PHYSIOLOGY OF THE HUMAN EYE (Ophthalmology)

JOSE ERNESTO G. ROCES M.D. (Caratact and Vitreo-Retina Surgery)

Lecture Trans (July 15, 2016)

THE EYE AND CAMERA

LAYERS OF THE EYE

Sclera
Choroid
Retina
SCLERA
-

White structure
Posterior 4/5 of the eye
Composed of tough fibers (collagen & elastin)
Functions:
Protective
Attachment for extra-ocular muscle

AMEC-BCCM
MEDICINE II
A.Y. 2016-2017

5 LAYERS OF THE CORNEA

Corneal Epithelium
Striated, squamous epithelium
Regenerative cells
Anterior Limiting Membrane (Bowmans)
Tough collagen fibers (type 1)
Protect corneal stroma
Corneal Stroma
90% of corneal thickness
Parallel collagen fibers and keratocytes
Posterior Limiting Membrane (Descemets)
Less rigid collagen fibers (Type IV)
Modified basement membrane
Corneal Endothelium
Monolayer, simple squamous layer
Regulates transport of fluid and nutrients the
aqueous humor and the avascular retina
Rich in mitochondria

CHOROID
Dark layer
Rich in blood supply
Melanin
Function:
Nourishes the outer portion of the retina
RETINA
Thin, transparent, multilayered sheet of neural tissue
Contains photoreceptors and nerve cells
10 layers

CORNEA
Anterior part of the eye that covers the iris, pupil, and
anterior chamber
Transparent, avascular and well-innervated tissue
Connected to the adjacent sclera by the corneal limbus

REFRACTIVE POWER OF THE EYE

Refraction
Change in direction of the light wave as it passes
through another medium of different density
Refraction the light velocity but does not affect the
frequency of the light waves and is usually measured by the
refractive index (ratio of the speed of the light in a vacuum
to the speed of light in a given material)
Diopter
Measuring unit of refractive power
The eye refracts light to be focused in the retina using 4
refractive surfaces:
Anterior and posterior surfaces of the cornea
Anterior and posterior surfaces of the lens
Aqueous humor
Vitreous humor

CORNEA PHYSIOLOGY
2/3 of the refractive power of the eye (43 diopters)
Focus is fixed
Anterior surface (curvature) greater refractive power
Refractive index: 1376
Corneal Reflex
Stimulus: touch
Receptor: mechanoreceptors on the surface
Afferent neuron: branches of Trigeminal Nerve (V)
Center: medulla
Efferent neuron: facial nerve (VII)
Response: closure of the eye
LENS
-

Transparent, avascular, biconvex structure

Refractive Index: 1406
Connected to the ciliary body by the suspensory ligament
Accommodative function (focusing ability)
3 LAYERS:
Lens capsule
Type IV collagen; very elastic
Lens epithelium
Simple cuboidal epithelium
Homeostatic function / transport of fluid
and ions from the aqueous humor
Lens fibers
Thin, long, transparent fibers (BULK)

LENS PHYSIOLOGY
Accommodation the adjustment of the eye for seeing at
different distances, accomplished by changing the shape of
the lens through action of the ciliary muscle (ciliary body),
thus focusing a clear image in the retina
Focus at a distance >>> ciliary muscle relax >>> lens
flatten
Focus at near >>> ciliary muscle contract >>> lens thicken
Accommodative Reflex
Accommodation, eye convergence and pupillary
constriction
Other functions of the ciliary body:
Aqueous humor production
Production and maintenance of lens zonules

Transcriber: Sagun Shrestha & Dawn Zoleta

PUPIL & IRIS

Round, black hole in the center of the eye
Extension of the choroid (part of the uvea)
Similar to camera aperture
Layers of the Iris:
Anterior limiting membrane
Stroma
Iris Sphincter Muscle
Pupillary Constrictor
Circular Smooth Muscle
Parasympathetic Innervation
Iris Dilator Muscle
Pupillary Dilator
Radial Smooth Muscle
Sympathetic
Innervation
Cervical Ganglion)
Anterior Pigment Myoepithelium

(Superior

PUPILLARY LIGHT REFLEX

Pupillary light reflex pathway
Light stimulus >>> photoreceptors >>> sensory
optic nerve (afferent pupillary fibers) >>> optic
chiasm >>> optic tract >>> synapses in pretectal
nucleus (midbrain) >>> decussates to ipsilateral
and contralateral Edinger-Westphal nucleus >>>
oculomotor nerve (efferent pathway) >>> ciliary
ganglion >>> short ciliary nerves (post-ganglionic
fiber) >>> iris sphincter muscle

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RELATIVE AFFERENT PUPILLARY DEFECT (RAPD)

Local eye problem vs.
serious
optic
nerve
problem
Direct light response in
the involved eye is less
intense
than
the
consensual response (in
the involved eye) evoked
when the normal eye is
stimulated.

AQUEOUS HUMOR AND INTRAOCULAR PRESSURE (IOP)

Aqueous Humor
Transparent, gelatinous fluid similar to plasma but
has a lower protein concentration
Volume
250uL
Rate of Production
1.5 2.0uL/min
Flow
Non-pigment cells of the ciliary body
>>> posterior chamber >>> pupil >>>
anterior chamber
>>> trabecular
meshwork >>> Schlemms canal >>>
aqueous vein >>> episcleral vein
Function
Maintain IOP
Immune response against pathogens
Nourishment of avascular structures
Transport of ascorbic acid (antioxidant)

PHYSIOLOGY OF THE VITREOUS HUMOR

Transparent, gelatinous humor that fill the posterior cavity
of the eye
98-99% water
Phagocytes, hyalocytes, collagen (type II),glycosaminoglycan,
hyaluronic acid, minerals and proteins
Functions:
Inflate the eyeball
Contributes to the refractive power of the eye
(refractive index 1.336)
Floaters, flashes and vitreous syneresis

TEAR PHYSIOLOGY
Volume = 7+/- 2uL
Albumin = 60%
Immunoglobulin: IgA, IgG and IgE
Average pH = 7.35
Isotonic (osmolality = 295 to 309mosm/L)
LAYERS OF THE TEAR FILM

Intraocular Pressure
IOP = F/C+PV
Where F = formation rate

C = outflow rate

PV = Pressure of the episcleric vein

Physiologic Variation
Caffeine
Exercise
Alcohol consumption

Transcriber: Sagun Shrestha & Dawn Zoleta

Normal Range:
10-20mmHg

Aqueous Layer
Produced by the lacrimal gland
Assists in tear distribution and osmoregulation
Proteins with protective functions
Lipocalin = immune response
Lactoferrin = antimicrobial activity and
anti-cancer properties
lyzosomes = antibacterial activity
lacritin = glycoprotein promoting tear
secretion and role in the proliferation
and survival of epithelial cells
Lipid Layer
Coats the aqueous layer
Prevents evaporation of tears
Oily substance produced by the meibomian glands
Mucous Layer
Hydrophobic layer
Composed of mucin which is produced by the
goblet cells of the conjunctiva

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TYPES OF TEARS
Basal
daily average production: 0.75 1.1grams
lubrication and nourishment of the cornea
protective function against microorganisms
Reflex
Response to an irritant (onion vapor, thermal, etc.)
Linked to yawning, vomiting and coughing
Emotional
Increased tear production accompanying positive
of negative emotions
Limbic system (hypothalamus) plays an important
role in tear production

OCULAR ADNEXA
Eyebrow
Eyelids/ eyelashes
Conjunctiva
EYEBROW
Physical barrier (protection) that prevents moisture and
sweat from entering the eye
Psychological functions:
Attraction
Expression
EYELIDS
Physical barrier (protection)
Distribute tears to prevent dry eye
Continuous moistening of the cornea

Levator Palpebrae: opens the eye (CN III)

Orbital septum
Fibrous portion
Tarsal plate
Dense connective tissue that gives the eyelid its
shape
Houses the meibomian glands
Palpebral conjunctiva
Non-keratinized stratified columnar epithelium
with goblet cells that produce mucin

EYE MOVEMENT
MONOCULAR EYE MOVEMENTS
Adduction
Directing the eye toward the nose
Abduction
Directing the eye laterally
Elevation
Directing the eye up
Depression
Directing the eye down
Intorsion
Directing the top of the eye away from the nose
Extorsion
Directing thesuperior aspect of theeye away from
the nose
MOVEMENTS OF BOTH EYES TOGETHER ALSO HAVE TWO DISTINCT
TYPES:
Version
Movement of theboth eyes in same direction
Vergence
Movement of both eyes but each eye moves in a
direction, opposite to the direction of the other
eye
EYE MOVEMENT

LAYERS OF THE EYELID

Skin

one of the thinnest

contains sweat glands and sebaceous glands (high
concentration)
Subcutaneous tissue
Loose connective tissue containing nerves and
blood vessels
Muscles
Orbicularis oculi: closes the eye (CN VII)

Transcriber: Sagun Shrestha & Dawn Zoleta

PHYSIOLOGIC ANATOMY OF THE EXTRAOCULAR MUSCLES

Superior Rectus Muscles
Supplied by the oculomotor nerve (CN III).
Acts as the primary elevator of the eye.
Inferior Rectus Muscles
Supplied by the oculomotor nerve (CN III).
Acts as the primary depressor of the eye.
Superior and inferiormuscles of the eye also have
secondary function which is torsion.
Superior rectus is an encyclotoorter, while inferior
rectus is an incyclotorter

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Their tertiary action is abduction.

Lateral Rectus Muscle
Supplied by abducent nerve (CN VI).
It has only horizontal action
It is the primary abductor of the eye.
Medial Rectus Muscle
Supplied by the oculomotor nerve (CN III)
Acts as a primary adductor of the eye.
Superior Oblique Muscles
Supplies by the Trochlear nerve (CN IV)
Primary action = incyclotorsion
Secondary = depression.
Inferior Oblique Muscles
Supplied by oculomotor nerve (CN III).
Primary action = encyclotorsion
Secondary = elevation
Tertiary action = abduction

EYE MOVEMENT IN DEPTH PERCEPTION

Saccadic movement
Controlled by saccadic system in thefrontal lobe of
the brain
Controls rapid movement and fixation of the eye.
Example of saccadic movement
Movement of your eyes when you read
these words.
Pursuit movement
Controlled by pursuit system located in the
ipsilateral parietal lobe in the brain.
It is smooth tracking when the eyes follow slowly
moving objects (such as following football players
during a football match)
Most movements of the eye are combined
saccadic and pursuit movement.
Vestibule-ocular movement
Stabilizes the eyes related to the external
environment
PHYSIOANATOMY OF THE RETINA
1.

Photoreceptors (rods and cones):

Rods are more numerous (about 120 millions
rods) than the cones (6-7 millions cones).
Rods
sensitive to dim light and in detecting
motion.
Cones
sensitive to colors and bright light. They
are concentrated in the peripheral
regions of the retina.
Fovea
devoid of rods.

Transcriber: Sagun Shrestha & Dawn Zoleta

2.

3.

4.

5.

Bipolar cells: Cells that connect Photoreceptors (rods and

cones) to the ganglionic cells of the retina. They receives
synapses from either rods or cones, but not from both.
Many rods may synapse with one bipolar cell, but only one
cone may synapse with a bipolar cell. There are two
populations of bipolar cells: ON and OFF bipolar cells,
depending on their reaction to glutamate, released by
photoreceptors.
Ganglion cells
Neurons that receives visual information from
photoreceptors via bipolar and amacrine cells and
transmit them to the brain.
The axons of ganglion cells from the optic nerve.
Three types of retinal ganglion cells in depending
on their structure and function:
Parvocellular:
Small cells with small cell bodies and
dendrites.
Their axons are projected to the
parvocellular cells layer of the lateral
geniculate nucleus (LGN) in the
thalamus.
Form 80% of the ganglion cells and
sensitive to clor vision.
Magnocellular:
Large cells that form 10 % of the
ganglion cells.
Sensitive to changes in contrast.
Their axons are projected to the
magnocellular cells layer of the LGN in
the thalamus.
Konicellular:
A very small cells that form 10% of the
ganglion cells.
Contributes to spatial resolution of the
image.
Horizontal cells:
Horizontally interconnecting neurons that regulate
signal input from the Photoreceptors.
two types:
HI
HII
HIII
Each type is selective for cone photoreceptor type
but this is not approved yet.
Amacrine cells:
Interneurons that regulate the input from bipolar
cells to the ganglionic cells, and transmit signal
from photoreceptors to ganglion cells as well.
About 22 different types of amacrine cells.
Amacrine cells lack axons.

CENTRAL VISUAL PATHWAY

The axons of the ganglion cells form the optic nerve which
travels and crosses in the optic chiasm. Crossing of the axons
in the optic chiasm is partial (the images on the nasal side of
each retina cross over to the opposite side, while the images
on the temporal side of the retina stay on the same side.
Crossing off the two optic nerves occurs on the sella turcica
beneath the pituitary gland.
Post chiasm fibers constitute the optic tract, which synapse
on the lateral geniculate nucleus (LGN) of the thalamus.
Lateral geniculate nucleus on each side of the brain has six
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layers of cells that receives input from both eyes. The axons
of the cells in the lateral geniculate nucleus form the optic
radiation, which travels to the visual cortex.
Visual cortex is located in the occipital lobe and is subdivided
into primary visual cortex (striated cortex V1)and secondary
cortex (V2). In these central structures the image formation
processes take place.

Transcriber: Sagun Shrestha & Dawn Zoleta

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