講義教案成果1.of the eye

1、Anatomy and Physiologyof the EyeNathan Congdon (康南) Glossary (Section 1)Myopia 近視Cataract 白內(nèi)障 a 青光眼Retinitis Pigmentosa 視網(wǎng)膜色素變性Age-related macular degeneration老年黃斑變性Diabetic retinopathy糖尿病視網(wǎng)膜病變Visual pathway視路Adnexa 眼附屬器 modation 調(diào)節(jié)Aqueous humor/Aqueous房水Cornea 角膜Sclera鞏膜Macula 黃斑Retina 視網(wǎng)膜Choroid 脈

2、絡(luò)膜Conjunctiva 結(jié)膜Vitreous 玻璃體Iris 虹膜Ciliary body 睫狀體Limbus 角膜緣Tear film淚膜Corneal transplantation 角膜移植OphthalmologyPathogenesis, development, prevention and treatment for diseases of the eye and its adnexasOver 90% of the information we have about the world comes from visionDiseases with the greatest

3、impact on human health & quality of life listed by WHOTumorCardiovascular diseasesOcular disorders and ametropiaUnique anatomical and physiological featuresComplex physiological functionsSense of light, color, shape, etc.Binocular visionRelation with general medicineWE ARE ALL DIFFERENTPROBLEMS ARE

4、SIMILAR2/3 of people over the age of 70 suffer from one or more of these ocular disorders:Anatomy of the Eye and AdnexaEyeball Receives visual informationVisual pathway Transmits visual informationAdnexa Protection of the eye (tear film, etc.)Mechanism of VisionLight rays from an objectImage on reti

5、naElectrical impulsesVisual center in occipital cortexRefraction modationEnergy conversionVisual pathwayThe EyeballMeasurementsVertical dia. = 23mm, Horizontal dia. = 23.5mmAxial length = 21 to 26 mmLonger in myopiaShorter in hyperopia1mm of axial length corresponds to 3D of refractive changeThe Wal

6、l of the EyeballOuter layerCorneaScleraLimbusMiddle layer IrisCiliary bodyChoroidInner layer RetinaLimbusPrecorneal Tearfilm3 layersLipid (Meibomian glands)Water (Lacrimal glands)Mucin (Goblet cells)FunctionsMoistening cornea and conjunctivaSmoothing out epithelial irregularitiesInhibiting growth of

7、 microorganisms(Lysozyme & IgG)Dry eyeDeficiency in any of these componentsThe CorneaMeasurement12 x 11 mm in dia.0.5 1mm thick5 layersRich in nerve fiber endingsTransparentNo blood vessels (avascular)Uniform collagen fibril alignment/refractive indexNa K pump in endothelium deturgescenceEpitheliumB

8、owmans layerStromaDescemets membraneEndotheliumThe CorneaImmunologically privileged siteCorneal transplantation (keratoplasty)Lamellar keratoplastyPenetrating keratoplastySlow healing responseMajor refractive medium+43 diopters (D) of total refractive powerCorneal refractive surgeriesRadial keratoto

9、my (RK)Photorefractive keratectomy (PRK)Laser in situ keratomileusis (LASIK)The ScleraAvascular, tough fibrous tissueThickness0.3 to 1.0 mmOpaque, collagen fibrils irregular in size and alignmentAnterior part covered by bulbar conjunctivaConnected to 6 extraocular musclesChannel passages artery / ve

10、in and nerveThe LimbusJunction of the cornea and scleraAnterior border End of Bowmans layerPosterior border End of Descemets membraneFunctionAnterior chamber angle Trabecular meshwork Canal of Schlemm Aqueous outflow Angle closure aSurgical landmarkIncision of surgeryThe IrisAnterior to the lensRegu

11、lates the amount of light - pupilSphincter muscleDilator muscle= camera shutterLight reflexAnt. & Post. ChambersUnique color, texture and patternThe Ciliary BodySecretes Aqueous humorMaintenance of normal intraocular pressure (IOP)Nutrition of cornea and lens, etc.Ora Serrata modation modation chang

12、e refractive power to focus on near objectsCiliary muscle zonule lensDuring aging- the elasticity of lens capsule decreases and the hardness of the lens nucleus increases: gradual loss of modation (presbyopia)Ciliary muscle at restCiliary muscle contractsThe Flow of Aqueous HumorNonpigmented epithel

13、ial cells Ciliary body Posterior Chamber Pupil Anterior Chamber Trabecular meshwork Schlemm canal Anterior ciliary veinPupil block & angle closure aThe ChoroidThree layersInnermost layerLarge vessels in the middle layerStill larger outer layerHigh blood flow from long and short posterior ciliary art

14、eries, drains through vortex veinsNutrition to outer layers of retinaRich in blood vessels and pigmentAbsorption of excessive lightGlossary (Section 2)Retinal pigment epithelium 視網(wǎng)膜色素上皮層Neurosensory retina 視網(wǎng)膜光感受器層Macula 黃斑Cones 視錐細胞Rods 視桿細胞Ganglion cells 視網(wǎng)膜節(jié)細胞Axon 視神經(jīng)軸索Fovea 黃斑無血管區(qū)Foveola 黃斑中心凹Ce

15、ntral retinal artery system 視網(wǎng)膜中央動脈系統(tǒng)Ciliary artery system 睫狀血管系統(tǒng)Orbicularis oculi 眼環(huán)輪匝肌Levator palpebrae 提上瞼肌Lacrimal apparatus 淚器Lacrimal puncta 淚點Lacrimal gland 淚腺Nasolacrimal duct 鼻淚管Extraocular muscle 眼外肌Strasbismus 斜視The RetinaHistologically 10 layersRetinal detachmentRetinal pigmented epithel

16、ium (RPE)Neurosensory retinaRPENeurosensoryPhotoreceptorsHighly specialized neuroepithelial cellsCones & rods6 million cones Central, bright & color vision125 million rods Peripheral, dark visionBipolar, horizontal & amacrine cellsGanglion cellsRetinal nerve fiber layerAxons to form optic nervePhoto

17、receptorBipolar c.Ganglion c.Inner segmentOuter segmentThe Macula (“yellow spot”)The center of the retina, temporal to the optic discFovea foveola avascular zone Only cones, no rodsFor detailed central visionHighly sensitive areaOptic DiscOptic nerve headNo photoreceptors“Blind Spot” in visual field

18、The Contents of the EyeContentsAqueous humorLensVitreous bodyRefractive mediumMaintain IOPAnatomy of the Eye and AdnexaEyeball Receives visual informationVisual pathway Transmits visual informationAdenxa Protection of the eye (lids, tear film, etc.)Mechanism of VisionLight rays from an objectImage o

19、n retinaElectrical impulsesVisual center in occipital cortexRefraction modationEnergy conversionVisual pathwayThe Crystalline LensBiconvex, avascular, colorless, transparentCapsule, lenticular fibers, and nucleusEpithelium beneath ant. capsule & equatorSubepithelial lamellar fibers produced and sque

20、ezed towards the centerFunctionsFocusing: modationChanges with age continues to grow throughout lifeLarger & harderLess elasticCataractVitreousConsists mainly of water: 99%2/3 of the eyes volumeViscosity mucopolysaccharide hyaluronic acidImportant for metabolism of intraocular tissuesAttached to the

21、 retina and oiptic nerveAging changesThinner & more liquid “Floaters (飛蚊）”Blood SupplyCentral systemCiliary systemBoth originate from the ophthalmic arteryCentral Retinal Arterial SystemOriginates from the ophthalmic arteryPenetrates the optic nerve4 branchesNourishes the inner 5 layers of the retin

22、aRetinal artery occlusion EMERGENCYCRAO & BRAORetinal vein occlusionCRVO & BRVOCiliary Artery SystemAnterior ciliary arteries: perfuse the Ciliary body & limbusLong posterior ciliary arteries: Iris & ciliary bodyShort posterior ciliary arteries: Choroid Vortex veins ophthalmic vein cavernous sinuses

23、Adnexa of the Eye(Protection & Motion of the eye)EyelidsConjunctivaLacrimal apparatusExtraocular musclesOrbitThe Eyelid5 layersSkinSubcutaneousMuscleTarsusPalpebral conjunctiva2 musclesLevator PalpebraeOrbicularis OculiFunctionsProtectionDistribution of tearsLimit light entering the eyeOutsideInside

24、The EyelidGlandsMeibomian ZeisMollThe ConjunctivaTransparent mucous membraneThree partsPalpebralBulbarFornicalConjunctivitisBulbar conjunctivaPalpebral conjunctivaFornical conjunctivaLacrimal ApparatusTears drainage systemLacrimal glandLacrimal punctaCanaliculusLacrimal sacNasolacrimal ductDacryocys

25、titisExtraocular MusclesRectus musclesSuperiorInferiorMedialLateral Abducens (VI)Oblique musclesSuperior Trochlear (IV)Inferior Oculomotor (III)StrabismusOculomotor (III)The OrbitProtective functionBonesFrontal b.Sphenoid b.Zygomatic b.Ethmoid b.Palatine b.Maxilla b.Lacrimal b.SinusesFrontal s.Maxillary s.Ethmoid & Sphenoid s.Important openingsOptic foramen cranial cavitySuperior & inferior orbital fissuresOptic Foramen 視神經(jīng)孔眶上裂眶下裂Visual PathwayOptic nerveOptic chiasmOptic tra