12. Structure and Function of the Eye Flashcards
Through what structure does the optic nerve pass?
Throught the bony orbit nasally
Describe the location and function of the lacrimal gland?
- Lacrimal gland located within orbit, latero-superior to globe
- Gland function = tear production
- Basal tears - these are tears that are produced at a constant level, even in the absence of irritation or stimulation
- Reflex tears - These are tears that are produced in response to irritation
- Afferent - Cornea - CN VI
- Efferent - Paraympathetic
- Neurotransmitters = ACh
- Crying (emotional) tears
Describe the Lacrimal system.
- Tear made by Lacrimal Gland
- Drains through two puncta= opening on medial lid margin
- Flows through superior + inferior canaliculi
- Gather in tear sac
- Exits sac via tear duct (nasolacrimal duct, opens into inferior meatus) into nose cavity
What is the function of the tear film?
- Tear film maintains smooth cornea-air surface
- Oxygen supply to cornea b/c normal cornea has no blood vessels
- Removal of Debris (Tear film + Blinking)
- Bactericide
Describe the structure of the tear film.
- Superficial Oily Layer to reduce tear film evaporation (produced by a row of Meibomian Glands along lid margins)
- Aqueous Tear Film made by tear gland
- Mucinous Layer on Corneal Surface to maintain surface wetting

Describe the conjunctiva.
- = the thin, transparenttissue covering outer surfaceof eye (including cornea)
- Begins at outer edge of cornea, covers visible part of eye, and lines inside of eyelids.
- Nourished by tiny blood vessels nearly invisible to naked eye.
- Ciliary body produces aqueous humour

Describe the layers of the eye.
3 layers:
- Sclera - Hard + opaque, protects eye + maintains shape of the eye –> “the white of the eye” - tough + has high water content
- Choroid - Pigmented + Vascular –> shields out unwanted scattered light + supplies blood
- Retina - Neurosensory Tissue converting light –> impulses to the brain via the optic nerve

Define the cornea.
Transparent, dome-shaped window covering front of the eye.
Describe the structural features of cornea.
- Front-most part of Anterior Segment
- Continuous with sclera
- Low water content
- Convex Curvature
- Higher refractive index than air
Describe the function of the cornea. What does prolonged contact-lens wear?
-
Powerful refracting surface, providing 2/3 of eye’s focusing/refracting power
- It has a convex curvature and a higher refractive index than air
- Acts as a clear window to look through
- Physical + infection barrier
Cornea relies on tear film + aqueous fluid for nutrients + oxygen supply
Prolonged contact-lens wear –> reduces oxygen supply to cornea + increases risk of corneal infection
Describe the physical 5-layer structure of the cornea.
- Epithelium - stratified
- Bowman’s Membrane (specialised basement membrane)
-
Stroma - regularity contributes to transparency, thickest
- Corneal nerve ending provide sensation and nutrients for healthy tissue
- No blood vessels in normal cornea so transparent
- Descemet’s Membrane (specialized basement membrane)
-
Endothelium – pumps fluid out of corneal and prevents corneal oedema,
- Only single layer (simple)
- No regenerative ability
- Endothelial cell density decreases w/ age
- Endothelial cells pump out excess fluid from cornea.
- Thus, dysfunction –> corneal oedema+ cloudiness
Define the uvea and describe its composition.
- Vascular coat of eye ball between sclera + retina.
- Composed of three parts:
-
Iris - Coloured part of the eye:
- Controls light levels inside eye(like aperture on a camera)
- Pupil = round opening in centre of iris
- Iris embedded w/ tiny muscles that dilate + constrict pupil size.
- Ciliary body
- Choroid - Between retina + sclera; composed of layers of blood vessels nourishing back of eye.
-
Iris - Coloured part of the eye:
- These three portions intimately connected –> disease of one also affects others, though not necessarily to the same degree.
Describe the lens structure and function.
Lens Structure:
- Outer Acellular Capsule
- Capsule encases regular inner elongated cell fibres– transparency
- May lose transparency w/ age –> Cataract (opaque lens) – quite common
Function
- Transparency due to regular structure
-
Refractive Power = 1/3 of overall power
- Higher refractive index than aqueous fluid + vitreous
- Accommodation – elasticity
Describe the Lens zonules (suspensory ligaments).
- Lens suspended by fibrous ring known as lens zonules, anchoring lens to ciliary body.
- Consists of passive connective tissue
- Surface of lens normally held flat + tort by tension along stretched lens zonules.

Describe the function of the optic nerve
- Transmits electrical impulses from retina –> brain.
- Connects to back of eye near macula.
- Visible portion of optic nerve = optic disc.
Describe the blind spot test.
Where optic nerve meets retina, no light sensitive cells present –> blind spot.
- On paper, draw a dot, then an “X” 10 cm to L
- Close R eye + hold paper at arm’s length.
- Look at dot + move paper towards you –> X disappears into blind spot!
Describe the macula
- Located roughly in centre of retina, temporal (closer to temples) to optic nerve.
- Small + highly sensitive part of retina allows for detailed central vision+ perform tasks that require central vision e.g. reading.
- Fovea= very centre of macula. Allows us to appreciate detail and perform tasks that require central vision such reading
Describe the anterior and posterior segments if the eye.
Anterior segment - between cornea and lens (filled with aq. fluid) - supplies nutrients
Posterior segment - posterior to lens

Describe the function ciliary body
- Secretes aqueous fluid/humour in eye
- Intraocular Aqueous Fluid flows anteriorly into Anterior Chamber
- Aqueous Fluid supplies nutrient
- Trabecular Meshwork(between ciliary body + cornea) drains fluid out of eye
- Normal IOP = 12-21mmHg

What does glaucoma primarily affect?
Glaucoma primarily affects the retinal ganglion cells
Leads to retinal ganglion cell death + enlarged optic disc cupping = loss of ganglion nerve fibres –> hollowing out of optic nerve head
Describe the types of glaucoma.
Patients with untreated glaucoma lose peripheral vision progressively.
Types
-
Primary Open Angle Glaucoma (on the left) - commonest
- Trabecular Meshwork Dysfunction
- Generally asymptomatic until advanced stages
-
Closed Angle Glaucoma - acute or chronic
- Increased IOP –> iris/lens pushed forward –> blocking trabecular meshwork - vicious cycle
- Risk factors = small eye (hypermetropia), narrow angle at trabecular meshwork
- May present with sudden painful red eye with acute drop in vision
- Can be treated with peripheral laser iridotomy –> create drainage hole on iris

What are the risk factors of glaucoma?
- HIGH PRESSURE DOES NOT MEAN GLAUCOMA àIT JUST MEANS HIGHER RISK OF GLAUCOMA
- Risk factors:
- Family history
- Age
Describe the fovea test.
- Fovea is most sensitive part of retina.
- Fovea has highest [cone cells], but low [rods]
- Explains why stars out of corner of eye brighter than when look directly.
- But only fovea has high-enough [cones] to perceive in detail –> try to read letters using peripheral vision, but can’t
Describe the difference in central and peripheral vision.
-
Central
-
DetailDay Vision,Colour vision - fovea has highest conc. of cone cells
- Reading, Facial recognition
- Assessed by Visual Acuity Assessment
- Loss of Foveal Vision –> poor visual acuity
-
DetailDay Vision,Colour vision - fovea has highest conc. of cone cells
-
Peripheral (by rod cells)
- Shape, Movement, Night Vision
- Navigation Vision
- Assessed by Visual Field Assessment
- Extensive loss of Visual Field –> unable to navigate in environment, patient may need white stick even with perfect visual acuity
Describe the retinal structure.
- Outer layer = Photoreceptors (1st Order) - light detection
- Middle layer = Bipolar Cells (2nd Order) - Local Signal Processing to improve contrast sensitivity, regulate sensitivity
- Sound amplifier
- Inner layer = Retinal Ganglion Cells (3rd Order) - transmission of signal from eye –> brain
Retinal pigment epithelium transports nutrient from choroid –> photoreceptors and removes metabolic waste from retina

Define the macula lutea and fovea
Macula - Yellow patch at centre of retina of about 6 mm in diameter
Fovea - forms pits at centre of macula due to absence of overlying ganglion cell layer
- Clinically assessed with OCT scan (Optical Coherence Tomography)
Describe the difference in Rod and Cone photoreceptors
-
Rod
- Longer outer segment with photo-sensitive pigment
- 100X more sensitive to light than cones
- Slow response to light
- Responsible for night vision (Scotopic Vision)
- 120M rods
-
Cone
- Less light-sensitive, but faster response
- Responsible for day light fine vision and colour vision (Photopic Vision)
- 6M cones
-
3 different types of cone cells for different colours:
- S for blue, M for green, L for red

Describe the distribution of photoreceptors.
- Rods widely distributed all over retina; highest density just outside macula.
- Density of rod photoceptors gently tails off towards periphery.
- Rod photo-receptors completely absent in macula.
- Cone photo-receptors distributed only in macula.
- More rod cells à more pigment à higher Spatial and Time Summation
Explain the peak light sensitivities of different photoreceptors. What photoreceptors are stimulated by yellow light?
- Rods vision has single peak light sensitivity at 498 nm
- S-Cones w/ pigment sensitive to short wavelength –blue
- M-Cones w/ pigment sensitive to medium wavelength –green
- L-Cones w/ pigment sensitive to long wavelength –red
- Yellow light wavelength between peak sensitivities of M and L
- Yellow light stimulates M + L equally
- Experience yellow = green + red combo
Describe Deuteranomaly.
- Commonest form of colour deficiency
- Caused by shifting of M-cone sensitivity peak towards L-cone curve –> red-green confusion.
- Colour vision deficit higher in Males than Females
Describe Anomalous Trichromatism.
colour vision deficits due to shift in photo-pigment peak sensitivity.
Describe Monochromatism and Dischromatism.
- Colour Vision deficits also caused by absence of cone photo-pigments type(s).
- Dichromatism = two cone photo-pigment sub-types present.
- Monochromatism = no colour vision.
- Rod Monochromatism = no cone photo-receptors –> no functional day vision
- Blue Cone Monochromatism –> normal daylight visual acuity
Describe the Isihara Test.
colour perception test for R-G deficiencies only

Describe Light Dark Adaptation.
- Dark Adaptation
- Increase in light sensitivity when moving from light to dark (in daylight, rod cells sensitivity suppressed as cone receptors are responsible for daylight vision)
-
Biphasic Process:
- Cone adaptation = 7 minutes to adapt
- Rod adaptation = 30 minutes – regeneration of rhodopsin
- Light Adaptation
- Adaptation from dark to light
- Occurs over 5 minutes
- Bleaching of photo-pigments
- Neuro-adaptation
-
Inhibition of Rod/Cone function
- rod function is greatly suppressed and cone function takes over within a minute
- Pupil Adaptation (minor) = constriction with light
Describe refraction (refraction index) and reflection
- Index of Refraction = speed of light in first medium/ speed of light in new medium
- As light goes from one medium to another –> velocity CHANGES
- As light goes from one medium to another –> path CHANGES
- When light reflected, angle of incidence = angle of reflection
- How do we change refraction? CHANGE THE LENS
- Concave – diverging
- Convex – converging - has a real focal point

Define Emmetropia.
- Adequate correlation between axial (eye) length + refractive power (of 0)
- Parallel light rays fall on retina (no accommodation)

Define Ametropia and types of them.
- Mismatch between axial length + refractive power
-
Parallel light rays don’t fall on retina (no accommodation); types:
- Near-sightedness (Myopia)
- Farsightedness (Hyperopia)
- Astigmatism
- Presbyopia

Describe Hyperopia
Parallel rays converge at focal point posterior to retina
- Aetiology: not clear, inherited; causes:
- Excessive short globe (axial hyperopia), more common
- insufficient refractive power (refractive hyperopia)
- Symptoms: (originally compensated by accommodation until certain point)
-
Near visual acuity blurs relatively early
- Blur varies in degree
- blurred vision more noticeable if person tired, printing is weak or light inadequate
- Asthenopic symptoms: eye pain, headache in frontal region, burning sensation in eyes, blepharoconjunctivitis
- Lazy Eye = Amblyopia – uncorrected hyperopia > 5 diopters
-
Near visual acuity blurs relatively early
- Treatment = convex glasses/contacts or remove lens + put in IOLs (cataract extraction)

Describe myopia.
Parallel rays converge at focal point anterior to retina
- Aetiology not clear, genetic factor; Causes:
- Excessive long globe/eye (axial myopia), more common
- Excessive refractive power (refractive myopia)
- Symptoms:
- Blurreddistancevision à squint to improve uncorrected visual acuity
- Headache
- Treatment = concave glasses or contacts or surgery

Describe Astigmatism.
- Parallel rays focus in multiple focal lines, NOT single focal point
- Aetiology = heredity; causes:
- Refractive index/cornea not evenly shaped, not spherical à refract differently along one meridian than along meridian perpendicular to it à 2 focal points (punctiform object is represent as 2 sharply defined lines)
-
Symptoms
- Asthenopic symptoms (headache, eye pain)
- blurred vision
- distortion of vision
- head tilting + turning
-
Treatment
- For regular astigmatism = cylinder lenses w/ or w/o spherical lenses (convex or concave), Sx
- Irregular astigmatism = rigid CL, surgery
Describe Presbyopia.
- Naturally occurring loss of accommodation (focus for near objects)
- Onset from age 40 years
- Distant vision intact
- Treatment = corrected by convex glasses in near vision à increase refractive power
- E.g. reading, Bi/trifocal, Progressive power glasses

Describe the near response triad.
For adaptation for near vision:
- Pupillary Miosis (Sphincter Pupillae) –> increase depth of field
- Convergence (medial recti from both eyes) to align both eyes to near object
- Accommodation (Circular Ciliary Muscle) –> increase refractive power of lens
Describe the types of optical correction.
- Spectacle lenses
- Monofocal: spherical or cylindrical
- Multifocal
- Contact lenses
- Higher quality of optical image + less influence on size of retinal image than spectacle lenses
- Indication: cosmetic, athletic activities, occupational, irregular corneal astigmatism, high anisometropia, corneal disease
- disadvantages: careful daily cleaning + disinfection, expense
- Complication: infectious keratitis, giant papillary conjunctivitis, corneal vascularization, severe chronic conjunctivitis
-
Intraocular lenses:
- Replacement of cataract crystalline lens
- Give best optical correction for aphakia, avoid significant magnification, and distortion caused by spectacle lenses
-
Surgical correction:
- Keratorefractive surgery: RK, AK, PRK, LASIK, ICR, thermokeratoplasty
- Intraocular surgery: clear lens extraction (with or without IOL), phakic IOL
Describe the accommodation mechanism.
Mediated by efferent oculomotor nerve
- Contraction of Circular Ciliary Muscle in Ciliary Body
-
Relaxes zonules, which are normally stretched between ciliary body attachment and lens capsule attachment
- Zonules are passive elastic bands with no active contractile muscle
- When no zonular tension, lens returns to natural convex shape due to innate elasticity
- Increases refractive power of lens