Visual system Oculus et structurae pertinentes

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Visual systemOculus et structurae pertinentes

• David Kachlík

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Odilo Redon
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Orbita Orbit

• tetrahedral pyramid tilted dorsally
• aditus x apex
• 10 openings their contetnt
• m. orbitalis Mülleri smooth muscle in the
  fissura orbitalis inferior
• content eyeball, oculomotor muscles, fat pad and
  related structures

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Orbita osseous walls

• cranially pars orbitalis o. frontalis (fovea
  trochlearis spina trochlearis, incisura/foramen
  frontalis/supraorbitalis, fossa glandulae
  lacrimalis), ala minor o. sphenoidalis (fissura
  orbitalis sup.)
• medially processus frontalis maxillae (fossa
  sacci lacrimalis), os lacrimale, lamina orbitalis
  o. ethmoidalis (foramen ethmoidale ant. et
  post.), ala minor o. sphenoidalis
• laterally facies orbitalis o. zygomatici
  (foramen zygomaticoorbitale), facies orbitalis
  alae majoris o. sphenoidalis

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Orbita osseous walls

• caudally facies orbitalis o. zygomatici, facies
  orbitalis corporis maxillae (sulcus et canalis
  infraorbitalis, fissura orbitalis inf.),
  processus orbitalis o. palatini
• aditus orbitae ? apex orbitae
• orbita is divided by theoretical planes into 3
  levels

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Orbita related structures

• medially cellulae ethmoidales (via very thin
  lamina orbitalis ossis ethmoidalis)
• caudally sinus maxillaris
• cranially fossa cerebri anterior
• dorsally sinus cavernosus fossa pterygopalatina

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Visual system

• bulbus oculi eyeball
• structurae pertinentes oculi related structures
  of the eye
• topography regio orbitalis
• development

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Eyeball

• tunica fibrosa (externa)
• tunica vasculosa (media)
• tunica interna (nervosa)
• corpus vitreum (vitreous body) lens

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Eyeball

• polus anterior, posterior
• equator x meriadiani
• axis bulbi externus, internus
• axis opticus ( linea visus)

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Tunica fibrosa (externa)

• sclera
• cornea

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Tunica fibrosa (externa)Sclera

• dense connective tissue ( reticulum
  trabeculare), collagen fibres, fibroblasts,
  ground substance
• lamina episcleralis, substantia propria, lamina
  fusca
• lamina cribrosa (entrance of n. II.)
• 5/6th of the eyeball surface, ø 2,2 cm
• sinus venosus sclerae (canalis Schlemmi s.
  Lauthi)
• sulcus sclerae sclerocorneal junction limbus
  corneae (angulus sclerocornealis)

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Tunica fibrosa (externa)Cornea

• perfectly transparent, non-vascular
• limbus, vertex
• 5 layers
• epithelium anterius cornae (stratified squamous
  ep.)
• lamina limitans anterior (Bowmans membrane)
• substantia propria corneae
• lamina limitans posterior (Descements membrane)
• epithelium posterius corneae (endothelium)
• 11 x 12 mm - physiological astigmatism

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Tunica vasculosa (media) Uvea

• choroidea
• corpus ciliare (ciliary body)
• iris

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Tunica vasculosa (media) Choroidea

• lamina suprachoroidea ( lamina fusca sclerae)
• spatium perichoroideum
• lamina vasculosa (choroideal stroma)
• larger vessels, connective tissue, smooth muscle
  cells, nerves
• lamina choriocapillaris
• capillaries
• lamina basalis Bruchs membrane
• BM of pigment epithelium and capillaries
  connective tissue

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Tunica vasculosa (media) Corpus ciliare

• annular shape, triangular profile
• processus plicae ciliares
• orbiculus (external part), corona (internal part)
• smooth musculus ciliaris
• fibrae meridionales, radiales, circulares,
  longitudinales

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Tunica vasculosa (media) Corpus ciliare

• stroma
• m. ciliaris parasympathetic ? accomodation ?
  focus at near
• (focus at far is assured with the elastic
  choroidea)
• capillaries and nerves supplying the muscle
• epithelial cover production of humor aquosus
• BL continuation of Bruchs membrane
• pigment epithelium (continuation of pigm.
  epith. of retina)
• cilliary canal
• nonpigment epithelium (continuation of sensory
  epith. of retina)
• BL
• fibrae zonulares fixation of lens

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Tunica vasculosa (media) Iris

• annular and flat shape
• function of photograph stop (shutter)
• margo ciliaris (external), m. pupillaris
  (internal)
• pupilla
• anulus iridis major minor (containing circulus
  arteriosus iridis major minor)
• m. sphincter pupillae (parasymp.) miosis
  (circular)
• m. dilatator pupillae (symp.) mydriasis
  (radiate)

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Tunica vasculosa (media) Iris

• plicae iridis, stroma iridis
• anterior surface
• no epithelium cover
• fibroblasts and melanocytes (colour)
• dentate line remnant of membrana pupillaris
  Wachendorfi
• posterior surface
• 2 layers of pigment epithelium
• internal pigment
• external myoepithelial
• m. sphincter pupillae
• m. dilatator pupillae

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Lens

• polus anterior, posterior
• axis, equator, radii (seams in shape of Y and
  inverted-Y)
• capsula lentis
• substantia lentis cortex, nucleus
• zonula ciliaris Zinni
• fibrae zonulares
• spatia zonularia
• catharact - replacement

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Lens

• transparen biconvex nonvascular structure
• capsula lentis similar to BL
• epithelium lentis unilayered cubic
• anterior surface only
• substantia lentis
• cortical contains oblong cells (fibres) with
  organels and nucleus
• nuclear cellular fibres without organels and
  nucleus
• cells contain specific proteins (filensin,
  crystallins)

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Accomodation

• focus at near
• contraction of m. ciliaris
• fibrae zonulares relax
• lens bulges
• parallel contraction of m. sphincter pupillae (
  miosis)
• focus at far
• vessels tonus keeps fibrae zonulares tightened
• lens is flatened
• contraction of m. dilatator pupillae ( mydriasis)

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Corpus vitreum Vitreous body

• membrana, stroma, humor vitreus
• 99 of water
• hyaluronic acid, collagen fibres
• cells hyalocytes during development only!
• no regeneration ! in trauma flows out and
  replaced with aqueous humor
• canalis hyaloideus Cloqueti remnant of fetal
  arteria hylaloidea
• fossa hyaloidea
• maintains the internal eyeball pressure, compress
  retina to the choroidea

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Humor aquosus Aqeous humor

• produced by corpus ciliare
• absorbed in angulus iridocornealis
• 0,2-0,3 ml of pellucid and colourless fluid
• daily production - 3 ml
• content 0,7-1,2 NaCl, glucose and urea traces
  (0,1), no proteins!
• corresponds to the lymph inside the eyeball
• intraocular pressure 14-17 mmHg
• ? intraocular pressure ? compression of retina ?
  glaucoma

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Camerae bulbi Chambers of eyeball

• camera postrema s. vitrea
• between corpus ciliare, lens and retina
• contains corpus vitreum
• spatium retrozonulare
• camera posterior
• between iris, lens and corpus ciliare
• contains and produces humor aquosus
• camera anterior
• between cornea and iris
• angulus iridocornealis
• contains and absorbs humor aquosus

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Angulus iridocornealis Iridocorneal angle

• in site of sclerocorneal junction
• trabecular net in the posterior wall spatia
  anguli i.c. Fontanas spaces
• no direct connection to Schlemms canal
• reabsorption of humor aquosus
• maintains the intraocular pressure
• !!! no application of parasympatheticolytics in
  patient with glaucoma !!!

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OCTOptic coherent tomographymeasurements of
light reflexion
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Break
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Tunica interna (nervosa) Retina

• pars caeca
• pars iridica
• pars ciliaris
• ora serrata
• pars optica 11 layers
• pigment part
• sensory part

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Tunica interna (nervosa)Retina pigment part

• unilayered cubic epithelium
• cells with thight junctions
• apical cell parts contain melanin granules
• encompass the external segments of sensory cells
• interfotoreceptor matrix
• nutrition of cells, regeneratin of fotopigment,
  degradation of membranous discs

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Tunica interna (nervosa) Retina sensory part

• light-sensitive neurons (transducers)
• rods and cones
• trasmission neurons (integraters)
• bipolar and ganglionic cells
• association neurons
• horizontal and amacrinne cells
• suppoting cells (glia)
• Müllers cells

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Tunica sensoria (interna)Rods Bacilli

• synaptic disc
• axon
• nucleus
• internal segment
• GA, ER, MIT synthesis of ATP and rhodopsin
• external segment
• membranous discs with fotopigment
• migrate externally until the separate
• black and white vision

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Tunica sensoria (interna)Rods Coni

• synaptic foot
• fotopigment - iodopsin
• external segment
• membranous discs with fotopigment
• communicate with environment
• colour vision 3 types of cones
• blue 420 nm
• green 535 nm
• red 565 nm

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Tunica sensoria (interna)Transmisison neurons
(Integraters)

• Bipolar cells
• rod-like bipolar cells
• cone-like bipolar cells dwarf x diffused
• contacts with ganglionic cells
• Ganglionic cells
• diffused type contact with more bipolare cells
• dwarf type contact with dwarf bipolare cell
• axons of ganglionic cells form nervus opticus

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Tunica sensoria (interna)Association neurons

• only neuritic processes in both directions
• horizontal cells
• contacts with rods and cones
• amacrinne cells
• contacts with bipolar and ganglionic cells
• modification and synchronization of signal

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Tunica sensoria (interna)Supporting cells

• Müllers cells
• macroglia
• their BL membrana limitans interna
• zonulae adherentes with rods and cones
• membrana limitans externa

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Tunica sensoria (interna)Layers of optic part of
retina

• 11 layers
• !!! ? do not be frightened ? !!!

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Tunica sensoria (interna) Layers of optic part
of retina

• stratum pigmentosum (1.)
• stratum nervosum (2.-10.)
• stratum segmentorum externorum et internorum(2.)
• stratum limitans externum (3.)
• stratum nucleare externum (4.)
• stratum plexiforme externum (5.)
• stratum nucleare internum (6.)
• stratum plexiforme internum (7.)
• stratum ganglionicum (8.)
• stratum neurofibrarum (9.)
• stratum limitans internum (10.)

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Tunica interna (nervosa) Specific spots of
retina

• discus n. optici ( blind spot)
• n. II leaves the eyeball
• no light-sensitive cells
• ? excavatio disci

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Tunica sensoria (interna)Specific spots of retina

• fovea centralis (macula lutea yellow spot)
• distant layers diverted laterally
• sharpest and most brilliant colour vision spot
• cones only (100.000 cones)
• ? foveola (2500 cones)

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OCTOptic coherent tomography
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OCT
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OCT

• ABRUPTIO RETINAE

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Arterial supply of the eye

• a. carotis interna ? a. ophtalmica ?
• aa. ciliares posteriores breves ? choroidea
• aa. ciliares longae (2?4) ? corpus ciliare iris
• aa. musculares ? aa. ciliares ant., a.
  epiclerales, aa. conjuctivales lat.
• a. centralis retinae ? retina
• a. lacrimalis ? aa. palpebrales lat.
• aa. palpebrales med. ? aa. conjuctivales med.

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Vasa sanguinea retinae fundus oculi

• a. centralis retinae ? arteriolae
• a. temporalis sup.inf.
• a. nasalis sup.inf.
• a. macularis sup.inf. ( media)
• veins correspond to arteries, they often cross

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A. cilioretinalis (cilioretinal a.)

• present in 10-33 of eyes
• branches from the a. ciliaris posterior brevis
• exits the discus n.II separately from a.
  centralis retinae
• additional supply to macula lutea from choroidal
  circulation
• provide a small amount of blood supply to the
  retina when a. centralis retinae is occluded
• 90 located temporally, 10 nasally
• occlusion of a. cilioretinalis ? central visual
  loss
• occlusion of a. centralis retinae ? spare central
  vision and macula lutea

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A. cilioretinalis (cilioretinal a.)
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Venous drainage of eye 3 directions

• vv. episclerales
• vv. ciliares ant. ? vv. sclerales ? sinus venosus
  sclerae Schlemmi s. Lauthi
• vv. vorticosae (4 in quadrants of eyeball)
• v. centralis retinae
• v. ophthalmica sup. ? sinus cavernosus
• v. ophthalmica inf. ? plexus pterygoideus
• v. angularis ? v. facialis ? v. jugularis int.
• ! danger of inflammation spreading !

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Nervous supply of eye

• n. opticus special sensory
• pars intraocularis, canalis, itracranialis
• vagina interna, externa
• n. ophthalmicus ? nn. ciliares longi
  somatosensory
• n. lacrimalis, n. frontalis, n. nasociliaris
  for surrounding structures
• nn. ciliares breves ? ganglion ciliare
  autonomic (visceromotor)
• (sympathetic fibres non-interpolated,
  parasympathetic interpolated)
• n.III., n. IV., n.VI somatomotor

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Nervus opticus

• evagination of diencephalon (thalamus opticus)
• axons separated with endoneurium
• covered with meninges
• a. et v. centralis retinea runs inside the nerve

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VISUAL PATHWAYProjection ? Ascendent ? Sensoric

• 4 - neuronal, partially crossed
• neuron rod and cones of retine
• neuron bipolar cells
• neuron ganglional cells ? n. II ? chiasma
  opticum ? corpus geniculatum laterale
• neuron cells in corpus geniculatum laterale ?
  tractus geniculocorticalis ( radiatio optica
  Gratioleti) ? lobus occipitalis, area 17 (around
  sulcus calcarinus)
• Meyers loop into temporal lobe

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VSIUAL PATHWAY branches from 3rd neuron

• to hypothalamus (nucleus suprachiasmaticus)
  converts optical signals to highest vegetativ
  centres (seeing meal salivation)
• pathways of pupillar reflex - through area
  pretectalis
• to nucleus accessorius dorsalis n. III
  /Edinger-Westphal/ - parasymphatetic pathway with
  n. III ? ganglion ciliare ? nn. ciliares breves ?
  m. ciliaris et m. sphincter pupillae /miosis
  accomodation/
• to reticular formation ? tractus reticulospinalis
  ? centrum ciliospinale /Budge/ C8-Th1 ?
  sympathetic pathway in truncus symphaticus ?
  ganglion cervicale superius ? plexus caroticus
  internus et ophtalmicus ? nn. ciliares breves ?
  m. dilatator pupillae /mydriasis/
• pathway for convergence ? nucleus interstitialis
  /Cajal/ ? fasciculus longitudinalis medialis ?
  nuclei of all ophtalmogyric nerves
• tectal optic circuit - tractus tectospinalis
  (control of synkinesis of eyes, head, neck to
  visual stimuli and for coordination with gross
  movements of body)

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Structurae oculi accessoriae Related strctures
of eye

• Apparatus ligamentosus
• Palpebrae Eyelids
• Conjunctiva
• Apparatus lacrimalis
• Apparatus muscularis
• Supercilium

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Apparatus ligamentosus

• periorbit
• vagina bulbi ( capsula Tenoni)
• lig. suspensorium bulbi
• spatium episclerale
• corpus adiposum orbitae
• fasciae musculares

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Tunica conjunctiva

• t.c. bulbi x t.c. palpebrarum
• fornix superior, inferior
• continuation of epithelium of cornea, dorsally to
  the eyelid, covers anterior surface of the
  eyeball
• stratified cylindric epithelium
• contains goblet cells
• glanduale conjuctivales Wolfringi
• caruncula lacrimalis

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Vícka Palpebrae

• palpebra superior, inferior
• tarsus superior (10 mm), inferior (5 mm)
• lig. palpebrale med. (2 pruhy) lat.
• facies ant.post., rima palpebrarum, commissura
  palp. med.lat., limbus ant. post.
• angulus oculi med. lat.
• m. tarsalis sup. (Mülleri) inf. smooth
  muscles
• pars palpebralis m. orbicularis oculi - n. VII
• m. levator palpebrae superioris - n. III
• cilia

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Palpebrae Eyelids

• palpebra superior, inferior
• tarsus superior (10 mm), inferior (5 mm)
• lig. palpebrale med. (2 bands) lat.
• facies ant.post., rima palpebrarum, commissura
  palp. med.lat., limbus ant. post.
• angulus oculi med. lat.
• m. tarsalis sup. (Mülleri) inf. smooth
  muscles
• pars palpebralis m. orbicularis oculi - n. VII
• m. levator palpebrae superioris - n. III
• cilia

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Palpebrae Eyelids

• external cutaneous part
• keratinizing stratified squamous epithelium
• gl. sebaceae Zeissi
• inflammation - hordeolum
• cilia gl. ciliares Molli
• apocrinne glands
• m. orbicularis oculi
• tarsus
• fibroelastic plate
• gl. tarsales Meibomi
• sebaceous glands - chalazion
• internal conjunctival part
• sulcus et epithelial transition

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Apparatus lacrimalis Lacrimal apparatus

• glandula lacrimalis
• pars orbitalis palpebralis
• 12-15 separate ductuli excretorii
• glandulae lacrimales accessoriae Krausei
• rivus lacrimalis
• lacus, papilla, caruncula lacrimalis
• puctum, canaliculus lacrimalis
• saccus lacrimalis ? ductus nasolacrimalis (plica
  lacrimalis Hasneri) ? meatus nasi inf.

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• Glandula lacrimalis
• tubuloacinar serous glands with myoepithelial
  cells

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Muscular apparatus

• mm. recti bulbi sup., inf., med., lat. (VI.)
• mm. obliqui bulbi inf., sup.(IV.)
• /fovea trochlearis, spina trochlearis, trochlea,
  vagina m.o.b.s./
• m. levator palpebrae sup. (pars spf.prof.)
• n. III other 5 muscles
• smooth svaly m. orbitalis Mülleri, m. tarsalis
  sup. Mülleri inf.

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Movements of the eye-ball I.

• movements around axis ductions
• around vertical axis
• adduction (internal)
• abduction (external)
• around horizontal axis
• elevation (sursumduction supraduction) up
• depression (deorsumduction infraduction) down
• around sagittal (antero-posterior) axis
• intorsion (incykloduction) tilted internally
• extorsion (excykloduction) tilted externally

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Movements of the eye-ball II.

• paired movements (both eyes working together)
• simultaneous movement of both eyes in the same
  direction version (conjugate movements)
• dextroversion (to the right) levoversion (to
  the left)
• supraversion (sursumversion) infra/deorsumversio
  n (up down)
• dextro/levoelevation dextro/levodepression
  (up/down and to side)
• dextro/levocykloversion (rotation to the
  right/left)
• simultaneous movement of both eyes in opposite
  directions vergence (disconjugate movements),
  convergence both eyes moving nasally or inward
  , divergence both eyes moving temporally or
  outward
• strabismus heterotropia squint one eye
  constantly is turned inward (crossed-eye),
  outward (wall-eye), upward, or downward.

http//www.tedmontgomery.com/the_eye/eom.html
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Movements of the eye-ball
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Strabismus concomitans

• esotropia (s. convergens)
• exotropia (s. divergens)
• hypertropia (s. sursumvergens)
• hypotropia (s. deosumvergens)

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Development of visual system

• neuroectoderm of the forebrain
• superficial ectoderm of head
• mesoderm in between
• cells from neural crest

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Development of visual system

• primordia from beginning of 4th week (22nd day)
• formation of optic grooves in the region of
  forebrain
• grooves deepen in optic vesicles
• formation of optic peduncle
• induction of ectoderm thickening
• formation of lens (optic) placode

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Development of visual system

• envagination of lens (optic) placode
• formation of hollow lens vesicle without
  connection to the external surface
• optic vesicles envaginate optic cup
• envagiantion of optic pedicle and cup migration
  of vascular mesenchyme formation of vitreous
  vessels

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Development of retina

• origin from optic cup
• external layer pigment epithelium
• internal layer proliferates into pars nervosa
• intraretinal space successively fades out
• inversion of retina

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Development of n. II

• fibres from ganglionic cells growth through the
  optic pedicle
• fissure (evagiantion) fades out

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Development of corpus ciliare

• protrusion of both layers of optic cup
• pigment epithelium from external layer
• non-pigment epithelium from internal layer
• ciliary canal from optic cup cavity
• m. ciliaris and connective tissue from
  mesenchyme

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Development of iris

• margin of eye cup
• external layer smooth muscles
• internal layer pigment epithelium

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Development of lens

• from lens (optic) vesicle
• anterior surface no change epithelium
  anterius
• posterior surface cells elongate as far as
  lumen disappers
• formation of primary fibres
• secondary fibres derived from epitheliuum
  anterius cells
• capsula lentis thickened BL of epitheliuum
  anterius
• a. hyaloidea fades out
• pupillary membrane covering lens fades out

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Development of camere bulbi

• camera anterior
• fissure between primordial lens and cornea
• camera posterior
• fissure in optic cup on sides of lens vesicle

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Development of cornea, choroidea and sclera

• cornea
• superficial ectoderm
• mesenchyme
• cells of neural crest
• choroidea and sclera
• surronding mesenchyme

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Development of palpebrae

• 6th week cutaneous folds across cornea
• 10th week both folds fuse
• 28th week folds separate again
• inbetween conjunctina adheres internally
• muscles IInd branchial arch
• tarsus and glands from mesenchyme

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Development of lacrimal glands

• evaginations of superficial ectoderm
• non-functionnal until 6th week
• newborn does not water in eyes

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• finallyEND !
• ?