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oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni
CORNEA
• Transparent anterior structure of the eye
2. REFLEX SECRETORS • This is the major refracting structure of the eye
• Are the amin lacrimal gland in the upper temporal (estimated total power 40 diopters)
portion of the orbit and the adjacent palpebral gland • The cornea forms part of the boundary in the anterior
• Exocrine glands that have efferent parasympathetic chamber angle
nerve supply
• Serous acinous glands similar to the salivary glands
• Infections and inflammations in the anterior chamber
• Always involved primarily in true hypersecretion area can produce fibrosis attaching the cornea to the iris
and commonly called anterior synechiae (similarly, the
iris can produce attachments to the anterior lens capsule
Schirmer’s test – standard in secretion test
and is called posterior synechiae)
Schirmer’s I – test the basic secretion; with anesthetic
• Layers of the cornea:
Schirmer’s II – test for reflex secretion; without anesthetic
1. epithelium
EXCRETORY SYSTEM • Anteriormost layer of the cornea near the tear film
a. lacrimal pump – consists of the movements of the • It regenerates in 24-72 hours & responsible for
orbicularis oris muscles to direct the flow of tears to the maintaining corneal hydration anteriorly
punctal area in the nasal side of the eye • If destroyed by trauma, infections & inflammations,
b. superior & inferior punctum – opening of the drainage corneal edema amy be evident that may extend up
system to the stromal layer
c. ampulla 2. bowman’s membrane
d. superior & inferior cannaliculus – 8mm 3. corneal stroma or substancia propria
e. common cannaliculus – present in 80% of individuals • 90% collagen; 5% cells (keratocytes & 5%
f. lacrimal sac – 10mm mucopolysaccharides
g. nasolacrimal duct (NLD) – 12mm; runs between the • thickest part of the cornea
anterior & posterior lacrimal crests of the lacrimal bone in 4. descemet’s membrane
the medial wall of the orbit; exits in the inferior meatus 5. endothelium
of the nose • a monolayer of mesodermal cells
h. valve of Rosenmuller – one way valve found between the • innermost layer of the cornea
common cannaliculus & lacrimal sac • responsible for maintaining deturgescence by acting
i. valve of Hassner – one way valve between the NLD & as a mechanical barrier & as a pump wherein it is
inferior meatus responsible for exchange of water and electrolytes
between the cornea and the aqueous humor
CONJUNCTIVA • Has a rich sensory nerve supply, which is part of the
• mucosal lining of the inner part of the lids & anterior protective mechanism of the eye. Thus pain is the most
portion of the eyeball common symptom of corneal dse.
• has 2 divisions: palpebral & bulbar portion separated by • Avascular and it is entirely dependent on air and tears
the fornix anteriorly & aqueous humor posteriorly for its nutrition
• palpebral portion has 3 sections:
marginal – groove near the lid margin to which it is ANTERIOR CHAMBER
adherent Angle structures:
tarsal – vascular portion attached to the tarsus 1. Schwalbe’s line – most anterior part of the angle; it
orbital - which is loosely connected to the palpebral is the posterior part of the cornea at the area of the
muscle limbus
• bulbar portion – thin layer that overlies the Tenon’s 2. Anterior TM – nearest the cornea; angles are closed
capsule but becomes fixed to it near the limbus if it’s only the TM (trabecular meshwork) structure
• has an epithelium of non-keratinized cells varying from 3- seen in angle examination (gonioscopy)
5 layers thick 3. Posterior Tm – angles are open if this area is viewed
clearly in gonioscopy
GLOBE 4. Scleral spur – part of the posterior sclera seen in the
• the anterior one third of the globe externally is occupied posterior angle
by the cornea and the posterior 2/3 is the sclera 5. Iris processes – peripheral part of the iris that
attaches to the scleral spur
• the junction of the two structures is called limbus, which
6. Ciliary body – longitudinal muscles and part of the
is the anatomical location of the trabecular meshwork ciliary body are seen as the most posterior part of
internally the angle
• limbusthe average axial length is 23.5mm. longer axial *pars plicata – w/ ciliary epithelium & muscle
lengths can produce myopia and shorter lengths can *pars plana – no structures like muscles; just
produce myopia and shorter lengths can produce connects ciliary body & uveal tract
hyperopia. Normal lengths are called emmetropias. *ciliary muscles – constricted with use of pilocarpine
• The central/paracentral area (spherical) is where the light
bends TRABECULAR MESHWORK
• Light does not bend in the peripheral area (flat) • The main site of the drainage of aqueous humor
• Three layers that make up the meshwork:
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May.Yvette.Allain.Cristina.Ralph.Sheryl.Bart.Heinrich.Pipoy.KC.Jam.Cecille.Denesse.Mike.Hoops.Ces.Christian.Elaine.Riza.Kristel.Ezra.G
oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni
Inferior temporal vessels • Optic radiations to the occipital lobe – when the
Nasal vessels radiations from the parietal & temporal lobes meet as it
Papillomacular approaches the visual cortex, the defect can be a
• Cottonwood spots – non-profused areas of the retina; quadrantanopsia or a congruous hemianopsia
pale retina with cherry red spot (CRAO-central retinal • Visual cortex – a quadrantanopsia if the lesion is above or
artery occlusion) below the calcarine fissure; a congruous hemianopsia if
• Macula divides into temporal and nasal visual fields; the lesion is the left or right visual cortex; macular
retinal nerve divides the structures into temporal & nasal sparing which are often seen in lesions of the cisual
sides cortex are due to predominance of macular fibers of the
tip of the visual cortex & its dual supply (middle &
OPTIC NERVE posterior cerebral artery) sparing them from damage in
Parts: the mild to moderate ischemia of the occipital cortex;
a. Intraocular ON – 1.75mm in length and is divided complete hemianopsia if it affects the whole half of the
into 3 layers: visual fields of both eyes
• Prelaminar layer – central part of the head is
called the optic cup, which is devoid of nerve
fibers & vessels. Enlargement of this area may
be 2O apoptosis of nerve fibers in glaucoma and
ischemic optic neuropathies
• Laminar layer – oriented beside the lamina
cribrosa of the posterior sclera
• Postlaminar layer – thickening of the diameter to
3-4mm 2O to myelination of the optic nerve
b. Intraorbital ON – 25-30mm in length
c. Intracannalicular ON – 5-6mm in length; adherent of
the dura of the optic canal; site of injury in direct
and indirect trauma of the orbit
d. Intracranial ON – 10-12mm; unites as optic chiasm
just above the pituitary gland
VISUAL PATHWAY
• Nerve fiber layer of the retina
1. superior arcade – retinal lesions in this area can
produce unilateral inferior defect
2. inferior arcade – unilateral superior field arcuate
defect
3. nasal fibers – temporal wedge defect
4. papillomacular bundle – central (<5 degrees in field)
& paracentral (10-15 degrees) visual field defect;
involvement of the papillomacular & inferior or
superior bundles can produce altitudinal field defect
(superior or inferior half of field)
• Optic nerve – unilateral visual field loss
• Optic chiasm – bitemporal hemianopsia; junctional
scotoma wherein there is a visual loss of one eye &
superotemporal quadrant of the other eye secondary to
compression of one side of the chiasm where inferonasal
fibers of the less involved eye as it crosses the chiasm
travels a short distance posteriorly as Willbrand’s knee
• Optic tract – posterior to the chiasm & produce an
incongruous hemianopsia (temporal loss: laterality of the
hemianopsia and nasal VF loss: laterality of the lesion in
the optic tract); visual pathway field loss respects the
vertical meridian, crossing the macular area or central
field while optic nerve fiber type defects respects the
horizontal meridian and oriented/connected with the
physiologic blindspot. One way to identify lesion in this
area is presence of relative afferent pupillary defect
(RAPD or Marcus Gunn pupil)
• LGB of the thalamus
• Optic radiations to the parietal lobe – pie on the floor
effect
• Optic radiations to the temporal lobe – pie in the sky
defect
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