PHYSIOLOGY OF EYE

BY
DR. MUDASSAR ALI ROOMI (MBBS, M. Phil.)

Eye

Eye
Macula lutea
Area immediately surrounding fovea Fairly high acuity
Pinhead-sized depression in exact center of retina Point of most distinct vision Has only cones

Fovea CENTRALIS

Macular degeneration

Leading cause of blindness in western hemisphere doughnut vision

The Eye as a Camera

Total refractive power of reduced eye: 59 d Ant. Surface of cornea provides: 40 d Lens within eye provides: 19 d IF WE BRING THE LENS OUT OF THE EYE ITS POWER WILL INCREASE

Measurement of the Refractive Power of a LensDiopter

REFRACTIVE ERRORS OF EYE

Refraction Errors

Normal vision

Far sightedness

Near sightedness

Vision Correction

Myopia corrected with concave lens

Hyperopia corrected with convex lens

Accommodation
It is the ability of the eye to keep the image focused on the retina (as the distance between the eyes & the object varies)

MECHANISM OF ACCOMMODATION
Accommodation results from contraction of the ciliary muscle, which is like a sphincter muscle. Under resting state ciliary muscle relax keep the aperture wide. Relaxation of ciliary muscle apply tension on suspensary ligaments which pulls the lens taut. Viewing an object 20 feet or more from a normal eye, the image is focused on the retina and the lens is in its more flat or least convex form. As the object moves closer to the eyes the muscles of the ciliary body contract and narrows the aperture of the ciliary body that reduces the tension on zonular fibers that suspend the lens. When tension is reduced, lens become more rounded and convex as a result of its inherent elasticity. Changes in the shape of the lens permit accommodation The ciliary muscle is controlled almost entirely by parasympathetic nerve signals transmitted to the eye through the third cranial nerve from the third nerve nucleus in the brain stem.

ACCOMODATION
Contraction pulls ligament forward relaxing tension on suspensory ligament making the lens fatter

Near Point
The nearest point to the eye at which an object can be brought into clear focus by accommodation is called near point of vision. Normally, it is 25 cm in young persons. It shifts away from eyes in presbyopia.

NEAR RESPONSE or accomodation for near vision

The three components of near response are:
1. accommodation, 2. convergence of the eyeballs & 3. Pupillary constriction

Presbyopia
As a person grows older, the lens grows larger and thicker and becomes far less elastic, partly because of progressive denaturation of the lens proteins. The ability of the lens to change shape decreases with age. The power of accommodation decreases from about 14 diopters in a child to less than 2 diopters by the time a person reaches 45 to 50 years

It may even decreases to essentially 0 diopters at age 70 years. Treated by biconvex lenses

intraocular fluid
Eye is filled with intraocular fluid. Aqueous humor and Vitreous humor.
They maintain sufficient pressure in the eyeball to keep it distended.

The intraocular fluid system of the Eye

Aqueous humor is continually being formed and reabsorbed . The balance between formation and reabsorption of aqueous humor regulates the total volume and pressure of the intraocular fluid.

The mechanism of formation of the Aqueous humor

Aqueous humor is formed almost as an active secretion by the epithelium of the ciliary processes. Secretion begins with active transport of sodium ions into the spaces between the epithelial cells. The sodium ions pull chloride and bicarbonate ions along with them to maintain electrical neutrality All these ions together cause osmosis of water from the blood capillaries lying in intercellular spaces. Resulting solution washes from the spaces of ciliary processes into the anterior chamber of eye.

Outflow of aqueous humor from the eye.

After forming . flows first through the pupil into the anterior chamber of the eye. Fluid flows anterior to the lens & into angle b/w cornea and iris. Then meshwork of trabeculae to canal of schlemm which empties into extra ocular veins.

Canal of Schlem
It is a thin walled vein that extends circumferentially all around the eye. Its endothelial membrane is permeable to large protein molecules and particulate matter up to the size of RBCs.

Canal of Schlem
It is a venous vessel but contains only aqueous humor instead of blood. Small veins drain aqueous humor from the canal of schlemm in to larger veins of the eye. These small veins are known as aqueous veins.

Regulation of Intraocular Pressure

TONOMETER IOP remains constant in the normal eye, which is 15mmHg (12-20) It is determined by resistance to outflow of aqueous It can be measured with the help of optical instrument called tonometer.

Tonometery
Cornea is anesthetized with a local anesthetic Footplate of the Tonometer is placed on the cornea. A small force is then applied to a central plunger which push the cornea slightly inward. The amount of displacement is recorded on the scale of the tonometer and this is calibrated in terms of intraocular pressure.

Glaucoma
Glaucoma is one of the causes of blindness. It is a disease of the eye in which the intraocular pressure becomes pathologically high sometimes rising acutely to 60 to 70 mm Hg Pressures above 25 to 30 mm Hg can cause loss of vision when maintained for long periods