EYE CARE

VINE PARAMEDICAL SCHOOL

OJAN RONALD BOLD
DEPARTMENT OF OPHTALMOLOGY
 INTRODUCTION
• Eye care/ ophthlamology is the branch of
medicine that deals with the anatomy,
physiology, and pathology of the eye.
• The eye is an organ of sight.
• It is located in the orbital cavity.
• It is a hollow sphere, about 24 mm in
diameter.
 EMBRIOLOGY
• The CNS develops from the neural tube.
• A thickening appears on the either side of the
neural tube in its anterior part, known as the
optic plate.
• The optic plate grows towards the surface to
form the optic vesicle.
• The two eyes develop from the optic vesicle and
the ectoderm and mesoderm coming in contact
with the optic vesicle.
cont
 cont
• The optic vesicle invaginates from in
front and below to form the optic cup.
• The line of invagination remains for some
time as the embryonic fissure.
• A hyaloid artery enters through the
fissure to provide nutrition to the
developing structures.
• Later this artery atrophies and
disappears
 cont
• The inner layer of the optic cup forms the
inner nine layers of the main retina and the
outer layer develops into the pigment
epithelium.
• The neural ectoderm secretes a jelly like
structure, the vitreous, fills the cavity.
• The ciliary body and iris are formed by the
anterior portion of the optic and mesoderm.
 cont
• The mesoderm around the cup
differentiates to form coats of the eye,
orbital structure angle of the anterior
chamber and the main structure of the
cornea.
• The surface ectoderm invaginates and
later separates to form the lens.
• The surface ectoderm remains as the
corneal and conjuctival epithelium.
 ANATOMY.
• The eye is an organ of sight situated in
the orbital cavity.
• Its almost spherical in shape and about
2.5 cm in diameter.
• The volume of the eye ball is
approximately 7 cc.
• The space between the eye and the eye
ball is occupied by fatty tissue.
 cont
• The bony walls of the orbit and fat helps
to protects the eye from injury.
• Structurally, the eyes are separate, but
they function as a pair.
• Its possible to see with only one eye, but
3 dimensional vision is impaired when
only one eye is used, specially in relation
to judgment of distance.
•
Structure of the eye.
The eye has three major layers/ tunics; that lie
flat against each other to form the eye ball.
– The outer fibrous layer; sclera and cornea
– The middle vascular layer; uvea (choroid,
ciliary body, iris)
– The inner nervous tissue layer; the retina.
 THE OUTER PROTECTIVE LAYER
THE SCLERA
• Also called the white of the eye.
• Forms a firm, tough, fibrous outermost layer
of the eye. Its made of collagen
• It maintains the shape of the eye,
• It also is the site of attachment for extra ocular
muscles.
• Its about 1mm thick.
• It becomes thin (sieve like membrane) at the
site where the optic nerve pierces it, called
the lamina cribrosa
 cont
• At the anterior 1/6 of the eye, is the window of
the eye; the cornea, the main refractive medium
• the sclera changes into the cornea at the limbus
• It is the point of entry of light into the eye.
• It also acts as lens, helping the actual ; it helps in
focusing light, by refraction from an object onto
the retina.
• The dioptic power of the cornea is +43 to +45D
• The cornea is avascular.
 Cornea-cont
• parts of the cornea
• Epithelium
• It is approximately 5-6 layer of cells thick.
• It is densely innervated, so any damage
to the epithelium is very painful.
• The superficial cells have a cell
membrane that enable tear film to
spread evenly over the whole cornea.
 cont
• The epithelial cells get the oxygen mainly
through tears
• The Bowman’s membrane that sits at
the basement of the epithelial cells
separates it from the stroma
Stroma
– Makes up approximately 90% of the
cornea.
 cont
• It consists of layers of parallel collagen
fibres lying at right angles to each other,
providing a regular lattice structure
• This is very important for the
transparency of the cornea.
• The stroma is separated from the
endothelium by the Descemet’s
membrane
 Cornea- cont
• The endothelium
• This is a single layer of cells that
pumps water out of the cornea,
keeping it dry, and transparent.
• It obtains its nutrients from the
aqueous humour.
 THE MIDDLE VASULAR LAYER
• Also called the UVEA or UVEAL TRACT.
• It consists the iris, ciliary body and choroid.
• All the uveal tissues are pigmented and
vascular.
• the choroid
– This is a thin layer of tissues that lies
between the sclera and retina.
– it extends from the ora serrata, up to
the aperture of the optic nerve in the
 cont
–It has dark brown pigment cells that
help to absorb light that has not
been focused on the retina to avoid
unnecessary reflection.
–It is richly supplied with blood, hence
it can supply oxygen to the other
parts of the retina.
 cont
Cliary body
– It lies between the edge of the choroid, and
the iris.
– It contains the ciliary muscle, which alters
focus of the eye by changing the shape of the
lens, to which it is attached by the zonules.
– The surface of the ciliary body consists of tiny
folds and processes the ciliary processes.
– A single layer of the processes, the ciliary
epithelium, secretes aqueous humour.
 Cont
The iris
• This is a ring of pigmented tissues
that controls the amount entering
the eye.
• At the center of the iris is the
apperture called the pupil, through
which light enters into the eye.
 cont

• The iris has muscles;

– the circular (sphincter papillae)
muscles, that constrict the size of the
pupil, when amount of light is high
(bright light).
– The radial (dilator papillae) muscles,
that enlarges the pupil size (dim light).
• The iris is innervated by both
parasympathetic and sympathetic
nerves (ANS)
 cont
• The parasympathetic stimulation
constricts the pupil (myosis) while the
sympathetic stimulation dilates it
(mydriasis)

• The iris also divides the anterior

chamber from the posterior chamber
 The inner nervous tissue layer
• This layer consists of the retina which forms ¾ of
the back of the eye ball.
• It forms the nervous tissue of the eye.
• The retina has ten layers.
• It is connected to nerve fibers lying on a
pigmented epithelial layer.
• Posteriorly, is a yellow area, the macula lutea,
with a central depression called the fovea
centralis the most sensitive part of the retina.
 Retina-cont
Consists of two kinds of
photoreceptors.
• Cones- color & bright light sensitive
cells that are found toward the
center.
• Rods- sensitive to dim lights that are
found peripherally.
• Also on the retina is a Blind spot, at the
optic disc, an area of complete blindness
in the visual field.
• - Anatomically it corresponds to optic
nerve head, which is located nasally and
measure 1.5 mm in diameter.
• - At this point, there are no
photoreceptors.
 FUNCTIONS OF THE RETINA
• It is the photosenstive part of the
eye.
• It has two light senstive pigment
cells; the rods and cones
• Light rays cause chemical change to
the pigment cells, which emit nerve
impulses, that pass to occipital lobe
of the cerebrum via the optic nerve.
 rods
• Rods are more sensitive than
cones. They are stimulated by low
intesity light or dim light, e.g by the
dim light in the interior of a
darkened room. (scotopic vision)
 cons
• Cones are senstive to bright light and
colour. The different wavelengths of
light stimulate the cones resulting in
the perception of the different
colours. In the bright light the light
rays are focused on the macula lutea
(Photopic vision)
 Note
• Visual purple (rhodopsin) is the pigment found
in the rods.
• It is bleached by bright light. (refractory period).
• Rhodopsin is quickly reconstituted when there
is constant supply of vitamin A.
• When an individual moves from bright light to
dim light, there is a variable period of time
when it is difficult to see.
THE LENS
- Consist of closely packed transparent cells
enclosed in a capsule.
Has unique feature
- Transparent with No blood or nerve supply.
- Has higher protein content than other body
tissues.
- Continues to grow through out life, new in
the top, old compressed towards the centre.
- The only solid structure inside the eye.
- Has biconvex shape.
• - Epithelial cells are not shedding type
• Has three anatomical parts: capsule,
cortex, nucleus
• Its nutrition is maintained by the
metabolic exchange between itself and
the aqueous humor.
• The eye is supplied by anastomosing vessels
BLOOD SUPPLY, DRAINAGE, INNERVATIONS
from internal and external carotid
AND LYMPHATIC DRAINAGE OF THE EYE arteries.
• ∗ Retina - inner layer gets blood from
central retinal artery, a branch of
ophthalmic artery and enters the eye with
optic nerve and divides on the optic disc
into its branches.
 cont
• Uvea - is supplied by ciliary circulation, from
ophthalmic artery.
• ∗ Eye lid gets its blood supply from facial and
ophthalmic arteries.
B- Venous Drainage
• Almost the entire blood from the anterior and
posterior uvea drains through four vortex veins
via superior and inferior orbital veins to
cavernous sinus.
 cont
• Eye lid drains through facial vein into
cavernous sinus
Lymphatic drainage
• There are no lymphatic vessels inside the
globe.
• The lymphatic drainage of the medial eye lid is
to sub mandibular lymph node and that of
lateral one is to the superficial preauricular
lymph nodes and then to deep cervical lymph
nodes.
 Innervations of the eye
• Innervations of the eye
• A- Motor
• - Oculomotor (CN III) Innervate- medial rectus,
superior rectus, inferior rectus, & inferior
oblique. (R3)
• -Trochlear (CN IV) nerve- innervates superior
oblique (SO4)
• -Abducent (CN VI) nerve- innervates lateral
rectus. (L6)
• - Facial nerve (CN VII) - innervates orbicularis
oculi muscle
 cont
• B- Sensory nerve
• - Ophthalmic branch of trigeminal
nerve is the sensory nerve of the
globe & adnexa and has three
branches -frontal, lacrimal,
nasociliary.
• I- Sympathetic nerve-
cont supplies Muller's
muscles and dilator papillae.
• II- Parasympathetic comes via
oculomotor and innervates the ciliary
muscle and sphincter papillae.
 Protection of the eye
• A - Eye Lids
• It has the following parts
• I. Skin - has three important features
– Thinnest, more elastic and mobile than skin
else where in the body
– Little or no subcutaneous fat under the skin
makes it a good source of skin graft
– Has an extremely good blood supply that is
why wound heals well and quickly.
 III. Tarsal plates
–Are composed of dense fibrous
tissue
–Keep the eye lids rigid and firm
–Contain meibomian glands, which
open at lid margin, and makes oily
secretion that forms a part of
corneal tear film.
 B. Conjunctiva
-It is a thin mucous membrane which
lines the inner surface of the eye lid and
outer surface of the eye ball.
– The main function of the conjunctiva is
to protect the cornea.
– During opening and closure of the
eyelids, it lubricates the cornea with
tears.
 cont
• It also protects the exposed parts of the
eye from infection because it contains
lymphocytes and macrophages to fight
infections.
• Mucin from goblet cells has wetting
effect of tear film
• It has three parts:
 cont
I. Tarsal Conjunctiva
– The part lining in the inner aspect of the eye
lid
– Firmly attached to the underlying tarsal plate
II. Bulbar Conjunctiva
– The part lining the eye ball
– Loosely attached to the underlying sclera
III. Fornix
– Part in which the tarsal and bulbar
conjunctivas are continuous.
– The conjunctival epithelium is
continuous with the corneal
epithelium at the margin of the
cornea, which is called limbus.
– Conjunctiva contains many small
islands of lymphoid tissue especially in
the fornix.
– Gray line is a mucocutaneous junction
of the skin and conjunctiva.
 C.LACRIMAL
Consists of APPARATUS
– Lacrimal gland
– Punctum
– Canaliculi
– Nasolacrimal sac
– Nasolacrimal duct
• Lacrimal apparatus produces and drain
tears that forms component of tear film.
 cont
• -The tear forms a thin film of fluid on the
surface of the conjunctiva and cornea,
• which is vital for the health, and
transparency of the cornea.
• Outer part( Lipid layer)- oily secretion
from meibomian and Zeis gland
 cont
• Middle part(Aqueous layer)-Water
from Lacrimal gland and accessory
lacrimal glands of Krause and
Wolfring.
• Inner part(Mucin layer)-Mucus from
goblet cells of the conjunctiva
 Function of tear film.
1. provides moist environment for the surface
epithelial cells of the conjunctiva and cornea
2. Along with the lids, it washes away debris
3. Transport metabolic products (oxygen, carbon
dioxide) to and from the surface cells
4. Antimicrobial actions
5. Provides a smooth refracting surface over the
cornea.
Lipid
layer

Aqueuos layer

Mucin layer
 EXTRAOCULAR MUSCLES
• EXTRA OCULAR MUSCLES
– They are six, and their action is so
complex.
– Control eye movement
– Form cone behind the eyeball
• Qn 1. write brief notes on the extrinsic
muscles of the eye while explain the
monocular action of each
•
ORBITAL BONES
Formed by seven bones and has four walls.
Roof
– Frontal bone and sphenoid bone
Floor
– Zygomatic, maxillary and palatine bones
Medial
– Ethimoid, frontal, Lacrimal and sphenoid bones
Lateral
-The strongest of all walls.
– Zygomatic and sphenoid bone
 THE CHAMBERS OF THE GLOBE

• A. Anterior chamber
• - Delineated anteriorly by the
posterior corneal surface and
posteriorly by iris.
• Depth- 3-4 mm, Volume of aqueous
humor in the anterior chamber is
about 0.25 ml.
• The acqueous humour is produced
by the ciliary epithelium,
CONT passes
infront of the lens, through the pupil
into the anterior chamber and
returns to the venous circulation
through the canal of schelmm,
situated in the angle of anterior
chamber.
• B. Posterior chamber
CONTand laterally by the
– Limited anteriorly
posterior iris surface and ciliary body
and posterior by lens & vitreous body
• C. Vitreous space
– Filled with vitreous humor, a
transparent, colourless, inert gel which
fills the posterior 4/5 of the eyeball.
• It contains few hyalocytes and wandering
leucocytes.
• - occupying posterior 4/5 of the globe
CONT
with volume of 4 ml.
• - Consist of water (99 %), collagen,
hyaluronic acid and soluble protein
which is Inert
• -Function: - to act as intervening medium
in the light pathway between the lens
and retina and also gives the shape of
the eye.
• In order to achieve clear vision, light
reflected from objects within the visual
PHYSIOLOGY OF SIGHT
field is focused on the retina of both
eyes.
• The process involved in producing clear
vision are;
– Refraction of light rays
– Accommodation of the eyes to light
• Light rays are bent when they pass from
a medium of one density
REFRACTION to a medium
OF LIGHT RAYS of
a different density.
• The media include the conjunctiva, the
cornea, aqueous humour, lens and
vitreous humour.
• All the above are more dense than air,
and they all have a constant refractive
power similar to that of water, except
the lens
 The lens
• It’s a biconvex elastic structure, suspended
behind the iris from the ciliary body
suspensory ligaments.
• It’s the only structure in the eye that changes
its refractive power.
• All rays entering the eye need to be bent
(refracted) to focus them on the retina.
• Light from distant objects need the least
refraction, while those from a near by object
need the most refraction
• Light approaching the
contlens from a nearby
object causes the ciliary muscles to contract,
and release their pull on the suspensory
ligaments and the anterior surface of the lens
bulges forward, increasing its convexity and
refractive power.
• When the biliary muscles relax, it slips
backwards, increasing its pull on the
suspensory ligaments, making it thinner
(distant object)
2. ACCOMODATION OF THE EYES TO LIGHT
• Three factors are involved in accomodation.
a. The pupil
b. Convergence, (movement of the eyeballs)
c. lens
• Size of the pupil
– Pupil size influences accommodation by
controlling the amount of light entering the
eye. In a bright light, the pupils are
constricted, while they are dilated in dim
light.
 cont
• The iris consists of one layer of circular
and radiating fibres smooth muscle
fibres.
• Contraction of the circular fibres
constricts the pupil (parasympathetic
stimulation), and contraction of the
radial muscles dilates it (sympathetic
stimulation).
CONVERGENCE-MOVEMENT OF THE EYEBALL

• Light rays from an object enters two eyes at

different angles.
• For clear vision, they must stimulate the
corresponding areas of the two retinae.
• Extraocular muscles move the eyes, and to
obtain a clear image, they rotate the eyes so that
they converge on the object viewed.
• The above co-ordinayed muscle activity is unde
autonomic control.
 cont
• When there is voluntary movement of the
eyes, both eyes move and convergence is
maintained.
• The nearer the object is to the eyes, the
greater the eye rotation to achieve
convergence.
• If convergence is not complete, there will be
double vision (diplopia)