OPHTHALMOLOGY

Cynderella of medicine

Birat Medical College 19th April 2023

Department of Ophthalmology
Prof BP Badhu
 Basic anatomy of the
Eyeball
Learning objectives
1. To be familiar with the layers of the eyeball
2. To correlate anatomical features with clinical conditions
 Embryology
• 3rd week of gestation: embryo is a three lamellar structure – ectoderm,
mesoderm and endoderm.
• Ectodermal cells-
• neural groove-neural tube:

• anterior portion of the neural tube:

• forebrain (prosencephalon),
• midbrain (mesencephalon) and hindbrain (rhombencephalon).

• Forebrain: -optic vesicles continuous with the forebrain.

Optic vesicle
• Distal part of the optic pits - optic vesicle lies in close apposition to
the surface ectoderm-the future site of lens plate.

• mesoderm-embryonic vascular system.

• Proximal part of optic vesicle forms the optic stalk – continuous with
the forebrain.
Invagination of optic vesicle forms two layered optic cup.
Embryology contd……
• Eye: neuro-epithelium, surface ectoderm, and the extra-cellular
mesenchyme which consists of both the neural crest and mesoderm.
• Neuro-epithelium
• retina, ciliary body, iris, and optic nerve.
• Surface ectoderm
• lens, corneal epithelium and eyelid.
• The extracellular mesenchyme forms the sclera, the corneal
endothelium and stroma, blood vessels, muscles, and vitreous.
Topographic Features of the Globe
• Radius of curvature of the cornea (7.8 mm)
• The antero-posterior diameter of the adult eye is approximately 24
±1
• Myopic eyes longer, and hyperopic eyes tend to be shorter.
• Weight: 7 gm, volume: 6.5 ml
• Corneal size: 11 – 11.5 mm
Clinical relevance
Contains 3
compartments/chambers
and two segments. • Anterior chamber (AC): 200 μL, 3
mm deep
• Posterior chamber (PC), and
• Vitreous cavity: the largest
compartment, more than two-
thirds of the volume of the eye
(6.5 mL) and contains the vitreous
gel.
• Segments: anterior and posterior
Anterior segment

Posterior segment
Clinical importance
of AC and PC

Aqueous humor
dynamics
Clinical importance
• Shallow anterior chamber: Angle closure glaucoma
• Deep anterior chamber: posterior dislocation of lens / aphakia
Eyeball

• Contains three layers of

tissues
• An outer protective layer
FIG-1
of Cornea and Sclera
• Middle layer of blood
vessels, muscles and
pigments- the Uvea
• Inner light sensitive layer-
the Retina
Cornea

• The density of pain receptors in the cornea is 300-600 times greater

than in skin and 20-40 times greater than dental pulp, making any
injury to the structure excruciatingly painful.

• Corneal abrasion: epithelial defect

Cornea contd..
• Schwalbe line—the termination of the Descemet membrane.

• The cornea is 0.5 – 0.6 mm thick centrally. The limbus, which borders
the cornea and the sclera, is gray and translucent.
Pre-corneal tear film

• It is composed of 3 layers.
• 1. a superficial oily layer produced by the meibomian glands
• 2. a middle aqueous layer produced by the main and accessory
lacrimal glands
• 3. a deep mucin layer derived from the conjunctival goblet cells
Pre-corneal tear film contd….
• vital for normal corneal function.
• a smooth optical surface;
• for the diffusion of oxygen and other nutrients;

• contains immunoglobulins, lysozyme, and lactoferrin.

• Aberrations in the tear film –

• a variety of diseases (eg, dry eye, blepharitis, following chemical
injury)
Cornea contd
• Cornea is transparent. Why? A common question!
• Avascularity
• Regularity in arrangement of stromal collagen fibrils. The fibrils are
remarkably uniform in size and separation.
• Relatively dehydrated state due to endothelial cells (posterior layer of cornea)
• Active transport of ions and transfer of water from stroma
• Unmyelinated nerve fibers
Functions
• Refraction +40D vs Lens +20 D
• Protection/support
Clinical conditions
Uvea: the middle layer

• choroid, ciliary body, and iris. Highly vascular, it serves nutritive and
supportive functions.
 Iris
• made of blood vessels and
• connective tissue,
• the melanocytes and pigment cells responsible for its distinctive color.
Description of normal and abnormal iris
• Ciliary body
-Triangular in shape
-consists of 2 parts: the pars
plana and the pars plicata

Functions: (1) aqueous humor

formation and (2) lens
accommodation.
Ciliary body
Ciliary body-parts
Clinical examples
Choroid Bruch’s
membrane

Chorio-
capillaries

Sattler’s layer

Haller’s layer
Anterior Chamber Angle Structures
 Irido-corneal angle
 Total internal reflection
Structures
1. Schwalbe line
2. Schlemm canal and trabecular
meshwork
3. Scleral spur
4. Anterior border of the ciliary
body and root of iris
Gonioscopy eliminates total internal
reflection making the angle structures visible
Retina
OCT - Retina
Retinal pigment epithelium
Functions:
1. vitamin A metabolism
2. maintenance of the outer blood–retina barrier
3. phagocytosis of the photoreceptor outer segments
4. absorption of light (reduction of scatter)
5. active transport of materials into and out of the RPE
Macula
Macula
The lens and Vitreous body
The aqueous fluid and the
intraocular pressure
Veinous drainage
Visual pathways
Ocular Adnexa

 Eye lids, conjunctiva and lacrimal apparatus protect

the eye from injury and infection
 They also keep the cornea healthy, moist and transparent
 They are known as ocular adnexa
Conjunctiva
The Eye
lids
The lacrimal apparatus
Summary
• Know the anatomy of the eye structures
Physiology will be continued …………
Physiology of eye
• Media clarity
• Tear film and its role
• Cornea and its functions
• Crystalline lens and its role
• Aqueous humor
• Vitreous body
Nature and formation of intra-ocular fluid
• Aqueous humour :
ionic composition similar to plasma but
contains less protein
and glucose and
more lactic acid and ascorbic acid.
• Functions:
• 1. to supply nutrients to cornea and lens
• 2. to maintain IOP value and globe configuration
The blood-aquous barriers
• Barrier: Semipermeable membranes system
Physiology of vision
• Formation of clear image
• Refracting system of the eye:
• cornea and lens
Retina
OCT - Retina
Retinal ganglion cells and photoreceptors
Retinal ganglion cells and photoreceptors
• 1 million RGCs
• 125 million photoreceptors
• Ratio of RGC : photoreceptors
• =1:1 in fovea
• Blind spot of Mariotte: optic disc

• Peripheral retina:
• more photoreceptors than RGCs: poor resolution
Light falling on retina: two reactions
A. Photochemical reaction:
• rhodopsin(chromo-protein) breaks into
• chromophore and protein . Initiates visual process

• Chromophore after absorbing a photon of light initiates

photoreaction. Rhodopsin loses its color (bleaching).
Light falling on retina: two reactions
contd….
B. Electrical reaction:

• Bleaching is associated with changes in electrical potential.

• Transmitted through bipolar cells to RGCs to ON and brain

• The pigments in cones are red, blue and green.

Rhodopsin cycle
Visual pigment
in outer segments of
rods
Photoreceptors Lateral geniculate nucleus regulates neural
transmit signals to
information from retina to cortex
bipolar cells connected
with RGCs

Neurotransmission and
communication between cells
is a complex retinal physiology.
Ganglion cells: three types
1. Parvocellular: color
sensitive, thin and small
axons in macula
2. Magnocellular: larger cells
3. Konio cells: intralaminar
area, blue
color/somatosense
Physiology of vision and developing brain
• Development of visual cortex and establishment of connections
with visual stimulus require normal visual experience after birth.

• “Use it or lose it” concept

• Sensitive period up to 8 years ( the first three years are critical).

Milestones of development
• Soon after birth: fixes at a light source
• One month: fixation of light more steady
• Three months: binocular vision, follows a moving object/ smiles
• Six months: ability to grasp and play
• From six months onwards test of vision can be attempted.
Binocular single vision
and stereopsis
• The images of two eyes are combined
by the visual cortex.

• Sensory and motor alignment

• Images on corresponding retinal points

• Horopter and Panum’s fusional area

Grades of binocular vision
• Simultaneous macular perception

• Fusion

• Stereopsis
Neurology of vision
• Visual pathway

• The pupillary pathway

The visual pathway
Field of vision
The pupillary
pathway
Reactions
Direct and consensual pupillary
light reaction

Pupillary muscles and their nerve

supply
Summary