Chapter 2: The Eye Flashcards
What is the radius of curvature of the cornea? What is the radius of curvature of the sclera? What effect do the differences in radius of curvature have on the shaper of the eye?
8 mm
11 mm
Therefore, shape of the globe is an oblate spheroid
What is the AP diameter of the eye? What is the average transverse diameter of the eye?
23-25 mm
24 mm
What are the borders of the anterior chamber? What is the volume of aqueous it holds? How deep is it?
Bordered by the cornea anteriorly and the iris posteriorly
200 micro L
3 mm deep
What are the borders of the posterior chamber? What is the volume?
posterior of the iris to the anterior of the lens/face of the vitreous
volume= 60 micro L
Vitreous Cavity
comprises 2/3 of the volume of the eye
5-6 mL
What is the total volume of the average eye?
65-70 mL
What are the layers of the eyeball?
outermost= cornea + sclera Middle= Uvea (choroid, ciliary body, iris) Inner= Retina
What are the three layers of the pre corneal tear film?
outer= superficial oily layer (produced by meibomian glands) middle= aqueous layer (produced by lacrimal glands) bottom= Deep mucin layer (produced by conjunctival goblet cells)
What are the functions of the pre corneal tear film?
lubrication
provides nutrients and 02 via diffusion
provides a clear smooth optical surface
contains Ig’s, lysozymes, and lactoferrin
What are the dimensions of the avg cornea? How much refractive power does the cornea provide?
dimensions: 12 mm wide x 11 mm tall x 0.5-1.0 mm thick (0.5 in center, 1.0 at periphery–due to posterior surface being more curved than anterior surface)
Cornea provides 2/3 of refractive power of the eye, or about +43 diopters
Note; center of cornea is nearly spherical, with a diameter of 4.0 mm and a thickness of 0.5 mm
Is the thinning of the cornea toward the periphery symmetrical in all quadrants?
No, it becomes more flat in the nasal and superior quadrants then in the inferior and temporal quadrants.
Embryologically, what is the anterior surface of the cornea derived from?
Surface Ectoderm
What kind of cells cover the anterior surface of the cornea?
non-keratinized stratified squamous epithelium
What cells cover the basal lamina of the outer layer of the cornea?
2-3 layers of polygonal “wing cells”
Are the surface of the wing cells smooth? If not, how does the body compensate for this?
The surfaces of the cells are covered with microplicae and microvilli, causing it to be irregular. The body compensates via the pre corneal tear film
Where do the corneal epithelial cells originate from?
They originate from limbal stem cells and migrate centripetally.
What non-epithelial cells are found in the outer layers of the cornea?
wandering histiocytes, macrophages, lymphocytes, and pigmented melanocytes.
antigen-presenting langerhans cells found peripherally (migrate centrally with keratitis or old age)
Where is Bowmans layer located? Does it regenerate after injury?
located beneath the basal lamina of the corneal epithelium, is a tough layer consisting of randomly dispersed collagen fibrils 8-12 micrometers thick
Is not restored after injury–becomes scar tissue
Corneal Stroma
constitutes 90% of corneal thickness, composed of collagen-producing keratocytes, ground substance, and collagen lamellae
How are the collagen fibrils in the cornea oriented?
In the anterior 1/3 of the stroma, the fibers are oriented obliquely
In the posterior 2/3 of the stroma, they are oriented parallel
What factors about the collagen promotes corneal transparency?
uniform fibril size and separation
What types of collagen are found in the corneal stroma?
Type I, III, V, VII
What is the ground substance found in the cornea? How does it contribute to corneal edema?
Ground substance consists of proteoglycans, which are highly charged, and contribute to swelling during corneal edema.
How many keratocytes are found in the cornea? How are they distributed within the stroma?
There are 2.4 x 10^6 keratocytes in the average adult cornea. There is a higher density of keratocytes anteriorly (1058 cells/mm^2) compared to posteriorly (771 cells/mm^2)
How do the keratocytes contribute to corneal transparency?
They have a flat profile and an even distribution within the coronal plane that minimizes the disturbance of light transmission
What is Descemets Membrane?
a true basement membrane, the basal lamina of the corneal endothelium
PAS +
Rich in Type IV Collagen
T/F: The thickness of descemets membrane increased with age?
True. At birth, it is between 3-4 mm thick, and increased in size until adulthood, where it is 10-12 mm thick.
What are the parts of Descemets Membrane?
Anterior banded zone that develops in utero, and a posterior non-banded zone that develops throughout life.
What are Hansall-Henle Warts?
Peripheral excrescences of descemets membrane that are common findings in the elderly
Describe the make-up of the corneal endothelium? From what embryonic layer are they derived?
Consists of a single layer of mainly hexagonal cells
Derived from neural crest cells
Describe the orientation of the endothelial cells and their function
The cells are oriented that their apical surface faces away from descemets membrane. They function as an ion pump that helps maintain corneal deturgescence and transparency.
Can you replace corneal endothelial cells?
Endothelial mitosis is limited. Therefore, when injury occurs, residual cells typically spread and enlarge, decreasing cell density.
What is the sclera?
covers 4/5 of the posterior surface of the globe
is covered by Tenons capsule
Where is the sclera the thinnest? Where is it the thickest?
It is thinnest behind the insertions of the rectus muscles (0.3 mm)
It is thickest at the posterior pole around the ON head (1.0 mm)
When scleral rupture occurs due to blunt trauma, where is the most common location of rupture?
The superonasal quadrant near the limbus
What is the blood supply of the sclera?
It is essentially avascular, except for the superficial episcleral vessels and the interscleral vascular plexus
What are Emissaria?
they are numerous channels that penetrate the sclera allowing for passage of arteries/veins/nerves
What are Axenfeld Loops?
They are branches of the ciliary nerve that supply the cornea, that sometimes leave the sclera to form loops posterior to the limbus
What is the episclera?
consists of dense vascular CT that merges with the superficial sclera and tenons capsule/conjunctiva
What part of the sclera contains the fibers with the largest diameter?
The outer collagen fibers have a larger diameter (1600 A) compared to the inner fibers (1000 A)
What is the opaque appearance of the sclera attributed to?
Two factors:
1- increased variation in the collagen fibril separation and diameter
2- increased degree of fibril interweaving
What is the limbus?
the transition zone b/w the peripheral cornea and the sclera (occurs over 1.0-1.5 mm)
What structures comprise the limbus?
There are 5 structures in total: 1- conjunctival and limbal palisades 2-Tenons Capsule 3- Episclera 4- Corneoscleral stroma 5- Aqueous outflow apparatus
How is the surgical limbus divided?
Into 2 zones.
1- Anterior blue-gray zone: overrides the clear cornea and extends from bowman’s membrane to schwalbes lines
2- Posterior White Zone: overlies the TM and extends from schwalbes line to the scleral spur (iris root)
What structures comprise the Anterior Chamber Angle?
1- Schwalbes Line (termination of Descemets) 2- Schlemm Canal and TM 3- Scleral Spur 4- Anterior border of Ciliary Body 5- Iris
Under what conditions is the angle deeper? More Shallow?
The angle is deeper in patients who are aphakic, pseudophakic, and myopic
The angle is more shallow in hyperopic patients
How deep is the angle at the center (typically)?
3 mm
What is the volume of the anterior chamber in the emmetropic eye?
200 micro L
What are the paths that the aqueous can drain through?
Primary drainage via the TM
Seconary drainage via the uveoscleral pathway
In what population does 50% of the aqueous drain via the uveoscleral pathway?
Young people
Internal Scleral Sulcus
accommodates schlemms canal externally and TM internally
Insertion and action of the longitudinal ciliary muscle? Innervation?
Inserts onto the scleral spur. Contraction causes the TM to open and therefore increased drainage.
Nerve fibers mediated via sympathetic, sensory, and pterygopalatine pathways
What is the Trabecular Meshwork?
a circular sponge work of CT lined by trabeculocytes consisting of 3 laters. Its apex is located at Schwalbes line and its base at the scleral spur and ciliary body
What are the three layers of the TM?
The Uveal Portion, the Corneoscleral Meshwork, and the Juxtacanalicular Tissue.
Uveal Portion of the TM
Composed of cord-like trabeculae
Has fewer elastic fibers than corneroscleral meshwork
apertures are larger and less circular than that of the corneroscleral meshwork
Corneoscleral Portion of TM
a series of thin, flat, perforated CT sheets arranged in a laminar pattern
each beam is covered by a monolayer of thin trabecular cells
Juxtacanalicular Tissues
Invest the extent of Schlemms Canal, including endothelial meshwork
What is the Endothelial Meshwork, and what is its significance?
= a multilayered network of cells b.w the outermost layers of the corneoscleral meshwork and the endothelial lining of schlemms canal
Significance: contributes most to outflow resistence
Why does the endothelial meshwork contribute most to outflow resistance?
thought to contribute due to it being a narrow and tortuous pathway that can also be blocked by glycosaminoglycans and proteoglycans
What is Schlemms Canal?
a circular tube resembling a lymphatic vessel formed by a continuous monolater of non-fenestrated endothelium with a thin CT wall
Endothelial cells are connected by tight junctions
What are the collector channels? What are they also known as?
arising from Schlemms canal, are 25-30 channels that drain into either the deep, midscleral, or episcleral venous plexuses.
Channels that drain into the episcleral venous plexuses are also known as “aqueous veins”
What is the uveal tract?
the main vascular component of the eye consisting of the iris, choroid, and ciliary body
What are the attachment sites of the uveal tract?
There are 3 attachment sites:
- Scleral Spur
- Exit points of the vortex veins
- Optic Nerve
What is the Iris?
The most anterior portion of the uveal tract
made up of blood vessels and CT
mobility allows the pupil to change size
What is the Iris Stroma?
composed of pigmented cells (melanocytes) and non-pigmented cells, collagen fibrils, and a matrix (containing hyaluronic acid)