眼科学基础ppt课件

1、IntroductionnOphthalmology is a special medical science, a branch of clinical medicine,which deals with research for development,treatment and prevention of the disorders of visual organs.nOcular disease have close relation to systemic ones.nLearning Ophthalmology and understanding its development a

2、nd present state are helpful to eatabilish foundations of clinic,teaching and science research.第一章第一章 眼科学根底眼科学根底 Chapter one Basic ophthalmology 第一节第一节 眼的组织解剖眼的组织解剖 anatomy of eyeball 眼球眼球 The globe (eyeball)anterior and posterior distance of normal eyeball is 16mm in born. At age 3 23mm.At adult 24

3、mm.nThe vetical one is average23mm，the horizontal one is average 23.5mm in normal adult.nThe anterior pole of the globe,protruded about 12-14mm bryond the prbital rim.nThe difference of the two eyes is usually less than 2mm.It is easy to be injuried,especially in its external part,the anterior part

4、of the globe is protected by the eyelids.The globe is composed of the eyecoats,the contents.The eyecoat is mainly divided into three layers.nOuter layernCorneanScleranMiddle layer nIrisnCiliary bodynChoroidnInner layer nRetina 外层外层 The outer coat nThe outer coat consists of the cornea and the sclera

5、. nThe anterior one sixth is transparent cornea,other five sixths is white sclera.nThe transitional srea of both is the limbus.nThe function is to maintain the shape of the globe and to protect inteaocular tissue.1角膜角膜 Cornean横径横径The horizontal diameter is 11.5-12mmn垂直径垂直径The vertical diameter is 10

6、.5-11mmn中央部中央部 The central thickness 0.6mmn周边部周边部 The periphery thickness 1mmn前外表曲率半径前外表曲率半径 n The radius of cornea curvature in front 7.8mmn后外表曲率半径后外表曲率半径 n The radius of cornea curvature in back 6.8mmnIts refractive power is equal to that of +43 diopter lens角膜角膜 CorneaThe central thickness 0.6mmTh

7、e radius of cornea curvature in front 7.8mmThe radius of cornea curvature in back 6.8mmThe periphery thickness 1mm组织学分层组织学分层 from anterior to posterior,the cornea has five distinct layers:上皮细胞层 Epithelium 前弹力层 Bowmans membrane基质层 Stroma后弹力层 Descemets membrane内皮细胞层 Endothelium EpitheliumBasement laye

8、rBowmans membraneStromaDescemets membraneendothelium regenerate after injery (2)巩膜 Sclera n表层巩膜 The episcleran巩膜本质层 The scleral stroman棕黑板层 The lamina fascia组织学分层 the sclera includes: ScleranThickness: 0.3 to 1.0 mm,at the insertion of the rectus musles,it is about 0.3mm, elsewhere about 1mm.nAnteri

9、or part covered by bulbar conjunctivanConnected to 6 extraocular musclesnThinner and translucent in childrenn角巩膜缘 the cornea scleral limbus :is a transitional zone of the cornea and the scleral,where the cornea inserts into the scleranits anterior border is Bowmans layernI t s p o s t e r i o r m a

10、r g i n i s Descemets membranenIts width is 1 mmnSurgical landmark of important structures前房角 Anterior chamber angle:Include:Schwalbe linetrabecular reticulumSchlenm cannelSclera spurCiliary bodyIris root包括包括:Schwalbe 线线小梁网小梁网Schlenm 管管巩膜突巩膜突睫状带睫状带虹膜根部虹膜根部 中层 The middle coat Including three parts: I

11、ris Ciliary body Choroid Rich in pigment and blood vessels 虹膜 IrisIt situates in the most anterior part of the middle coat,infront of the lens,connected with the cilliary body in perphery.The iris includs layers : Anterior surface layer Stroma layer Pigment epithelial threre is a round hole in the c

12、entre called Pupil 直径2.5-4mm 虹膜 Iris睫状体 Ciliary bodynConnect iris root and choroidnA distence of about 6mm，corona：2mm ，Pars plana：4mmnThe ciliary body is divided into 5 layers from inner to outer n 1、ciliary muslen 2、 Vascular layern 3、Bruchs membranen 4、Epithelium layern 5、The internal limiting mem

13、brane 1睫状肌4睫状体 Ciliary body扁平部睫状突锯齿缘睫状冠pars plicata脉络膜 ChoroidnIt is situated beween the sclera and the retina,anterior to ora serrata,going behind to the surrounding of the optic nerve.nFull of the pigment acts as a dark room and a shade of light.nIncluding：n1、大血管层 Large vascular layern2、中血管层Middle

14、 vascular layern3、毛细血管层Capillary layer 内层the Inner coat nis the retina,which covers the hr inner aspect of the posterior two-thrids of the wall of the globe.nThe outside of the retina is the choroid,the inside is the vitreous.nThe optic never fixes the retina to the wall of the globe.nThe retina is

15、0.1mm thick at the ora serrata and 0.23mm thick at the posterior pole. 内层the Inner coat nThe 黄斑 Macula area is a special region of the retina with the sharpest visual sensation.its diameter is about 1-3mmna small foveola is in its centre called 黄斑中心凹Fovea centralis,with the direct ophthalmoscope the

16、 Fovea centralis produce a clearly fovea reflaction.nA pink area located at nasal side about 3mm to the macula is the 视盘 Optic disc.thevisual fibers on the retina come together to go out of the globe to visual centre.there are artery and vein.nA small depression on its centre is called 视杯Optic cup 视

17、网膜Ratina divided into 10 layers from outside to inside. outside: Retinal pigment epithelium, RPE 视网膜色素上皮层内层 insiden 视锥、视杆细胞层光感受器细胞层n Cone and rod layern 外界膜 External limiting membranen 外核层 Outer nuclear layern 外丛状层 Outer plaxiformn 内核层 Inner nuclear layern 内丛状层 Inner plexiform layern 神经节细胞层 Ganglion

18、 cell layern 神经纤维层 Nerve fiber layern 内界膜 Limiting membrane1 RPE Retinal pigment epithelium2 Cone and rod layer3 External limiting membrane4 Outer nuclear layer5 Outer plaxiform1.色素上皮2.视锥和视杆细胞3.外界膜4.外核层 5.外丛状层6 Inner nuclear layer 7 Inner plexiform layer 8 Ganglion cell layer 9 Nerve fiber layer 10

19、Limiting membrane 6.内核层 7.内丛状层 8.神经节细胞层 9.神经纤维层 10.内界膜二 眼球内容 Contents of the eyen1. 房水 Aqueous humorn前房 Anterior chamber：it is bounded anteriorly by the cornea,posteriority by the iris and the lens.the deepth in the centre is 2.5-3.0mm.the volume in human eye is about 0.2ml.n后房Posterior chamber: it

20、is bounded anteriorly by the iris,posteriority by lens anterior capsule and its zonule.the volume in human eye is about 0.06ml.nPosterior chamber n flows into the anterior n chamber through the pupil.The Flow of Aqueous Humor :ciliary睫状体 posterior chamber后房 pupil瞳孔 anterior chamber前房 trabecular小梁网 S

21、chlemm canal Schlemm管 collection canal集液管 aqueous vein房水静脉 ciliary veins睫状前静脉脉络膜上腔2、晶状体 LensnTransparent ，double convex mirrornBe suspended Between pupil-iris and vitreous body,connect with ciliary bodynAbout 4mm thick and 9mm in diameternThe radius of lens curvature in front ：10mmnThe radius of len

22、s curvature in back ：6mmnDiopter ：19Dn透明，双凸透镜n位于瞳孔-虹膜和玻璃体之间n前面曲率：10mmn后面曲率：6mmn屈光度：19DLensnThe sole function of the lens is to focus light rays upon the retina.nDistant object the ciliary muscle relaxes zonular fibers tension lens minimizednNesar object the ciliary muscle contracts zonular fibers re

23、leaseing the tension lens more sphericalnAs the lens ages its n accommodative power n is gradually reduced.lensnComposition n the lens consists of about 65% water,obout 35% protein(the hightest protein content of any tissue of the body)nThere are no pain fibers,blood vessels,or nerves in lensnFuncti

24、ons:1、Focusing 2、accommodationnChanges with agenLarger & hardernLess elasticnCataract3、玻璃体 Vitreous bodynConsists mainly of watern2/3 of the eyes volume and weightnViscousitynImportant for metabolism of intraocular tissuesnAttached to retinanThe vitreous has two functions:the refraction and main

25、tainence the transparent and form of the eye.Vitreous bodynAging changes： Thinner&more liquid n“floaters 视路及瞳孔反射 Optic pathway and pupillary reflex The visual message obtained from the retina is transmitted to brain via the optic never视路 optic pathwayn 一视神经 Optic nerven (1)眼内段 Intraocularn (2)眶内

26、段 Intraorbitaln (3)管内段 Intracanalicularn (4)颅内段 Intracranialn 二视交叉 Optic chiasmn 三视束 Optic tractn 四外侧膝状体 Lateral geniculate bodyn 五视放射 Optic radiationn 六视皮质 Visual cortex视路 optic pathwaynIt is a portion of central nervous system,composed of fibers send out by retina ganglim cells.the optic never is

27、the segment of nerve from the disc to the anterior angle of the chiasm,about 42-47mm long.n(1)眼内段 Intraocular 1mmn(2)眶内段 Intraorbital 25-30mmn(3)管内段 Intracanalicular 4-10mmn(4)颅内段 Intracranial 10mm视路 Visual pathwayn光感受器retinal photoreceptor 双级细胞bipolar cell 神经节细胞nervous ganglion cells 视乳头optic disk

28、视神经optic nerve 视交叉optic chasm 视束optic tract 外侧膝状体lateral geniculate body 视放射optic radiation 视皮质visual cortex. Optic nerveOptic chiasmOptic tractLateral geniculate bodyOptic radiationOccipital cortex视路 Visual pathway瞳孔反射路 Pathway of pupillary reflexn光反射 Light reflexn 直接光反射 direct reflexn 间接光反射 indire

29、ct reflexn 近反射 Near reflexn when the eyes look at a near object,3 reactions occur: accmmodation, convergence, and constrictionof the pupil.二、眼眶及附属器 Orbit and accessory apparatusn(一) 眼眶 OrbitnThe depth of adults is about 4-5cm,the external rim is a little behind with much exposure of the globe which

30、is easy to be injuried.the external wall of the orbit is quite hard,the other three are with thin bone.眼眶眼眶OrbitnFrontal 额骨nZygomayic 颧骨nMaxillary 上颌骨nEthmoidal 筛骨nSphenoid 蝶骨nLacrimal 泪骨nPalatine 颚骨 The orbit is composed of 6 bones:眼眶眼眶Orbitn1.视神经孔和管 Optic foramen and canaln4-9mm in length,4-6mm in

31、 width.the optic nerve and the ophthalmic artery through pass to the cranial cavity.n2.眶上裂 Superior orbital fissurenThere are the 3rd,4th,6thcranial nerves and the first branch of trigeminal nerve,the opthalmic nerve,the superior ophthalmic vein as well as the sympathetic nerve passing through the f

32、issure. n3.眶下裂 Inferior orbital fissurenIt transmits the 2nd branchof the 5th cranial nerve ,inferior ophthalmic never and artery and inferior ophthalmic vein. n4.眶上切迹和眶下孔 nThe supraorbital notch and infraorbital foramenn Here are nerve and blood vessel with the same name passing through them眼眶眼眶Orb

33、it二眼睑 Eye lids nThe eyelid are divided into upper and lower one,situated in the anterior mouth of the orbit,cover on the anterior surface of the globe,the upper one is limited by the eyebrow,the lower eyelid is connected with facial skin.nPalpebral fissure(睑裂)between two eyelids 8mmnZeis gland and M

34、oll gland open their mouths at hair folliculosis(毛囊) Eye lidsn1 皮肤层 The skinnIt is one of the most flexible and thinnest skin in the body.n2 皮下组织层 SubcutaneousnIt is composed of loose connective tissue and a little fat.n3 肌层 Muscular layern4 睑板层 Layer of the fibrous layernThere are verticall gland-M

35、eibomglandn5 结膜层 The conjunctival layernClosely attached to the posterior surface of the fibrous layerZeis腺毛囊Moll腺Muller肌结膜睑板层meibom眼轮匝肌Meibom开口皮肤提上睑肌Eye lidsnSensory of the eyelid:n they are innervated by the 1st and 2nd branch of the trigeminal nerve.nFunction :to protect the globe,due to cnostant

36、 blinking,the tears may mosit the surface of the globe,to clean dust and bacteria in conjunctive sac. (三) 结膜 Conjunctivan1 睑结膜 Palpebral conjunctivan it closely adhere to the fibrous layer,cant be pushe,smooth and transparent vertical small blood vessels may be seen in it.n2 球结膜 Bulbar conjunctivan

37、it covers on the sclera situated in anterior part of the globe,loosely connected with tenons capsule,easy to be pushed,elevated.n3穹窿结膜 Fornical conjunctiva n 1、goblet cell 2、krause and wolfring glangn睑结膜 nPalpebral conjunctivan球结膜 nBulbar conjunctivan穹窿结膜 n Fornical conjunctivaBulbar conjunctivaPalp

38、ebral conjunctivaFornical conjunctiva(四)泪器 Lacrimal apparatus1泪腺 Lacrimal gland There are about 10-20 excretory ducts opening their mouths in the external and superior fornical conjunctive.2泪道 Lacrimal passages (1)泪小点 Lacrimal puncta There are each one in the upper and lower eyelids,open their mouth

39、s into the lacrimal lake . (2)泪小管 Lacrimal canaliculus Link up the puncta and the lacrimal sac. (3)泪囊 Lacrimal sac 12mm in length,4-7mm in width. (4)鼻泪管 Nasolacrimal duct 18mm length,the secretion is 0.9-2.2mm each eye.1泪腺 Lacrimal gland2泪道 Lacrimal passages (1)泪小点 Lacrimal puncta (2)泪小管 Lacrimal ca

40、naliculus (3)泪囊 Lacrimal sac (4)鼻泪管 Nasolacrimal duct(五) 眼外肌 Extraocular muscles 4条直肌 Rectus 上直肌 superior recti muscles 下直肌 inferior recti muscles 内直肌 medial recti muscles 外直肌 external recti muscles2条斜肌 Oblique muscle 上斜肌 superior oblique muscles 下斜肌 Inferior oblique musclesn4条直肌 Rectusn 上直肌 superio

41、r recti musclesn 下直肌 inferior recti musclesn 内直肌 medial recti musclesn 外直肌 external recti musclesn2条斜肌 Oblique musclen 上斜肌 superior oblique musclesn 下斜肌 Inferior oblique muscles上直肌 上斜肌 外直肌内直肌下直肌下斜肌四、眼球的血液循环和神经分布 Blood circulation and innervation of the globen一血液循环 Blood circulationn动脉 Arteryn 1、视网膜中

42、央血管系统 n the central retinal vascular system n 2、睫状血管系统n the ciliary vascular system n1.视网膜中央血管系统n The central retinal vascular systemn 视网膜中央动脉n Central retinal artery, CRA视网膜中央血管系统 The central retinal vascular system2. 睫状血管系统the ciliary vascular system n (1)睫状后短动脉n Short posterior ciliary arteryn (2

43、)睫状后长动脉n Long posterior ciliary arteryn (3)睫状前动脉n Anterior ciliary artery(1)睫状后短动脉 Short posterior ciliary artery (2)睫状后长动脉 Long posterior ciliary artery (3)睫状前动脉 Anterior ciliary artery睫状后长动脉睫状后短动脉睫状前动脉静脉 Veinn1. 视网膜中央静脉 n Central retinal vein CRVn2. 涡静脉 Vortex veinn3. 睫状前静脉 Anterior ciliary vein n1. 视网膜中央静脉 n Central retinal vein CRVn2 . 涡 静 脉 Vortex veinn3 . 睫 状 前 静 脉 Anterior ciliary vein视网膜中央静脉涡静脉睫状前静脉visual organvisual orga