A REVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE EYE

Senior Cycle 2 2012-13

Learning Outcomes
At this end of this tutorial, you will be able to: Describe the anatomy and physiology of the orbit, its contents, and adnexa Understand and describe the components of the visual pathway Understand and describe the optical elements of the eye Explain the principles of refractive error and its related terminology

Orbit

Thin walled; medial and floor Transmission of cranial nerves via fissures and foramen Close proximity to paranasal air sinuses (Sinusitis) Susceptibility to trauma (Blowout Fractures) Orbital fat swells in thyroid disease

Image credit: http://frca.mikrocom.co.uk/Anaesthetics/FRCA/headNeckAnatomy.php

Eyelids

Protect Ocular surface Facilitate spread of precorneal tear film Comprises skin and orbicularis muscle (anterior lamella) & tarsus and conjuctiva (posterior lamella) Meibomian glands located in tarsus

http://health-7.com/Atlas%20of%20Pediatric%20Physical%20Diagnosis/Eyelids %20%26amp%3B%20Adnexae-Anatomy%20of%20the%20Eyelid

Eye lids

Tears: Protect and maintain clarity

Important for maintenance of corneal clarity and refraction Contains important defence mechanisms against infection Requires integrity of lids and in correct position to spread tears and drain (dryness vs. epiphora)

Conjunctiva

Important to recognise extent of conjunctival covering Areas of redness important in differentiating causes of red eyes (conjunctivitis, iritis, etc)

Conjunctiva: Clinical appearance

Cornea

Transparency dependent upon hydration maintained by endothelial pump Devoid of blood vessels Highly innovated from Trigeminal nerve

Cornea: The effect of Overhydration

Sagittal View of the Eye

Aqueous maintains intraocular pressure

Aqueous humour formed by ciliary body Constantly produced and drained via canal of Schlemm Maintains intraocular pressure (10-21 mm Hg)

Lens

Normally transparent Refractive Reduced elasticity with age (Presbyopia) Loss of transparency with age (Cataract)

Uveal Tissue

Consists of Iris, Ciliary body and choroid Highly vascularised Immune competent Susceptible to inflammation
Image credit: http://www.vision-and-eye-health.com/uveitis.html

The optic nerve

The pupil and autonomic control

Constrictor and dilator muscles control pupil aperture Sympathetic control for dilation via sympathetic chain (Horners) Parasympathetic control for constriction via IIIn

Retina

Transparent inner most layer of globe Underlying melanin rich Retinal pigment epithelium for maintenance of photoreceptor health

Retina: Organised Neurosensory arrangement and end artery blood supply

Cones are colour-sensitive and centrally distributed Rods are for peripheral and night vision Blood supply of inner 2/3 via central retinal artery (Internal Carotid) and central retinal vein

Macula: the area of greatest resolving power

Highest concentration of cones More than one layer of ganglion cells Fovea is central and lacks blood vessels (nourished by choroid)

Synchronous movements of eyes in nine positions of gaze

Must recognise muscle actions and their nerve supply Underactive muscles cause squints and symptoms of diplopia MR, IR and SR: III nerve LR: VI nerve SO: IV nerve

Visual Pathway

Made up of
Retina Optic

nerve Optic chiasm Optic tracts Lateral Geniculate Body Optic radiations Visual cortex

Visual Pathway

Image credit: http://www.vision-andeye-health.com/uveitis.html

Optics of the eye

Terms to know: Emmetropia Myopia Hypermetropia Astigmatism Presbyopia

Emmetropia
Eye without refractive error Distant objects are focussed on retina with lens in a relaxed state Close-up objects are focussed by accommodation - the intraocular lens becomes thicker and stronger Presbyopia is the natural loss of accommodation power after age 40, resulting in need for reading glasses

Refractive Error- myopia

Short-sightedness Poor distance vision, good near vision Eye is too long, or cornea is too curved Myopia very uncommon in young children, tends to develop in teenage years and beyond 4% in 11-13 year olds 25% in adults >20 years

Refractive Error - hypermetropia

Long-sightedness Poor near vision, good distance vision Eye is too short or cornea is too flat Very common in infants and reduces significantly in early life

Refractive Error - astigmatism

Eye is short sighted in one plane and long sighted at 90 to this Images are distorted due to irregular cornea

Optics of the eye

Presbyopia
The

ability of the lens to accommodate gradually declines with age and by middle age reading glasses (convex lenses) are usually necessary of the two eyes is different

Anisometropia
Refraction

Learning Outcomes
Describe the anatomy and physiology of the orbit, its contents, and adnexa Understand and describe the components of the visual pathway Understand and describe the optical elements of the eye Explain the principles of refractive error and its related terminology