- •Preface
- •Acknowledgments
- •Anatomic Features
- •Anatomic Directions and Planes
- •Refractive Conditions
- •Epithelial Tissue
- •Glandular Epithelium
- •Connective Tissue
- •Muscle Tissue
- •Nerve Tissue
- •Intercellular Junctions
- •References
- •Cornea
- •Corneal Dimensions
- •Corneal Histologic Features
- •Epithelium
- •Epithelial Replacement
- •Bowman’s Layer
- •Stroma or Substantia Propria
- •Descemet’s Membrane
- •Endothelium
- •Corneal Function
- •Corneal Hydration
- •Aquaporins
- •Corneal Metabolism
- •Corneal Repair: Wound Healing
- •Epithelium
- •Bowman’s
- •Stroma
- •Descemet’s
- •Endothelium
- •Absorption of Ultraviolet Radiation (UVR)
- •Corneal Innervation
- •Corneal Blood Supply
- •Sclera
- •Scleral Histologic Features
- •Episclera
- •Sclera
- •Physiology of Scleral Changes in Myopia
- •Scleral Spur
- •Scleral Opacity
- •Scleral Color
- •Scleral Foramina And Canals
- •Scleral Blood Supply
- •Scleral Innervation
- •Limbal Histologic Features
- •Palisades of Vogt
- •References
- •IRIS
- •Histologic Features of Iris
- •Anterior Border Layer
- •Iris Stroma and Sphincter Muscle
- •Anterior Epithelium and Dilator Muscle
- •Posterior Epithelium
- •Anterior Iris Surface
- •Posterior Iris Surface
- •Iris Color
- •CILIARY BODY
- •Supraciliaris (Supraciliary Lamina)
- •Ciliary Muscle
- •Ciliary Stroma
- •Ciliary Epithelium
- •Choroid
- •Suprachoroid Lamina (Lamina Fusca)
- •Choroidal Stroma
- •Choriocapillaris
- •Functions of Iris
- •Functions of Ciliary Body
- •Aqueous Production
- •Function and Rate of Production
- •Vitreous Production
- •Blood-Aqueous Barrier
- •Functions of Choroid
- •Iris
- •Ciliary Body
- •Choroid
- •References
- •Retinal Pigment Epithelium
- •Photoreceptor Cells
- •Composition of Rods and Cones
- •Outer Segment
- •Cilium
- •Inner Segment
- •Outer Fiber, Cell Body, and Inner Fiber
- •Rod and Cone Morphology
- •Rods
- •Cones
- •Bipolar Cells
- •Ganglion Cells
- •Horizontal Cells
- •Amacrine Cells
- •Interplexiform Neurons
- •Neuroglial Cells
- •Müller Cells
- •Microglial Cells and Astrocytes
- •Retinal Pigment Epithelium
- •Photoreceptor Layer
- •External Limiting Membrane
- •Outer Nuclear Layer
- •Outer Plexiform Layer
- •Inner Nuclear Layer
- •Inner Plexiform Layer
- •Ganglion Cell Layer
- •Nerve Fiber Layer
- •Internal Limiting Membrane
- •Physiology of the rpe
- •Scotopic and Photopic Vision
- •Neural Signals
- •Number and Distribution of Neural Cells
- •Physiology of the neural retina
- •Retinal Synapses
- •Neurotransmitters
- •Phototransduction
- •Information Processing
- •Receptive Fields
- •Light and Dark Adaptation
- •Circadian Rhythm
- •Retinal Metabolism
- •Central Retina
- •Macula Lutea
- •Fovea (Fovea Centralis)
- •Foveola
- •Parafoveal and Perifoveal Areas
- •Peripheral Retina
- •Optic Disc
- •Blood-Retinal Barrier
- •References
- •Lens Capsule
- •Lens Epithelium
- •Lens Fibers
- •Epithelium-Fiber Interface
- •Lens Capsule
- •LENS Fibers
- •Fiber Components
- •Formation of Lens Fibers
- •Fiber Junctions
- •Lens Metabolism
- •Ionic Current
- •Regulation of Fluid Volume
- •Oxidative Stress
- •Cataracts
- •The Physiology of Cataract Formation
- •Age-Related Cortical Cataract
- •Age-Related Nuclear Cataract
- •Posterior Subcapsular Cataract (PSC)
- •Steroid-Induced Cataract
- •References
- •Scleral Spur
- •Trabecular Meshwork
- •Canal of Schlemm
- •Juxtacanalicular Connective Tissue
- •Function of the Filtration Apparatus
- •Posterior Chamber
- •FACTORS AFFECTING Intraocular Pressure
- •Drugs that Effect IOP
- •Vitreous Chamber
- •Vitreal Attachments
- •Vitreous Zones
- •Vitreous Cortex
- •Intermediate Zone
- •Cloquet’s Canal
- •Composition of Vitreous
- •Collagen
- •Hyaluronic Acid (hyaluronan)
- •Hyalocytes
- •Vitreal Function
- •Age-Related Vitreal Changes
- •References
- •Optic Pits
- •Optic Cup, Lens, and hyaloid vessels
- •Optic Cup
- •Lens
- •Hyaloid Arterial System
- •Retinal Pigment Epithelium
- •Neural Retina
- •Retinal Vessels
- •Cornea
- •Sclera
- •UVEA
- •Choroid
- •Ciliary Body
- •Iris
- •Pupillary Membrane
- •Anterior Chamber
- •Vitreous
- •Optic Nerve
- •Eyelids
- •Orbit
- •Extraocular Muscles
- •Nasolacrimal System
- •References
- •Orbital Walls
- •Roof
- •Floor
- •Medial Wall
- •Lateral Wall
- •Orbital Margins
- •Orbital Foramina and Fissures
- •Paranasal Sinuses
- •ORBITAL CONNECTIVE TISSUE
- •Periorbita
- •Orbital Septum
- •Tenon’s Capsule
- •Suspensory Ligament (of Lockwood)
- •Orbital Muscle of Müller
- •Orbital Septal System
- •Orbital Fat
- •Aging Changes in the Orbit
- •References
- •Palpebral Fissure
- •Eyelid Topography
- •Eyelid Margin
- •Eyelid Structures
- •Orbicularis Oculi Muscle
- •Palpebral Portion
- •Orbital Portion
- •Orbicularis Action
- •Superior Palpebral Levator Muscle
- •Levator Aponeurosis
- •Levator Action
- •Retractor of Lower Eyelid
- •Tarsal Muscle (of Müller)
- •Tarsal Plate
- •Palpebral Ligaments
- •Glands of the Lids
- •Histologic Features
- •Skin
- •Muscles
- •Tarsal Plates
- •Palpebral Conjunctiva
- •Glands
- •Innervation of Eyelids
- •Blood Supply of Eyelids
- •Conjunctiva
- •Plica Semilunaris
- •Caruncle
- •Conjunctival Blood Vessels
- •Conjunctival Lymphatics
- •Conjunctival Innervation
- •Lacrimal Secretory System
- •Tear Film Distribution
- •Nasolacrimal Drainage System
- •Puncta and Canaliculi
- •Lacrimal Sac and Nasolacrimal Duct
- •Tear Drainage
- •References
- •Sliding Ratchet Model of Muscle Contraction
- •Structure of the Extraocular Muscles
- •Fick’s Axes
- •Ductions
- •Vergences and Versions
- •Positions of Gaze
- •Origin of the Rectus Muscles
- •Insertions of the Rectus Muscles: Spiral of Tillaux
- •Medial Rectus Muscle
- •Lateral Rectus Muscle
- •Superior Rectus Muscle
- •Inferior Rectus Muscle
- •Superior Oblique Muscle
- •Inferior Oblique Muscle
- •FIBERS OF THE Extraocular muscleS
- •ORBITAL CONNECTIVE TISSUE STRUCTURES
- •Horizontal Rectus Muscles
- •Vertical Rectus Muscles
- •Oblique Muscles
- •Movements From Secondary Positions
- •Vertical Rectus Muscles
- •Oblique Muscles
- •Yoke Muscles
- •Innervation
- •Blood Supply
- •References
- •Ophthalmic Artery
- •Central Retinal Artery
- •Lacrimal Artery
- •Posterior Ciliary Arteries
- •Ethmoid Arteries
- •Supraorbital Artery
- •Muscular Arteries
- •Anterior Ciliary Arteries
- •Medial Palpebral Arteries
- •Supratrochlear Artery
- •Dorsonasal Artery
- •Facial Artery
- •Superficial Temporal Artery
- •Maxillary Artery
- •Superior Ophthalmic Vein
- •Central Retinal Vein
- •Vortex Veins
- •Inferior Ophthalmic Vein
- •Anterior Ciliary Veins
- •Infraorbital Vein
- •Cavernous Sinus
- •References
- •Trigeminal Nerve
- •Ophthalmic Division of Trigeminal Nerve
- •Nasociliary Nerve
- •Frontal Nerve
- •Lacrimal Nerve
- •Ophthalmic Nerve Formation
- •Maxillary Division of Trigeminal Nerve
- •Infraorbital Nerve
- •Zygomatic Nerve
- •Maxillary Nerve Formation
- •Trigeminal Nerve Formation
- •Oculomotor Nerve: Cranial Nerve III
- •Oculomotor Nucleus
- •Oculomotor Nerve Pathway
- •Trochlear Nerve: Cranial Nerve IV
- •Trochlear Nucleus
- •Trochlear Nerve Pathway
- •Abducens Nucleus
- •Abducens Nerve Pathway
- •Superior Orbital Fissure
- •Control of Eye Movements
- •Facial Nerve: Cranial Nerve VII
- •Facial Nucleus
- •Facial Nerve Pathway
- •References
- •Optic Nerve
- •Optic Chiasm
- •Optic Tract
- •Lateral Geniculate Nucleus
- •Optic Radiations (Geniculocalcarine Tract)
- •Primary Visual Cortex (Striate Cortex)
- •Retina
- •Optic Disc
- •Optic Nerve
- •Optic Chiasm
- •Optic Tract
- •Lateral Geniculate Nucleus
- •Optic Radiations
- •Striate Cortex
- •Striate Cortex Maps
- •Macular Sparing
- •References
- •Sympathetic Pathway to Ocular Structures
- •Parasympathetic Pathway to Ocular Structures
- •Neurotransmitters
- •Ophthalmic Agonist Agents
- •Ophthalmic Antagonist Agents
- •Disruption in the Afferent Pathway
- •Disruption within the Central Nervous System
- •Disruption in the Efferent Pathway
- •Disruption in the Sympathetic Pathway
- •References
- •Index
118 Clinical Anatomy of the Visual System
intermediate zone is inner to the cortex and surrounds the center canal.
Vitreous Cortex
The vitreous cortex, also called the hyaloid surface, is the outer zone.69 It is 100 μm wide,2 and it is composed of tightly packed collagen fibrils, some of which run parallel and some perpendicular to the retinal surface.70,71 The anterior cortex lies anterior to the base and is adjacent to the ciliary body, posterior chamber, and lens. The posterior cortex extends posterior to the base and is in contact with the retina. It contains transvitreal channels that appear as holes—the prepapillary hole, the premacular hole, and prevascular fissures. The prepapillary hole can sometimes be seen clinically when the posterior vitreous detaches from the retina.60 The premacular hole, a weak area, may be a region of decreased density rather than an actual hole.60,71 The prevascular fissures provide the avenue by which fine fibers enter the retina and encircle retinal vessels.61
Intermediate Zone
The intermediate zone contains fine fibers that are continuous and unbranched and that run anteroposteriorly.60,70,72 These fibers arise at the region of the vitreous base and insert into the posterior cortex.73 The peripheral fibers parallel the cortex, whereas the more central fibers parallel Cloquet’s canal. Membranelike condensations, called vitreous tracts, may be differentiated as areas that have differing fiber densities (Figure 6-13).71
Cloquet’s Canal
Cloquet’s canal, also called the hyaloid channel or the retrolental tract, is located in the center of the vitreous body.2 It has an S shape, rotated 90 degrees with the center dip downward, and is the former site of the hyaloid artery system, which was formed during embryologic development (see Chapter 7). Cloquet’s canal arises at the retrolental space. Its anterior face is approximately 4 to 5 mm in diameter.2 It terminates at the area of Martegiani, a funnel-shaped space at the optic nerve head that extends forward into the vitreous to become continuous with the canal.2,60
COMPOSITION OF VITREOUS
The highly transparent vitreous is a dilute solution of salts, soluble proteins, and hyaluronic acid contained within a meshwork of the insoluble protein, collagen. Vitreous is 98.5% to 99.7% water and has been described as having connective tissue status and being an extracellular matrix.71,74 Because of its high water content, study
1
2
3
3
2
1
FIGURE 6-13
Eisner’s interpretation71 of vitreous structures (according to slitlamp examinations of eyes obtained at autopsy). Vitreous body is divided into three zones: Externally, as far as retina extends, there is a relatively thick vitreous cortex (light orange). It has holes at characteristic locations: in front of papilla, in region of fovea centralis, in front of vessels, and in front of anomalies of ora serrata region (enclosed ora bays, meridional folds, zonular traction tufts). Intermediate zone (medium orange) contains vitreal tracts, membranelles that form funnels packed into one another and that diverge from region of papilla anteriorly. Central channel (dark orange) is space delimited by hyaloid tract. It is closed off anteriorly by a retrolental section of anterior vitreous membrane. It contains no typical tracts but only irregularly arranged vitreous fibers, part of which are residua of Cloquet’s canal. Outermost vitreous tract, the preretinal tract (1), separates intermediary substance from vitreous cortex. Innermost tract, the hyaloid tract (3), inserts at the edge of
the lens. Between these tracts extends the median tract (2) to median ligament of pars plana and the coronary tract to
coronary ligament. (From Sebag J: The vitreous. In Hart WM Jr, editor: Adler’s physiology of the eye, ed 9, St Louis, 1992, Mosby.)
of the vitreous is difficult. Attempts at tissue fixation often have dehydrating effects that introduce artifacts. Recent investigations suggest that the epithelium of the pars plana has a significant role in the production and secretion of several connective tissue macromolecules of the vitreous body.74
Collagen
The collagen content of the vitreous is highest in the vitreous base, next highest in the posterior cortex, next in the anterior cortex, and lowest in the center.60 A fine meshwork of uniform collagen fibrils, each 8 to 16 nm in diameter, is evident on electron microscopy and fills
