S3: The Eye and Visual Pathways Flashcards

1
Q

How does the anatomy of the eye give it a stable shape?

A
  • The outer coating (sclera) of the eye is flexible so it will bend but won’t stretch. The sclera continues as the transparent cornea at the front.
  • The shape of the eye is maintained by internal pressure by the aqueous fluid. The aqueous humour fills the front of the eye and the vitreous humour is the transparent jelly at the back. The aqueous humour diffuses back to vitreous to hydrate it.
  • As long as the aqueous humour is being produced and removed at the right rate, the pressure in the eye will remain stable and the shape of the eye is kept.
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2
Q

How does the anatomy of the eye give it a the ability to focus a image?

A

It has an optical apparatus:

  • Lens sits in central axis of the eye and held in place by a ring of suspensory ligaments attached to ciliary bodies.
  • The cornea us a powerful lens that refracts the right rays.
  • The iris (coloured) has a pupil at its centre.
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3
Q

How does the optic apparatus work?

A
  • Light reflects off the point we are looking at and some light rays will hit and pass straight through the cornea and some will hit the lens which refracts light rays and bends them inwards into a single point on the retina. The cornea is also a powerful lens and the lens is less powerful in comparison.
  • However, the lens can change shape allowing variable fine focus allowing us to see different distances by changing focal power (becoming thicker and thinner).
  • Our pupil becomes larger and smaller to adapt to different levels of light so our iris controls how much light enters our eye by blocking it. Our retina also has the capacity to adapt to light and it is stronger than our pupil.
  • Our pupil has one important characteristic - it cuts out light rays that would otherwise go to edge of lens. Our lens is just a bag of proteins and more lens used, the less focused the light rays will be so to have good focus we need to use to centre of the lens which is what the iris and pupil do. So during darkness, the pupil opens up to get more light in eye so image is bright enough to see but it does it at the expense of the quality and focus of the image (it gets blurrier).
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4
Q

Describe the retinal layers in the anatomy of the eye and how they are needed to capture a pattern of light

A
  • The neural retina develops as part of the neural tube so is a part of the brain, the optic nerve hence is a central nerve (of CNS). The axons in the optic nerve are myelinated by oligodendrocytes rather than Schwann cells and are therefore vulnerable to MS.
  • Photoreceptors in the retina are the light sensitive cells and are linked via afferents to the retina ganglion cells (these have axons which run along the surface of retina which bundle and form optic nerve which then carry signal back to the brain).
  • The neural retina ends at the ora serrata (serrated edge). This is a bit of the retina but is non-neural. The non-neural retina extends back and goes behind the neural retina. So the neural retina is resting on this, here is called the retinal pigment epithelium.
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5
Q

Describe layers of the cross section through the peripheral retina

A
  • At the bottom is the vitreous layer that is inside the eye.
  • The neural retina includes everything above this up until the pigment epithelium , behind which is the blood rich choroid.
  • The photoreceptors are on the outside of the globe and the light passes from the inside to the outside through the retina.
  • The layers of the retina are are (inside eye to outside): the ganglion cells, interneurone layer, photoreceptor layer and the pigment epithelium.
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6
Q

What is the primary role of the retina?

A

To detect light and this is done by photoreceptors.

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7
Q

What are the two photoreceptors and their role?

A
  • Cone photoreceptors are used for daylight vision (works best in bright light and have a wider range of illumination). These can constantly reset their sensitivity so can work in different levels of light.
  • Rod photoreceptors are used for night vision, also called scotopic vision (work best in dim light and in bight light their mechanism saturates so become useless). These are very sensitive so they work at night.
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8
Q

What is the secondary role of the neural retina?

A

Transmit information they detect to the brain. This is done by afferents and in the visual system, these are the ganglion cells that sit in an layer in the retina. The axons of the ganglion cells run over the surface of the retina and head to the optic nerve.

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9
Q

What does the bipolar interneurone do?

A

It connects the photoreceptors to the ganglion cells. Interneurones are found in the inner nuclear layer which is found between the photoreceptor layer and the ganglion cells.

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10
Q

What forms the ganglionic cell receptive field?

A

The rays of the visual image that enter our eye that are detected by these cones ( a few of them), form the retinal receptive field for this ganglionic one ganglion cell. Changes in brightness in this field will ultimately be sent to this ganglion cell directly to relay back to the brain.

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11
Q

What is the inherent weakness of the eye in the peripheral retina?

A
  • When the light enters the eye it has to pass through the vitreous and multiple layers of the retina before it reaches the cones. It is also the outer portion of the cones which actually detect the change in illumination.
  • The multiple layers however not 100% transparent rather they are translucent and hence light gets scattered.
  • This is a weakness as the light that hits the retina being detecting is blurred because it passes through the inner segments of the retina first.
  • Where the light from the visual image is blurred there is no point in sampling that particular visual image and sending it off because it is such poor quality.
  • Instead, the image will be sampled by cones that are separated by a large number of rods.
  • These pool of cones will converge input onto a single ganglion cell, so the receptive fields in the peripheral retina (where this is most present) are very large and because of this the resolution of the image gets poorer as you go further out.
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12
Q

Describe function of the peripheral retina

A
  • Peripheral retina is only capable of coarsed vision hence the image we see is optically blurred.
  • This is due to the fact that cone photoreceptors in the periphery are large and spaced widely apart (separated by rods) to try and gather as much of the scattered/blurred light as possible.
  • The bipolar cells pick up input from multiple cones. These cones gather this blurred light and converge it onto a single ganglion cell to transmit the information.
  • This is why when reading we can only read well with the centre of our eyes, in the periphery we will be unable to pick out words as the image is blurred due to the large receptive fields.
  • The visual receptive fields get lower so resolution falls but also the wiring gets more disorganised and less specific. This is why we don’t have good colour vision in the periphery.
  • So convergence gets larger, pixel size bigger and focus worse as we go further out into the periphery of the retina.
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13
Q

What is the central retina?

A
  • Vision from our central retina produces clear vision.
  • Within the central retina is an area of yellow pigment called macula lucida. This catches some short wave length light which is damaging so it protects the fovea.
  • Within the macula lucida is the fovea centralis. This is specialised and a small area of the eye. The fovea has no overlying blood vessels or capillary bed.
  • Surrounding the macula lucida is the global central retina.
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14
Q

Describe how the fovea is specialised for its function

A

The fovea is specialised because it contains a small region, only 0.35 mm across where the ganglion cells and interneurones have been pushed back and halted to leave a foveal pit.

  • This directly exposes the photoreceptors and means that light that passes into the eye and vitrous humour does not have to pass through multiple layers e.g. nerve cells or dense capillary network first. The light is therefore not scattered.
  • To further enhance the resolution the cones in the foveal pit are very slender thus a huge number are packed together. Each photoreceptor then synapses onto a single ganglion cell, so there is no convergence. This means the fine image (because no scattering!) detected by each single photoreceptor is signalled to a single ganglion cell so there is no “noise” added to the fine image and instead is signalled back to the brain completely as the fine image.
  • There are no rods and no blood vessels.
  • The fovea also has the best colour vision because tiny receptor fields can keep input from the difference types of photoreceptors separate (red, green and blue cone).
  • The foveal pit is the only part of the eye where vision is very well focused/ resolution and it visualises about the size of your thumbnail at arms-length so the fovea represents a tiny amount of our visual field.
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15
Q

What would damage to fovea lead to?

A

If there is damage to the fovea or improper function this would have very serious problems and one would be registered blind.

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16
Q

Describe the primary visual pathway

A

The primary visual pathway is the pathway from the eye to the thalamus to the primary visual cortex.

  • This starts at the retinal ganglion cells which project back to the lateral geniculate nucleus (LGN) in the thalamus.
  • From here, axons go back to the primary visual cortex which is located in the occipital cortex, or more precisely. embedded in the calcarine sulcus. The axons that go back from the LGN are part of the optic radiation (optic nerve, tract and chiasm).
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17
Q

What other pathway do we have alongside the primary visual pathway?

A
  • Pathway that is associated with reflexes and orientating responses.
  • The nuclei involved in this reflexive movement and control of the eye are in the brainstem. The most prominent one being the superior colliculi.
  • The superior colliculi are involved in reaching movements, turning the head and eyes towards a stimulus requiring attention and navigating in locomotion.
  • Hence the ganglion cells that project back to the lateral geniculate nucleus have branches that go to the brainstem to drive these reflexive processes but these brainstem structures are not directly involved in visual perception.
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18
Q

What is the retinatopic cortex?

A

Neighbouring points within the retina project to neighbouring points within the visual cortex. The fovea has a far larger area of cortex, as does the macula.

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19
Q

Describe how the image is inverted by the optics

A
  • The nasal axons (from nasal half of the retina) have to cross at the chiasm and run along side the ones at equivalent location of other retina. Axons from the right temporal hemiretina join axons from the left nasal hemiretina in the right optic tract synapsing at the right LGN which projects to the right primary visual cortex.
  • The right temporal retina and left nasal retina will be looking at the left visual field, thus the right optic tract, LGN and visual cortex are involved in dealing with the left visual field.
  • RHS visual image is mapped to L visual cortex in brain. So each half of the brain is looking at the contralateral side of the world.
  • Image is flipped when it passes through the visual pathway, The LHS visual world equated to RHS of two retina to RHS of the brain.
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20
Q

What gives up binocular vision?

A

The two fields (R and L eye) are not separate, rather most of what we can see we see simultaneously through both eyes as the visual fields cross over. This gives us binocular vision with a small amount on either side that we can see only through one eye.
- Remember we have a nasal retina and temporal retina.

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21
Q

Key rules for visual field defects

A
  • Behind the optic chiasm the defect is symmetrical, before the optic chiasm the defect is independent in both eyes.
  • Each half of the brain maps the contralateral visual field.
  • The retinal image is inverted (left is right, up is down and vice versa).
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22
Q

Describe visual field defect: scotoma

A

If the scotoma was in the right eye only (temporal), it would be due to damage to the right eye nasal retina, which normally takes in light from the right visual field. In this case, there has been loss of the right visual field in the right eye due to a detached retina.

23
Q

What can retinal injury be caused by?

A

Retinal injury can be caused by detachment, tumour, infection or metabolic disease. The particular defect depends on the location of the lesion on the retina.

24
Q

Describe visual field defect: monocular blindness

A

Monocular blindness is a complete loss of the visual field in one eye while the other eye is normal.
- If the monocular blindness was in the left eye, the lesion would be in the left optic nerve. This is because it has taken out all the ganglion axons from this eye, leading to complete blindness in just the eye.

25
Q

What can cause damage to the optic nerve?

A

Damage to the optic nerve may be caused by tumour, a cranial fracture (as optic nerve passes through optic foramen) or multiple sclerosis (as optic nerve is a central pathway).

26
Q

Describe visual field defect: homonymous hemianopia

A

Homonymous hemianopia (hemianopia = blindness over half of the visual field, usually either left or right of the midline, homonymous = the same side of each eye).

  • .In this case there is complete loss of the right visual field in both eyes so a right sided homonymous hemianopia.
  • The lesion would be in the left optic tract, left cortex or left LGM.
27
Q

What can cause optic tract damage?

A

Optic tract damage may be caused by tumour or stroke and if damage is complete. It will lead to contralateral homonymous hemianopia.

28
Q

Describe visual field defect: homonymous hemianopia with macula sparing

A

In this case the right visual field has been lost except for the visual field that is visualised by the macula.
- This is caused by lesion in primary visual cortex. As the macula has such a massive representation on the visual cortex, if it is damaged there is a good chance some macular will survive.

29
Q

What can cause lesion in primary visual cortex?

A

It may be due to tumour or stroke.

30
Q

Describe visual field defect: tunnel vision

A
  • In this case, the visual field loss is unmatched and in the periphery.
  • It must be caused by damage in front of optic chiasm so bilateral retinal damage.
31
Q

What can cause retinal damage?

A

This damage is often elicited by glaucoma (raised intraocular pressure).
This is because the raised intraocular pressure pushes back on the optic nerve and damages nerves from the peripheral retina. This causes tunnel vision.

32
Q

Describe visual field defect: central scotoma asymmetrical

A

Here there is disease of the macular. This is commonly age related macular degeneration (AMD), where there is a loss of central photoreceptors.
This will result in an unmatched (as affecting eye before optic chiasm) central scotoma and a massive loss of acuity (as we use our fovea for acuity).
- Cause is likely lesion within the retina.

33
Q

Describe visual field defect: central scotoma symmetrical

A

This is likely to be a lesion in the primary visual cortex.

34
Q

Describe visual field defect: bilateral temporal visual loss

A

Here there are blind spots on the left side of the left eye and right side of the right eye.
In this case, the areas where the vision has been lost would usually be processed by the nasal retina, which processes information of the peripheral field. It is the temporal field that has been lost.
- Due to lesion in optic chiasm as the nasal retina fibres cross over. It is the nasal fibres that take in the temporal visual field.

35
Q

What causes damage to optic chaism?

A

It may be caused by a pituitary tumour. Large central tumour would cause the textbook bitemporal hemianopia (i.e. temporal field loss in both eyes).
Also called bilateral temporal visual field loss.

36
Q

Describe visual field defect: homonymous upper quadrantanopia

A

Here we have matching visual field loss in the same top corner (quandrant) in both eyes.
It is called homonymous superior quadrantanopia.
- The lesion must be in the optic radiation at temporal loop. The axons in the temporal loop contain fibres from the lower half of the retina and therefore take in the superior visual field.

37
Q

What causes damage in optic radiation?

A

Tumour/Stroke.

38
Q

Summary of lesions

A
  • Glaucoma preferentially compresses axons of the peripheral retina, causing a loss of peripheral vision called tunnel vision
  • A lesion of one optic nerve causes monocular blindness in the corresponding eye (as the nerve contains all the fibres for the visual field of that eye)
  • A lesion of the optic chiasma destroys crossing nasal fibres (nasal fibres look at the temporal field on both sides) this leads to a bitemporal hemianopia
  • A lesion of the optic tract (which is carrying axons for the right OR left visual field only) will lead to a contralateral homonymous hemianopia (contralateral as other side e.g. right optic tract will lead to left hemianopia, homonymous as in both eyes, hemianopia as in half visual field loss)
  • Lesions of the optic radiation are unlikely to destroy all of it unless very large
  • Lesions of the upper part of the optic radiation going under the parietal cortex will destroy the pathway from the upper retina which looks downwards, leading to a contralateral homonymous lower quadrantanopia
  • A lesion of the temporal lobe will destroy the pathway from the lower retina which looks upwards, thus produce a contralateral homonymous upper quadrantanopia
  • Lesions of the visual cortex (like lesions of optic tract) create contralateral homonymous hemianopia. However unlike lesions of the optic tract, there is frequently macular sparing as the representation of the macular is so large in the primary visual cortex.
39
Q

List muscles that control the optics

A
  • Sphincter pupillae
  • Dilator pupillae
  • Ciliary muscles
40
Q

Describe muscle involvement in dilating the pupil

A
  • The sphincter pupillae is a ring muscle and when it contracts it makes the pupil smaller. When the sphincter pupillae is relaxed, the pupil is large and dilated.
  • Dilator pupillae will produce a certain amount of tone which will pull the pupils large if the constrictor stops contracting as hard. When the eye dilates it is NOT in response to a decrease in light rather it is due to strong emotional drive. For example, fear, love which can occur during activation of sympathetic nervous system by NA. This dilation is brought about by the long ciliary nerves which innervate dilator pupillae. This is a sympathetic pathway.
41
Q

Describe muscle involvement in constricting the pupil

A

The sphincter pupillae are under the control of the short ciliary nerves which are parasympathetic nerve fibres, they use Ach as their neurotransmitter. The short ciliary nerves come from the ciliary ganglion, a parasympathetic ganglion. The pre-ganglionic fibres going into this pathway of contracting sphincter pupillae are actually primarily driven by the retina itself. This is the direct/consensual light reflex.

42
Q

Describe muscle involvement in changing the size of the lens

A
  • When the ciliary muscle contracts, it moves forwards and this causes the zonular fibres/suspensory ligaments to relax and be under less tension.
  • This causes the lens to bulge and this increases the refractive power.
  • It is through changing the shape of the lens that allows us to accommodate to distance and it is innervated by the short ciliary nerve parasympathetic fibres. CN III carries parasympathetic pre-ganglionic fibres to the ciliary ganglion.
43
Q

Describe the direct light reflex

A
  • At the back, there’s the brainstem with CN III going out to the ciliary ganglion.
  • In the retina, we have the retinal ganglion cell which will be activated if there is illumination of that retina.
  • Signals from that ganglion cell are sent to various places, including the brainstem, to the pretectal nucleus.
  • The pretectal nucleus sends axons to the Edinger-Wesphal nucleus. This sends pre-ganglionic parasympathetic fibres (running down CN III) to the ciliary ganglion.
  • These will synapse with the post-ganglionic short ciliary nerves and there will be release of Ach onto the sphincter pupillae causing the pupil to constrict of the same eye that was subject to the increased illumination.
  • This is the direct reflex and allows the pupil to contract if light becomes too bright.
44
Q

Describe the consensual light reflex

A
  • From the direct light reflex, it is not just the pupil of the same eye that was exposed to increased luminescence that will contract, the iris of the other eye will also contract making the pupil smaller.
  • Hence increased light in one eye will lead to constriction of both pupils!
  • This is because the pretectal nucleus neurones synapse onto both sides of the Edinger-Westphal nucleus, so both parasympathetic pathways get activated.
  • This is the consensual light reflex.
45
Q

Why is the consensual reflex of clinical importance?

A

This is something HCPs will look at when a patient may have undergone trauma etc. and they have raised intracranial pressure. This is because the preganglionic fibres in cranial nerve III are vulnerable to raised intracranial pressure. This can stop them functioning, meaning that one side may respond far slower.

46
Q

What structure in the eye is primarily responsible for focusing light?

A

Cornea

47
Q

Difference cornea and lens in refracting light

A

The cornea is fixed in its refractory ability, the lens although weaker is adjustable and hence allows us to accommodate to things far away and close.

48
Q

Describe how the size of the pupil is a compromise between light and focus of image

A
  • The iris controls the amount of light that enters the eye via the pupil.
  • If the pupil was a pinpoint, then the image would be clearly focused on the back but it would be very dim as hardly any light would get through.
  • The larger the pupil the more light enters in and will hit the outside of the lens which is not as good at focusing the image and it leads to more blur.
  • Hence the pupil is as small as possible to optimise the clarity of the image but has to be big enough in different light levels to produce a bright enough image on the retina to be useful.
49
Q

Describe how a normal eye works when looking at an object close and far

A
  • In an individual who has normal vision and requires no visual aids, the length of their eye is perfectly matched to the strength of their optics.
  • If the person is looking at something very far away, the light rays will enter into their eye near enough parallel and only need a little extra refraction in the lens to get the image onto the retina (so lens will be flattened).
  • If an individual wants to look at an object close to them the light rays will be diverging more thus more refractive power is needed to bring the rays together. The lens will be made fatter and this will refract the light nicely onto the retina and it is well focused.
50
Q

Describe how a myopic (myopia) eye works when looking at an object close and far

A
  • This is when the optics of their eye are simple too strong, the refractive power is too much for the length of their eyeball. This makes the eye myopic.
  • The individual with a myopic eye will look at something close and lens will bulge as light rays are more divergent. However, the power of the optics is too strong and thus the light rays and image will be refracted so strongly it will focus in front of the retina. This is what a myopic eye is, when objects are focused in front of the retina.
  • A myopic eye can however still focus on close objects by flattening out the lens for close objects and thus reducing the refractive power to get the image onto the retina. This flattened lens would usually only be for distant objects, so person is essentially using long distance vision to view close objects. As the myopic eye has compensated and used long distance vision to look at close objects, the lens cannot get flatter to look at long objects.
  • This is why myopia is called short sightedness, as they can’t see at short distance but they are able to adapt so they can.
51
Q

How can myopia be corrected?

A

The way to fix myopia is with a concave (negative) lens. This will diverge the rays a bit more and thus weakens the overall optics of the eye so the image will be able to focus onto the retina.

52
Q

Describe how a hypermetropic eye works when looking at an object close and far

A

If the optics of a persons eye are too weak and the refractive ability of their eye is too weak for the length of their eye. Then the eye is hypermetropic, this is where the image focuses behind the retina as the optics are not powerful enough to focus it properly!
- We can see this where the long distance image with its rays very straight, cannot be focused enough.
- However just like in myopia the lens can compensate and adapt in order to focus far away objects by bulging out and increasing the refractive power (as if the object were close!). This brings the object into focus on the retina.
- The problem then arises with near objects, here the light rays are much more divergent thus requiring more refraction by the lens.
However the lens has already refracted strongly for distant objects and cannot get any more fat and has reached its maximum refractive power. This level it is not enough and the image will be focused after the retina.

53
Q

How can Hypermetropia be corrected?

A

Hypermetropia can be corrected with a convex (positive) lens that increases the refractive power of the overall optics. This helps bring the rays together and gets them focused onto the retina.

54
Q

Describe problems an ageing eye encounters

A
  • Unfortunately the lens has a very little capacity to regenerate and thus can fail with age.The reason is that in order to have such a transparent structure it needs to be made up of cells that contain very few organelles. Due to this they have very little regenerative capacity.
  • In middle age, the lens becomes stiff and stops responding to changes in the ciliary muscle. Because of this focus becomes fixed (presbyopia) and the individual may need two pairs of glasses to see properly both long and short distance.
  • In old age or in pathological conditions things can get worse, the lens can become opaque, this is a cataract. The only solution here is to take it out and replace it with an artificial lens.