OPTHALMOLOGY

ANATOMY
COATS OF THE EYEBALL:
• Outer fibrous coat:
– Sclera (opaque)
– Cornea (transparent)
Middle vascular coat:
– Iris
– Ciliary body
– Choroid
• Inner nervous coat
– Retina
OUTER FIBROUS COAT:
CORNEA: no blood vessels [avascular]
• Transparent anterior 1/6th of the fibrous coat [hydration – kept at minimum]
• Function: It is MOST IMPORTANT Refracting medium of eye
SCLERA:
• Opaque posterior 5/6th of the fibrous coat
• Posteriorly forms a circular mesh like area to allow the nerve fibres of retinal
to pass through to form the optic nerve

LAMINA CRIBROSA
• Pierced by ciliary vessels + nerves + vertex veins [blood to out]

Carry blood inside
• Function: Protection of the eyeball
• Junction of cornea & sclera = LIMBUS
MIDDLE VASCULAR COAT:
IRIS:
• Circular disc shaped structure with a central aperture called pupil
• Pupil diameter – controlled by 2 muscles
– Sphincter papillae
– Dilator papillae
FUNCTIONS:
1) Eye colour
2) Regulates the amount the light entering the eye by constriction & dilatation of
pupil
CILIARY BODY:
• Divided into 2 parts
Anteriorly – pars plicata
Posteriorly – pars plana
• Functions:
– Gives attachment to the ciliary zonules which help to keep the
crystalline lens in position
– Responsible for ACCOMODATION
– Formation of AQUEOUS HUMOUR
CHOROID:
– Posterior part of the middle vascular coat
– Function: Main vascular structure of the eyeball
INNER NERVOUS COAT:
RETINA:
• Function: Neural perception
• Nerve fibres of retina – form the optic nerve
CONTENTS OF THE EYEBALL
Crystalline Lens
Aqueous Humour
Vitreous Humour
CRYSTALLINE LENS:
• Maximum Retractive Index
• Avascular [no blood vessels]
• Biconvex structure suspended by ciliary zonules
• Posterior surface is more convex than Anterior surface
FUNCTION:
– Acts as a refracting medium  transparent
– Accommodation
– Divides the eye ball into anterior & posterior segments
AQUEOUS HUMOUR:
– Transparent watery fluid filling the anterior segment of the eye
– Produced form the CILIARY BODY & drains through the angle of
anterior chamber
FUNCTIONS:
– Acts as a refractive medium
– Provides nutrition & removes metabolic wastes mainly from cornea &
lens
– Maintains intra ocular pressure & shape of eyeball.
VITREOUS HUMOUR:
– Transparent GEL filling the posterior segment
FUNCTIONS:
• Acts as a refractive medium
• Maintains intraocular pressure & shape of the eyeball.

STRUCTURES ARISING FROM NEUROECTODERM:

– Optic nerve
– Retina
– Epithelium of ciliary body
– Anterior epithelium of Iris
– Muscles of Iris
– Vitreous
STRUCTURES ORIGINATING FROM NEURAL CREST CELLS:
– All corneal layers except epithelium
– Angle of anterior chamber
– Stroma of Iris
– Ciliary body & choroid

STUCTURES ORIGINATING FROM MESODERM:

– Sclera
– Extraocular muscles &
– Orbital soft tissue
• OCULAR CHANGES IN MYOPIA:
• Pseudo proptosis [ looks like protusion of eye as
myopia – big eye ball]
• Divergent squint
• Thin cornea
• Deep anterior chamber
• Anterio posteriorly flat lens [as big eye ball – zonules
contract]
• Subluxation of the lens – [due to nephere of zonules]
• Complicated cataract [ gets cataract earlier than
normal people]
• Vitreous liquetaction / Vitreous degeneration
• Vitreous detachment [ form lens + retina]
•
• Retinal / fundal changes – by stretching of
the globe:
• Lattice degeneration – periphery of the retina
• Laquer cracks – at centre of Retina\
• Myopia crescent – margin of optic disc
• Posterior staphyloma – posterior protrusion of
the globe
• Foster fuchs spots – pigmented (black) lesion
at the centre of posterior staphyloma
• More stretch – Retinal tears
• 
• Retinal detachment
LACQUER CRACKS
Degenarative Retinoschisis
DEGENARTIVE
RETINOSCHISIS
• PRESBYOPIA
• Decrease in amplitude of accommodation
with age.
• Age > 40 yrs
• Feature: Difficulty in NEAR VISION
• OCULAR CHANGES IN PRESBYOPIA
• Decrease in contraction of ciliary body
• Rigidity of zonules
• Decreased flexibility of lens capsule
• Rx : + lenses/convex lenses – for near
work
 TREATMENT OF REFRACTIVE ERRORS

 1st line of management = Spectacles

 2nd line of management = Contact lens

Soft contact lens Rigid Gas Permeable [RGP Lens]

Material : HEMA [Hydroxy Ethyl Methacrylate]
Indications: Myopia, Hypermetropia
Low Astigmatism
Contact lens (semi soft)
- CAB [Cellulose Acehyl Butyrate]
- Silicon PMMA [Polymethyl Methacrylate]
- High Astigmatism & Irregular Astigmatism
(rare type)
• ADVANTAGES OF CONTACT LENS:
• Cosmetics
• Increase in the field of vision [ in high
refractive errors (+0. +2)
• Devoid of spherical & chromatic aberrahons
[less than glasses]
• Change in image size is much less as
compared to glasses
• [one eye – 4, other +4 (maximize) Brain
confused]
DISADVANTES OF CONTACT LENS:
- Most important complication: Allergic conjunctivitis
- Corneal hypoxia [as closed with lens – air can’t contact no O2 m cornea

Anaerobic shift in metabolism leading anerobic – lactic acid accumulates]

To accumulation of lactic acid
Water accus edema
Corneal hydration & Edema

CORNEAL INFECTION:

Most common (important) corneal infection – PSEUDOMONAS

3RD LINE OF MANAGEMENT : Refractive Surgery

CORNEA BASED SURGERY LENS BASED SURGERY

1) Most common : LASIK - Phakic Intraocular Lens

- Laser Assisted In-Situ Keratomileusis - Insertion of corrective lens in from of the
(changing the shape of cornea) patients
- Laser used in lasik – Excimer laser - Crystalline lens [lens over normal lens]
- Eligibility criteria for LASIK: [not as cataract & remove lens & keep
 Age more than 18 years less]w
 Stability of refraction for atleast 6
months
 Minimum corneal thickness of
500 microns
 Minimum residual thickness of
250 microns
2) Photo refractive keratectomy PRK
3) EPILASIK (epithelial LASIK)
4) Femtosecond LASIK
• Rx ; Low anisometropia upto 2 diopters –
Glasses
• High Anisometropia – Contact lens
• Children < 3 yrs, non school going –
Atropine
• Adults – Tropicamide
• School going children –
Homatropine, (or) Cyclopentolate