changing refraction during development. In humans, there is a
positive correlation between sleeping in a lighted room before the age of 2 and the
subsequent development of myopia. Thus, the shape of the eye appears to be
determined in part by the refraction presented to it. In young adult humans the
extensive close work involved in activities such as studying accelerates the
development of myopia. This defect can be corrected by glasses with biconcave
lenses, which make parallel light rays diverge slightly before they strike the eye.
Astigmatism is a common condition in which the curvature of the cornea is not
uniform. When the curvature in one meridian is different from that in others, light
rays in that meridian are refracted to a different focus, so that part of the retinal
image is blurred. A similar defect may be produced if the lens is pushed out of
alignment or the curvature of the lens is not uniform, but these conditions are rare.
Astigmatism can usually be corrected with cylindric lenses placed in such a way
that they equalize the refraction in all meridians. Presbyopia has been mentioned
above.
The conjunctiva has many small blood vessels that provide nutrients to the eye and
lids. It also contains special cells that secrete a component of the tear film to help
prevent dry eye syndrome.

Conjunctiva Problems

A number of conditions can affect the conjunctiva. Among the more common
conjunctival problems are:

Conjunctivitis. Also called pink eye, this is inflammation of the conjunctiva. It

can have several causes.

Conjunctival pallor. This is an unhealthy pale appearance to the palpebral

conjunctiva that can be a sign of anemia.

Injected conjunctiva. This is a red eye caused by dilation of blood vessels in the
conjunctiva. It can have many causes.
Conjunctival cyst. This is a thin-walled clear sac in the conjunctiva that contains
clear fluid. It resembles a small, clear blister on your skin. A conjunctival cyst or
sac can occur as a result of an eye infection, inflammation or other causes.

Conjunctival hemorrhage. This is bleeding from a small blood vessel on the front
surface of the eye, over the sclera. Because the leaking blood spreads out under the
conjunctiva, it causes the white of the eye to appear bright red. More accurately
called a subconjunctival hemorrhage, this type of red eye is harmless and typically
resolves on its own within a couple weeks.

Conjunctival lymphoma. This is a tumor of the front surface of the eye that
usually appears as a salmon-pink, "fleshy" patch. Conjunctival lymphomas
typically are hidden behind the eyelids and painless; therefore they may be present
for quite some time before they are discovered — especially in people who don't
have routine comprehensive eye exams. If you have a growth on your eye that
resembles this description of a conjunctival lymphoma, immediately see an
ophthalmologist who can evaluate it and perhaps perform a biopsy to determine the
proper treatment.

Conjunctival hemangioma. This is a benign (noncancerous) tumor of tiny blood

vessels that creates a red, blood-filled sac in the conjunctiva. Large conjunctival
hemangiomas can be surgically removed if they cause irritation.

Conjunctival nevus. This is a common, benign growth in the bulbar conjunctiva.

In fact, conjunctival nevi (plural of nevus) are the most common growth that
occurs on the surface of the eye. A conjunctival nevus can range in color from
yellow to dark brown and can darken or lighten with time. In most cases, no
treatment is needed for a conjunctival nevus, but if a nevus is growing in size, it
can be surgically removed.

Conjunctival melanoma. This is an elevated, dark or relatively clear cancerous

growth in the bulbar conjunctiva. Conjunctival melanomas are uncommon but
potentially lethal. The cancer cells from a conjunctival melanoma can infiltrate the
eyeball and spread via the lymphatic system or bloodstream to the lungs, liver,
brain and bones.

In some cases, a conjunctival melanoma can arise from a benign conjunctival

nevus. To be safe, if one notices any type of growth or dark spot on the eye, or an
unusual appearance to ones conjunctiva, it is better to see eye doctor immediately
for an evaluation.
 Sclera: The White Of The Eye

The sclera is the white part of the eye that surrounds the cornea. In fact, the sclera
forms more than 80 percent of the surface area of the eyeball, extending from the
cornea all the way to the optic nerve, which exits the back of the eye. Only a small
portion of the anterior sclera is visible.

Sclera Definition

The sclera is the dense connective tissue of the eyeball that forms the "white" of
the eye. It is continuous with the stroma layer of the cornea. The junction between
the white sclera and the clear cornea is called the limbus.

The sclera ranges in thickness from about 0.3 millimeter (mm) to 1.0 mm. It is
composed of fibrils (small fibers) of collagen that are arranged in irregular and
interlacing bundles. The random arrangement and interweaving of these connective
tissue fibers are what account for the strength and flexibility of the eyeball.
The sclera is relatively inactive metabolically and has only a limited blood supply.
Some blood vessels pass through the sclera to other tissues, but the sclera itself is
considered avascular (lacking blood vessels).

Some of the nourishment of the sclera comes from the blood vessels in the
episclera, which is a thin, loose connective tissue layer that lies on top of the sclera
and under the transparent conjunctiva that covers the sclera and episclera. Larger
episcleral blood vessels are visible through the conjunctiva.

Other nourishment of the sclera comes from the underlying choroid, which is the
vascular layer of the eyeball that is sandwiched between the sclera and the retina.

Sclera Function

The sclera, along with the intraocular pressure (IOP) of the eye, maintains the
shape of the eyeball.

The tough, fibrous nature of the sclera also protects the eye from serious damage
— such as laceration or rupture — from external trauma.

The sclera also provides a sturdy attachment for the extraocular muscles that
control the movement of the eyes.

Sclera Problems

Here are a few conditions that can affect the sclera:

Scleral icterus (yellow eyes). This condition — also called icteric sclera — is a
yellowing of the white of the eye. It is associated with hepatitis and other liver
disease.

There is some controversy about the accuracy of the name of this condition. Some
researchers have stated that the yellowing of the eyes (jaundice) actually takes
place in the conjunctiva, not the sclera itself, and that the condition should
therefore be called conjunctival icterus instead. Despite this, many doctors
continue to call yellow eyes or yellowing of the eyes "scleral icterus" because it's
the color of the underlying white sclera that is altered by the condition.

Increased blood serum levels of bilirubin (an orange-yellow pigment formed in the
liver) is commonly associated with scleral icterus. If you develop yellow eyes, you
should have blood tests to see if you have this condition and associated liver
problems.

Blue sclera. As you would expect, this condition is when a normally white sclera
has a somewhat blue color. Blue sclera is caused by a congenitally thinner-than-
normal sclera or a thinning of the sclera from disease, which allows the color of the
underlying choroidal tissue to show through it.

Congenital and hereditary diseases associated with blue sclera include osteogenesis
imperfecta (brittle bone disease) and Marfan's syndrome (a connective tissue
disorder). Acquired diseases such as iron deficiency anemia also can be associated
with blue sclera.

Episcleritis. This is inflammation of the episclera that lies atop the sclera and
under the conjunctiva. Episcleritis is relatively common and tends to be benign and
self-limiting. It has two forms: nodular episcleritis where the redness and inflamed
tissue occurs on a discrete, elevated area overlying the sclera, and simple
episcleritis, where dilated episcleral blood vessels occur without the presence of a
nodule.

The cause of most cases of episcleritis is unknown, but a significant minority (up
to 36 percent) of people who get the eye condition have an associated systemic
disorder — such as rheumatoid arthritis, ulcerative colitis, lupus, rosacea, gout and
others. Certain eye infections also may be associated with episcleritis.

Most episodes of episcleritis will resolve on their own within two to three weeks.
Oral pain medication and refrigerated artificial tears may be recommended if
discomfort is a problem.

Scleritis. This is inflammation of both the episclera and the underlying sclera
itself. Scleritis is a more serious and typically more painful red eye than
episcleritis. Up to 50 percent of cases of scleritis involve an underlying systemic
disease, such as rheumatoid arthritis.

Generally, the onset of scleritis is gradual, and most patients develop severe,
piercing eye pain over several days. This pain tends to worsen with eye
movements. In most cases, the inflammation begins in one area and spreads until
the entire sclera is involved.
Scleritis can cause permanent damage to the eye and vision loss. Frequent
complications include inflammation of the cornea
(keratitis), uveitis, cataract and glaucoma.

Scleritis typically is treated with oral non-steroidal anti-inflammatory drugs

(NSAIDs) and corticosteroids. In some cases, immunomodulatory therapy may
also be prescribed. Scleritis may remain active for several months or even years
before going into long-term remission.

What Is A Scleral Buckle?

A scleral buckle is not a condition of the sclera — it's the name of a surgical
procedure used to repair or prevent a detached retina.

In the scleral buckle procedure, a band of silicone, rubber or semi-hard plastic is

generally placed around the mid- to posterior sclera and sutured in place. This band
pushes in, or "buckles," the sclera inward, toward the detached or torn retina,
allowing the loose retinal tissue to rest against the inner wall of the eye.

The retinal surgeon then uses either extreme cold (cryopexy) or a specific band of
focused light (laser photocoagulation) to seal the retinal tissue against the wall of
the eyeball, repairing the torn or detached retina.
Cornea Of The Eye

Cornea Definition

The cornea is the clear front surface of the eye. It lies directly in front of the iris
and pupil, and it allows light to enter the eye.

Viewed from the front of the eye, the cornea appears slightly wider than it is tall.
This is because the sclera (the "white" of the eye) slightly overlaps the top and
bottom of the anterior cornea.

The horizontal diameter of the cornea typically measures about 12 millimeters

(mm), and the vertical diameter is 11 mm, when viewed from the front. But if
viewed from behind, the cornea appears circular, with a uniform diameter of
approximately 11.7 mm. This makes the cornea about two-thirds the size of a
dime.

The center thickness of the average cornea is about 550 microns, or slightly more
than half a millimeter.
The cornea has five layers. From front to back, these layers are:

1. The corneal epithelium. This outer layer of the cornea is five to seven cells
thick and measures about 50 microns — making it slightly less than 10
percent of the thickness of the entire cornea. Epithelial cells are constantly
being produced and sloughed off in the tear layer of the surface of the eye.
The turnover time for the entire corneal epithelium is about one week.
2. Bowman's layer.

This is a very thin (8 to 14 microns) and dense fibrous sheet of connective

tissue that forms the transition between the corneal epithelium and the
underlying stroma.

3. The corneal stroma. This middle layer of the cornea is approximately 500
microns thick, or about 90 percent of the thickness of the overall cornea. It is
composed of strands of connective tissue called collagen fibrils. These fibrils
are uniform in size and are arranged parallel to the cornea surface in 200 to
300 flat bundles called lamellae that extend across the entire cornea. The
regular arrangement and uniform spacing of these lamellae is what enables
the cornea to be perfectly clear.
4. Descemet's membrane. This very thin layer separates the stroma from the
underlying endothelial layer of the cornea. Descemet's (pronounced "DESS-
eh-mays") membrane gradually thickens throughout life — it's about 5
microns thick in children and 15 microns thick in older adults.
5. The corneal endothelium. This is the innermost layer of the cornea. The
back of the endothelium is bathed in the clear aqueous humor that fills the
space between the cornea and the iris and pupil. The corneal endothelium is
only a single layer of cells thick and measures about 5 microns. Most of the
endothelial cells are hexagonal (six-sided), but some may have five or seven
sides. The regular arrangement of these cells is sometimes called the
endothelial mosaic.

Cornea Function

As already mentioned, the clear cornea allows light to enter the eye for vision. But
it has another very important function as well — the cornea provides
approximately 65 to 75 percent of the focusing power of the eye.

The remainder of the focusing power of the eye is provided by the crystalline lens,
located directly behind the pupil.
Most refractive errors — nearsightedness, farsightedness and astigmatism — are
due to a less-than-optimal curvature or symmetry of the cornea. Presbyopia, on the
other hand, is due to an aging change in the crystalline lens.

In addition to allowing light to enter the eye and providing most of the focusing
power of the eye, individual parts of the cornea have specialized functions:

Corneal epithelium. The corneal epithelium provides an optimal surface for the
tear film to spread across the surface of the eye to keep it moist and healthy and to
maintain clear, stable vision.

Bowman's layer. The dense nature of Bowman's layer helps prevent corneal
scratches from penetrating into the corneal stroma. Corneal abrasions that are
limited to the outer epithelial layer generally heal without scarring; but scratches
that penetrate Bowman's layer and the corneal stroma typically leave permanent
scars that can affect vision.

Corneal endothelium. The single layer of cells that forms the endothelium
maintains the fluid content within the cornea. Damage to the corneal endothelium
can cause swelling (edema) that can affect vision and corneal health.

Cornea Problems

A number of conditions can affect the cornea. Among the more common corneal
problems are:

Appearance of arcus senilis (corneal arcus).

Arcus senilis. As people get older, a white ring often develops in the periphery of
the cornea. This is called arcus senilis (also called corneal arcus), and it's the most
common aging change in the cornea. Arcus senilis typically is separated from the
limbus by an area of clear cornea. The white ring — which is composed of
cholesterol and related compounds — can be barely noticeable or very prominent
In older individuals, corneal arcus typically isn't related to blood cholesterol levels;
but if it occurs in a person under age 40, blood tests should be performed to check
for hyperlipidemia (abnormally high concentration of fats or lipids in the blood).

Corneal abrasion. A scratched cornea can be very painful and can lead to an eye
infection.

Pterygium. A pterygium is a fibrous growth that starts on the sclera but can grow
into the peripheral cornea and cause irritation, vision problems and disfigurement
of the front of the eye.

Dry eyes. Though the cause of dry eyes typically begins in the tears gland
and eyelids, it can lead to damage of the corneal epithelium, which causes eye
discomfort and vision disturbances.

Corneal ulcer. A corneal ulcer is a serious abscess-like infection of the cornea that
can lead to significant pain, scarring and vision loss.

Corneal dystrophy. A dystrophy is a weakening or degeneration of a tissue. The

most common corneal dystrophy — called Fuch's dystrophy — affects the corneal
endothelium, causing corneal swelling, foggy vision, light sensitivity and other
problems.

Acanthamoeba keratitis. This is a very serious and painful corneal infection that
can cause significant pain and vision loss
Fungal keratitis. This is another dangerous corneal infection that (like
Acanthamoeba keratitis) tends to affect contact lens wearers more often than
people who wear glasses.

Keratoconus. This is a thinning and deformation of the cornea that causes vision
problems that can't be corrected with regular eyeglasses or contact lenses. In some
cases, vision problems from keratoconus can be corrected with scleral contact
lenses or hybrid contacts. But in severe cases, a cornea transplant may be required.

Corneal ectasia. This is thinning and deformation of the cornea that resembles
keratoconus but occurs as a rare complication of LASIK or other corneal refractive
surgery.

No, the uvea is not that little lobe of tissue that dangles from the back of your
mouth when your doctor tells you to open wide and say "Ahh!" That's your uvula.
Iris and uvea definition

The uvea is the pigmented middle layer of the eyeball. It has three segments: the
iris, the ciliary body and the choroid.

Iris: The iris of the eye is the thin, circular structure made of connective tissue and
muscle that surrounds the pupil. The color of our eyes is determined by the amount
of pigment in the iris.

Ciliary body: The second part of the uvea is the ciliary body. It surrounds the iris
and cannot be seen because it's located behind the opaque sclera (white of the eye).

Choroid: The posterior portion of the uvea is the choroid, which is sandwiched
between the tough outer sclera of the eyeball and the retina in the back of the eye.

Iris, ciliary body and choroid functions

Each component of the uvea has a specific function:

Iris: In addition to giving the eye its color, the iris acts like the diaphragm of a
camera and controls the size of the pupil. One muscle within the iris constricts the
pupil in bright light (full sunlight, for example), and another iris muscle dilates
(enlarges) the pupil in dim lighting and in the dark.

Ciliary body: The ciliary body holds the lens of the eye in place. It is connected to
the lens with a network of many tiny ligaments (called ciliary zonules or zonules of
Zinn) that suspend the lens in place behind the pupil. The ciliary body also secretes
the clear aqueous fluid that fills the space in the anterior segment of the eye
between the cornea and the iris and lens, and it contains the muscle that controls
accommodation of the eye.

Choroid: The posterior portion of the uvea — the choroid — contains many tiny
blood vessels and has the vital role of nourishing the retina.

Uvea problems

A number of things can go wrong with the uvea. Some uvea problems are genetic,
while others are age-related conditions or are associated with other health
problems.
Here's a short list of conditions and diseases of the uvea:

Uveitis: This is inflammation of the uvea. When confined to the iris, it's
called iritis. If the inflammation affects the iris and the ciliary body, it's called
anterior uveitis or iridocyclitis. There are many potential causes of uveitis, but
often the cause cannot be determined. Symptoms include a painful red eye,
sensitivity to light and decreased visual acuity. [Read more about uveitis and iritis.]

Synechia: Pronounced "si-NECK-ee-ah," this is when parts of the iris adhere to

the back surface of the cornea or the front of the lens. Synechiae (plural;
pronounced "si-NECK-ee-ee") can occur because of trauma to the eye, iritis or
other causes. Synechiae are dangerous because they can lead to certain types
of glaucoma.

Iris coloboma: This is a congenital disorder where a portion of normal iris tissue
is missing, causing a misshapen "keyhole" or "cat-eye" appearance to the pupil. In
some cases, iris colobomas can cause blurred vision, decreased visual
acuity, double vision and ghost images. Often, people with iris colobomas choose
to wear prosthetic contact lenses to improve the appearance of the eye and decrease
any visual symptoms.

Uveal melanoma: This is a cancerous growth within the iris, ciliary body or
choroid. If the growth occurs in posterior uvea, it's called a choroidal melanoma; if
in the iris, it's called an iris melanoma. The tumors are called melanomas because
they develop in pigment cells (melanocytes) located within the uvea. Uveal
melanomas are the most common type of cancer inside the eye, and the tumors can
metastasize to other parts of the body. There are treatment options, but in some
cases, removal of the affected eye (enucleation) may be necessary

Choroidal nevus: A choroidal nevus is a flat, benign pigmented freckle in the

choroid. If a choroidal nevus is detected during a comprehensive eye exam, your
eye doctor typically will take a photograph or other type of image of the interior of
your eye to document the shape and size of the freckle and monitor it over time to
insure no changes occur.
Choroideremia: This is a hereditary, progressive degeneration of the choroid that
primarily affects men. Choroideremia ("ko-roy-duh-REE-me-ah") is characterized
by night blindness, decreased visual field and (eventually) blindness.

Iris nevus: This is a freckle (localized concentration of pigment) in the iris of the
eye. Like freckles on your skin, iris nevi (plural of nevus) almost always are stable
and harmless. However, if you have an eye freckle that appears to be getting larger,
see your eye doctor immediately. In rare cases, an iris nevus can transform into a
malignant growth.

Importance of routine eye exams

Many uvea problems can be detected by your eye doctor before you notice any
significant symptoms.

Routine eye exams are essential to examine your eyes for signs of uveal melanoma
and other serious eye conditions so treatment can begin as soon as possible to
protect your eyesight.

Pupil: Aperture Of The Eye

One of the most important parts of the eye isn't a structure at all — it's an open
space. It's the pupil of the eye

Pupil Definition

The pupil is the opening in the center of the iris (the structure that gives our eyes
their color). The function of the pupil is to allow light to enter the eye so it can be
focused on the retina to begin the process of sight.

Typically, the pupils appear perfectly round, equal in size and black in color. The
black color is because light that passes through the pupil is absorbed by the retina
and is not reflected back (in normal lighting).

If the pupil has a cloudy or pale color, typically this is because the lens of the eye
(which is located directly behind the pupil) has become opaque due to the
formation of a cataract. When the cloudy lens is replaced by a clear intraocular lens
(IOL) during cataract surgery, the normal black appearance of the pupil is restored.

There's another common situation when the pupil of the eye changes color — when
someone takes your photo using the camera's flash function. Depending on your
direction of gaze when the photo is taken, your pupils might appear bright red.
This is due to the intense light from the flash being reflected by the red color of the
retina.

Pupil Function

Together, the iris and pupil control how much light enters the eye. Using the
analogy of a camera, the pupil is the aperture of the eye and the iris is the
diaphragm that controls the size of the aperture.

The size of the pupil is controlled by muscles within the iris — one muscle
constricts the pupil opening (makes it smaller), and another iris muscle dilates the
pupil (makes it larger). This dynamic process of muscle action within the iris
controls how much light enters the eye through the pupil.

In low-light conditions, the pupil dilates so more light can reach the retina to
improve night vision. In bright conditions, the pupil constricts to limit how much
light enters the eye (too much light can cause glare and discomfort, and it may
even damage the lens and retina).

Pupil Size
The size of the pupil varies from person to person. Some people have large pupils,
and some people have small pupils. Also, pupil size changes with age — children
and young adults tend to have large pupils, and seniors usually have small pupils.

Generally, normal pupil size in adults ranges from 2 to 4 millimeters (mm) in

diameter in bright light to 4 to 8 mm in the dark.

In addition to being affected by light, both pupils normally constrict when you
focus on a near object. This is called the accommodative pupillary response.

Pupil Testing

During a routine eye exam, your eye doctor or an assistant will inspect your pupils
and perform testing of pupil function.

Typically, pupil testing is performed in a dimly lit room. While you are looking at
a distant object, the examiner will briefly direct the beam of a small flashlight at
one of your eyes a few times. While doing this, the response of the pupil of both
eyes is observed.

The observer typically will then alternately direct the light at each eye and again
observe the pupil responses of both eyes. This is called Marcus Gunn pupil testing,
which is sometimes called the "swinging flashlight test."

Pupils normally react both directly and indirectly to light stimulation. The reaction
of the pupil of the eye receiving direct illumination is called the direct response;
the reaction of the other pupil is called the consensual response.

The examiner may then turn up the room lights a bit and have you focus on a hand-
held object while moving that object closer to your nose. This is a test of the
accommodative response of your pupils.

If your pupils appear normal and respond normally, the clinician may record this
popular acronym in your medical chart: PERRLA, which is an abbreviation for
"pupils are equal, round and reactive to light and accommodation."

A pupil is abnormal if it fails to dilate in dim lighting or fails to constrict in

response to light or accommodation.
Conditions That Affect The Pupil

Miosis

When the pupil shrinks (constricts), it is called miosis. If the pupils stay small
even in dim light, it is a sign that the eye is defective. This is called abnormal
miosis, and it can happen in one or both of your eyes

.A number of conditions can affect the size, shape and/or function of the pupil of
the eye. These include:

Adie's tonic pupil. This is a pupil that has nearly no reaction to light (direct or
consensual) and there is a delayed reaction to accommodation. Adie's tonic pupil
(also called Adie's pupil, tonic pupil, or Adie's syndrome) usually affects only one
eye, with the affected pupil being larger than the pupil of the unaffected eye. The
cause of Adie's pupil usually is unknown; but it can be caused by trauma, surgery,
lack of blood flow (ischemia) or infection.

Argyll Robertson pupil. This is a pupil that is not reactive to light (direct or
consensual), but reaction to accommodation is normal. Argyll Robertson pupil
usually affects both eyes, causing smaller-than-normal pupils that do not react to
light. The condition is rare and the cause usually is unknown, but it has been
associated with syphilis and with diabetic neuropathy.

Marcus Gunn pupil. Also called relative afferent pupillary defect (RAPD) or
afferent pupillary defect, this is an abnormal result of the swinging-flashlight test
where the patient's pupils constrict less (therefore appearing to dilate) when the
light is swung from the unaffected eye to the affected eye. The most common
cause of Marcus Gunn pupil is damage in the posterior region of the optic nerve or
severe retinal disease.

Trauma. Penetrating eye trauma that affects the iris is a common cause of
abnormally shaped pupils. Similar trauma can occur in complications of cataract
surgery, phakic IOL surgery or refractive lens exchange. Pupillary responses to
light and accommodation often remain normal or nearly normal.
Sexual arousal. Recent research has confirmed that sexual arousal elicits a pupil
dilation response, and that this response may be useful in sexuality research to
evaluate sexual orientation.

Adie syndrome.

The Retina: Where Vision Begins

The first step in the process of vision is the conversion of light into signals that can
be interpreted in the brain. This takes place in the retina, which is located in the
back of the eye.

Retina Definition

The retina is the sensory membrane that lines the inner surface of the back of the
eyeball. It's composed of several layers, including one that contains specialized
cells called photoreceptors.
There are two types of photoreceptor cells in the human eye — rods and cones.

Rod photoreceptors detect motion, provide black-and-white vision and function

well in low light. Cones are responsible for central vision and color vision and
perform best in medium and bright light.

Rods are located throughout the retina; cones are concentrated in a small central
area of the retina called the macula. At the center of the macula is a small
depression called the fovea. The fovea contains only cone photoreceptors and is the
point in the retina responsible for maximum visual acuity and color vision.

Retina Function

Photoreceptor cells take light focused by the cornea and lens and convert it into
chemical and nervous signals which are transported to visual centers in the brain
by way of the optic nerve.

In the visual cortex of the brain (which, ironically, is located in the back of the
brain), these signals are converted into images and visual perceptions.

Retina Problems

There is a wide variety of retina problems, conditions and diseases. Here is a short
list of the more common retina problems:

Macular degeneration. Age-related macular degeneration (AMD) is the most

common serious, age-related eye disease, affecting 9.1 million Americans. And the
prevalence of AMD — which affects one in 14 Americans over age 40 and more
than 30 percent of seniors over age 75 — is increasing as the U.S. population
continues to age.

Diabetic retinopathy. One of the devastating consequences of diabetes is damage

to the blood vessels that supply and nourish the retina, leading to significant vision
loss.

Macular edema. This is an accumulation of fluid and swelling of the macula,

causing distortion and blurred central vision. Macular edema has several causes,
including diabetes. In some cases, swelling of the macula can occur after cataract
surgery.
Central serous retinopathy. This is when fluid builds up under the central retina,
causing distorted vision. Though the cause of central serous retinopathy (CSR)
often is unknown, it tends to affect men in their 30s to 50s more frequently than
women, and stress appears to be a major risk factor.

Hypertensive retinopathy. Chronic high blood pressure can damage the tiny
blood vessels that nourish the retina, leading to significant vision problems. Risk
factors for hypertensive retinopathy are the same as those for high blood pressure,
including obesity, lack of physical activity, eating too much salt, a family history
of hypertension and a stressful lifestyle.

Solar retinopathy. This is damage to the macula from staring at the sun, which
can cause a permanent blind spot (scotoma) in your visual field. The risk of solar
retinopathy (also called solar maculopathy) is greatest when viewing a solar eclipse
without adequate eye protection.

Detached retina. A retinal detachment — a pulling away of the retina from the
underlying choroid layer of the eye that provides its nourishment — is a medical
emergency. If the retina is not surgically reattached as soon as possible, permanent
and worsening vision loss can occur

Importance Of Routine Eye Exams

It's essential to keep your retina functioning properly to enjoy a lifetime of good
eyesight. Many retina problems can be detected by your eye doctor before you
notice any significant symptoms.

Routine eye exams enable your eye doctor to examine your eyes for signs of
macular degeneration and other serious retina problems so treatment can begin as
soon as possible.

Macula lutea
What is the macula lutea?

The macula lutea — more commonly called the macula — is the most sensitive
spot in the center of the light-sensitive retina in the back of the eye. The macula is
responsible for visual acuity, central vision and color vision.

“The macula is the area of the retina that allows us to see 20/20,” says Maria
Richman, OD, spokeswoman for the American Optometric Association. “It is the
small and highly sensitive part of the retina that’s responsible for detailed central
vision. The macula allows one to appreciate detail and perform tasks that require
central vision, such as reading.”

The macula makes it possible to see in great detail while the rest of the retina
provides peripheral (side) vision.

Why is it called macula lutea?

Like many medical terms, macula lutea is Latin: Macula means “spot”
and lutea means “yellow.” The macula lutea is a very small spot in the central
retina — it’s just 5.5 millimeters (less than a quarter-inch) in diameter.

Also, when viewed or photographed by your eye doctor, the macula lutea has a
yellowish appearance (in contrast to the rest of the retina, which is red). The
yellow color is due to the macular pigment, which is composed mainly of lutein
and zeaxanthin from your diet.

Macular pigment protects cells in the macula from the potentially harmful effects
of high-energy visible (HEV) blue light from the sun and other sources, including
the LED screens of computers and phones.

Anatomy of the macula

There are two types of photoreceptor cells in the retina. These cells —
called cones and rods — make our sense of vision possible by converting light rays
into signals that are transmitted to the brain.

There is a very high concentration of cone photoreceptor cells in the macula, which
are responsible for our color vision and our ability to see fine details.

It’s estimated that there are 6 million to 7 million cone cells in the retina, with most
of them located in the macula. The highest concentration is in the fovea (or fovea
centralis), which is a central pit within the macula that contains only cone cells.

Most rod photoreceptor cells are located outside the macula. While they don't
provide high-resolution or color vision, rod cells provide peripheral vision,
perceive movement and shades of gray, and can function in low-light conditions.
There is an estimated 120 million rod photoreceptor cells in the retina.
The macula (specifically, the fovea) is the only area of the retina where 20/20
vision is attainable and where color and fine detail can be distinguished.

Consequently, the macula is responsible for enabling the sharp visual detail that's
so important for activities like driving, recognizing faces, watching TV, using a
computer and engaging in all other visual tasks that require an ability to see details.

Conditions that affect the macula

Conditions that affect the macula and cause vision loss include:

 Age-related macular degeneration. Macular degeneration (AMD) is an

age-related deterioration of the macula and the leading cause of permanent
vision loss for people ages 50 and older.

 Diabetic macular edema. Also called DME, this swelling of the macula is
caused by leaky blood vessels in the retina that have been damaged from the
effects of diabetes (diabetic retinopathy).

 Central serous retinopathy. Central serous retinopathy is the accumulation

of fluid under the retina that can affect the macula and cause blurry vision.
The exact cause is not fully understood, but it appears to be stress-related
and most often affects middle-aged men.

 Macular hole. This is a small break in the macula that can cause blurry or
distorted vision. Macular holes are usually caused by age-related changes in
the eye. If left untreated, a macular hole can cause a detached retina, a sight-
threatening condition that requires immediate medical attention.

 Macular dystrophies. A number of rare, inherited conditions that affect

central vision, macular dystrophies can appear in childhood but some are not
diagnosed until later in life. The most common form of juvenile macular
dystrophy is Stargardt’s disease.

 Epiretinal membrane. Also called macular pucker or cellophane

maculopathy, an epiretinal membrane is a thin sheet of fibrous tissue that
can grow onto the surface of the macula. Epiretinal membranes can cause
blurred or distorted vision, and, in some cases, surgery may be required to
restore vision.
Cherry red macula
A cherry red macula is a rare condition characterized by a reddish area developing
at the center of macula. According to Richman, one of the most common
conditions causing a cherry red macula is a lipid storage disorder that leads
to central retinal artery occlusion.

When lipids (fatty acids) accumulate in harmful amounts in various tissues and
cells in the body, they can cause health problems. Symptoms may appear early in
life or develop in the teen or even adult years.

“Over time, this storage of excessive fats can cause permanent damage to cells and
tissues in the brain, the peripheral nervous system and in other parts of the body,”
Richman says.

“Retinal artery occlusion refers to blockage of the retinal artery carrying oxygen to
the nerve cells in the retina at the back of the eye. The lack of oxygen delivery to
the retina may result in severe loss of vision,” she adds.

Management of cherry red macula depends on the cause, which can include Tay-
Sachs disease in addition to retinal artery occlusion and several other diseases and
conditions.

Keeping your macula lutea healthy

The best way to protect the health of the macula of your eyes for a lifetime of good
vision is to have routine eye exams.

During a comprehensive eye exam, your optometrist or ophthalmologist can

inspect and evaluate the health of your macula lutea and detect potential problems
before you experience any vision loss.

Another essential part of keeping your macula healthy is decreasing your risk for
diabetes and cardiovascular disease through diet and lifestyle changes.

Choroid of the eye: Anatomy and function

What is the choroid?

The choroid is the middle layer of tissue in the wall of the eye. It’s found between
the sclera (the whites of the eyes) and the retina (the light-sensitive tissue in the
back of the eye).
This thin layer of tissue is made up almost entirely of blood vessels. These blood
vessels supply oxygen and nutrients to the outer part of the retina. In short, the
choroid is the life source that keeps the retina healthy and functioning.

Choroid anatomy

The choroid is part of the uvea, which also consists of the iris and the ciliary body.
The iris and ciliary body are located in the front of the eye and work together to
dilate and constrict the pupils.

The choroid layer begins in the peripheral edges of the eyeball and lines the entire
back of it, sandwiched between the sclera and the retina. The thickness of the
choroid varies depending on what part of the eye it’s lining. For example, it’s the
thickest in the back of the eye (approximately 0.2 mm) and narrows to
approximately 0.1mm as it gets to the peripheral part of the eyeball.

There are four different layers of the choroid:

 Bruch’s membrane – Thin layer of tissue located on the innermost part of

the choroid.

 Choriocapillaris – Layer made up of capillaries (tiny blood vessels that

connect arteries to veins).

 Sattler’s layer – Layer of medium blood vessels.

 Haller’s layer – Outermost layer of the choroid that contains large blood
vessels.

Choroid function

The eyes and clear vision depend on sufficient blood supply in order to function.
Choroidal circulation accounts for 85% of blood flow within the eye, making it a
vital structure to the function of your eyes.

Other important functions of the choroid include:

 Providing nutrients for the retina, macula and optic nerve.

 Regulating the temperature of the retina.

 Helping control pressure within the eye.

  Absorbing light and limiting reflections within the eye that could harm
vision. This part of the choroid is what causes “red eyes” when a photograph
is taken using the flash unit of a camera.

Conditions that may affect the choroid

Choroid eye conditions can develop sporadically, genetically or as a result of eye

trauma. Each of the following conditions can be evaluated by an eye doctor, who
will then determine and prescribe proper treatment:

Choroidal detachment – A “serous choroidal detachment” occurs when fluid

fills between the sclera and choroid. It can occur due to injury, medications or
some medical conditions, but it most typically occurs due to low pressure after eye
surgery.

Hemorrhagic choroidal detachment – A “hemorrhagic choroidal detachment”

occurs when blood fills the space between the sclera and choroid, such as when a
blood vessel bursts. It is associated with high pressure in the eyes and can occur
during surgery. It is usually more painful than a serous detachment.

Choroidal rupture – A tear in the choroid, Bruch’s membrane and the retinal
pigment epithelium (RPE) that result from an eye injury.

Choroid plexus papilloma – Rare, benign brain tumor that develops in the
choroid plexus (tissue that makes cerebrospinal fluid).

Chorioretinitis – Inflammation of the choroid caused by infection or an

autoimmune disease.

Choroideremia – A hereditary, progressive deterioration of the choroid; this

condition primarily affects men.

Importance of routine eye exams

While the choroid is an important part of the eye, it’s difficult to identify any
problems with it unless you have an eye exam. During a fundoscopic eye exam,
your eye doctor will use a tool that allows them to view the back of the eye, where
the choroid is located.

Using this method, they can determine the health of the choroid and prescribe
treatment if they detect a problem.
Lens of the eye

What is the lens of the eye?

The lens of the eye, also called the crystalline lens, is an important part of the eye’s
anatomy that allows the eye to focus on objects at varying distances. It is located
behind the iris and in front of the vitreous body.

In its natural state, the lens looks like an elongated sphere — a shape known as
ellipsoid — that resembles a deflated ball. The average lens size in adults is
approximately 10 mm across and 4 mm from front to back.
The lens is made up almost entirely of proteins. In fact, proteins make up nearly
60% of the eye’s lens — a higher protein concentration than any other bodily
tissue. The tissue is transparent, which allows light to easily enter the eye. It’s also
flexible, so it can change shape and bend the light to focus properly on the retina.

Function of the lens of the eye

The primary function of the lens is to bend and focus light to create a sharp image.
To do that, the lens uses the help of ciliary muscles to stretch and thin out when
focusing on distant objects, or to shrink and thicken when focusing on near
objects.

When light enters the eye, the lens will bend and focus incoming light directly on
the retina, which is how the clearest possible image is produced.

The crystalline lens projects a focused image on the retina. However, the initial
image projected is inverted (either upside down or reversed). When the image is
sent to the brain via the optic nerve, the brain will flip the image back to normal.

The ciliary body is critical for the lens to function correctly. While the ciliary
muscles allow the lens to change shape to focus, the lens itself is kept in place by
little fibers that are connected to the ciliary body — these are called zonular fibers,
or zonules. The ciliary body also produces aqueous humor, which keeps the lens
healthy and functioning.

The lens relies on the aqueous humor for energy and cleansing rather than nerves
or blood flow. Aqueous humor is the clear fluid located between the cornea and the
lens that flows through the eye and then drains from the eye through the trabecular
meshwork.

Accommodation

Accommodation refers to the lenses' ability to bounce between focusing on near

objects and far objects with little interference.

For example, if you’re approaching a traffic light while driving, the lenses in your
eyes will be focused distantly, because the light is relatively far away. As you get
closer to the light, your lenses will make tiny changes in shape to accommodate the
approaching object that used to be distant.
Accommodation relies on elasticity of the crystalline lens, which makes it easier to
change focal distances. As we age, the crystalline lens loses its elasticity, which
results in a condition called presbyopia.

Presbyopia

Presbyopia is a natural, age-related vision change that affects a person’s ability to

focus on close-up objects. The condition affects almost everyone, even if they’ve
never had vision problems before.

The cause of presbyopia is related to alterations within the lenses’ composition.

Aging triggers a change in the protein of the lenses, which causes them to thicken
and become inflexible. The ciliary muscle fibers that keep the lens in place and
help it change shape are also affected.

All of these developments make it difficult for the eyes to focus on nearby objects.

Signs of presbyopia typically begin around the age of 40 and gradually progress
until age 65 or 70, when presbyopia plateaus. Presbyopia is not harmful and can be
corrected with glasses, contacts or vision surgery.

Clouding of the lens (cataract)

Cataracts occur when the lens of the eye becomes cloudy or hazy, resulting in
blurred vision. Advanced age is the leading cause of cataract development, though
it’s possible for children to be born with congenital cataracts.

As the eye ages, the proteins that make up the lens begin to clump together. This
may occur in one or both eyes and likely will not affect vision in the beginning.
Over time, eyesight can appear blurry, dull, hazy or dim, which can greatly affect
one’s ability to see in low-light conditions (at night). If untreated, cataracts can
lead to vision loss.

Cataract surgery can be performed to remove the clouded lens and replace it with
an artificial one, known as an intraocular lens (IOL). There are many types of IOLs
available for the surgery, including monofocal, multifocal and toric.

When to see an eye doctor

The lens is a vital part of the eye and makes clear vision possible. Because it’s an
internal structure, it can be difficult to know if something is amiss with the lens.
Having an eye doctor conduct a comprehensive eye exam gives them the
opportunity to look inside the eye and make sure everything in it — including the
lens — is healthy.

If you notice any sudden changes in your vision, or if it’s been longer than two
years since your last eye exam, it’s time to schedule one. It’s a small but important
step in keeping your vision clear and your eyes healthy.

CILIARY BODY OF THE EYE

The ciliary body is a circular structure in the eye that is connected to the iris and is
located directly behind it. It produces the aqueous fluid inside the eye. The ciliary
body also includes a muscle that enables the lens of the eye to focus on near
objects. This ring of tissue is one of three components that make up the uvea of the
eye — the pigmented middle layer of the eye. The other two parts are the iris (the
colored part of the eye), and the choroid (the part of the eye that nourishes the
retina). These two segments are connected together by the ciliary body.

What is the ciliary body?

Structurally, the ciliary body is a ring of tissue that surrounds the iris and connects
it to the choroid. The ciliary body can’t be seen when you look at the eye, because
it’s located behind the iris and sclera, which is the white part of the eye.

Structures contained within the ciliary body include:

 The ciliary muscle, which influences the shape of the lens inside the eye.
Contraction of the ciliary muscle makes the lens become more convex,
enabling the eye to focus on near objects. The ciliary muscle is connected to
the lens by a series of very thin, radially-arranged fibers called the ciliary
zonules (also called the zonular fibers or zonules of Zinn), which hold the
lens in place within the eye.

 The ciliary processes, which are about 70 ridges in the ciliary body that
contain cells involved in the production of the aqueous humor in the eye that
controls eye pressure.
Ciliary body functions

There are three main functions of the ciliary body: accommodation, holding the
lens in place and producing aqueous fluid.

 Accommodation refers to the eye’s ability to automatically increase its

focusing power to enable the eye to see near objects clearly. This action
depends on the ciliary muscle.

 The ciliary body holds the lens of the eye in place behind the pupil using
tiny fibers called ciliary zonules or zonules of Zinn.

 Aqueous fluid production occurs in the ciliary body. Aqueous fluid (or
aqueous humor) is the clear fluid in the eye that provides nourishment and
helps the eye maintain its shape as well as healthy pressure levels.

Each of these functions is essential for the health of the eye — in fact, conditions
such as ocular hypertension and glaucoma can occur if too much aqueous fluid is
produced by the ciliary body.

Ciliary body and glaucoma

The aqueous humor — which is constantly produced by the ciliary body — drains
through a channel called the trabecular meshwork, located at the angle where the
iris and cornea meet.

There must be a balance between how much aqueous humor is being produced and
how much is drained in order to maintain a healthy amount of pressure in the eye.
This is known as the intraocular pressure (IOP).

Ocular hypertension is the term used to describe higher-than-normal IOP. This

elevated pressure can in turn lead to glaucoma — the term used to describe a group
of related eye conditions that cause damage to the optic nerve and can lead to
blindness if left untreated.

How does glaucoma medication affect the ciliary body?

Typically, the initial treatment used for glaucoma is medicated eye drops, which
are designed to help regulate eye pressure by reducing the production of aqueous
fluid by the ciliary body and/or increasing its drainage from the eye.
Some of the most common forms of glaucoma medication that affect the ciliary
body include:

 Carbonic anhydrase inhibitors such as Azopt (brinzolamide) and Trusopt

(dorzolamide).

 Beta blockers such as Betoptic (betaxolol) and Timoptic (timolol).

 Alpha-adrenergic agonists such as Alphagan P (brimonidine) and Iopidine

(apraclonidine).

Ciliary body and presbyopia

Presbyopia is the normal, age-related loss of ability of the eyes to focus on near
objects. It usually occurs sometime after age 40.

Presbyopia occurs because the lens of the eye thickens over time and loses its
natural flexibility. The ciliary body retains its ability to function, but the lens fails
to change shape to enable near objects to come into focus.

Fortunately, presbyopia is treatable with eyeglasses, contact lenses or vision

surgery. For some, over-the-counter reading glasses are a simple solution for
presbyopia.

When to see an eye doctor

Problems related to the ciliary body can be associated with serious eye conditions
such as glaucoma. Because there are no early warning signs of the
disease, comprehensive eye exams by an optometrist or ophthalmologist are the
only way to prevent vision loss from glaucoma. If you have noticed signs of
presbyopia, contact an eye doctor for an eye exam and to discuss the best treatment
option moving forward.

The ciliary body is not the only part of the vision system that must be cared for.
Stay up to date on annual eye exams to ensure optimal eye and vision health, and
don’t hesitate to contact your eye doctor for any additional vision concerns you
may have.