INDEX

Accessory ciliary ganglion, 8 –9 Accommodation, 118–, 168 –72

amplitude, 94–95

anatomy and physiology, 103 consensuality, 97

dynamic responses, 97–98 fluctuations, 98, 101

related input to Edinger-Westphal nucleus, 138–142 responses of Edinger-Westphal neurons, 136–138 sensory mechanisms, 99–100

static stimulus-response relationship, 95–97, 100, f 3.2 tonic, 97

vergence interaction, 101 Acetylcholine

ATP as cotransmitter, 178 in ciliary ganglion, 119

in iris and ciliary body, 9–11 in lens, 190

regulation of corneal physiology, 74–77 Acetylcholinesterase (AChE) and corneal nerves, 17, 66, 92 –5 Adenosine, 216, f 6.1

extracellular sources, 178–180 receptors, 173–174

A1 receptor, 174, 189, 193, t 6.1 A2A receptor, 174, 189, 194, t 6.1 A2B receptors, 174, 189, t 6.1

A3 receptors, 174, 189, t 6.1 in the lens, 189

in the retina, 193–195 role in cornea, 183–184 role in iris-ciliary body, 185 sources in retina, 195

vascular properties in the retina, 198

Adenosine 5′-triphosphate (ATP), 216, 218–24, f 6.1 and cataracts, 191

as cotransmitter, 178, 184, 197 in lens, 190

as neurotransmitter, 8, 16, 183 protective role in UV light, 189 role in cornea, 183

role in iris-ciliary body, 186

sources of extracellular ATP, 178–180

Index 343

vascular properties in the retina, 199 Adnexa

motor innervation, 264 neural regulation, 265

parasympathetic innervation, 264 sensory innervation, 263–264 sympathetic innervation, 264

Adnexal elements, 321

Adrenergic nerve regulation of corneal epithelial cell physiology corneal transparency, 89 epithelial cell migration, 73–74

epithelial cell proliferation, 72–73 ion transport, 70–72

Adrenergic nerves

corneal, see corneal nerves, sympathetic Adrenergic neurons

of Edinger-Westphal nucleus, 148 Adrenoceptors

α-adrenoceptors, 13, 15, 24, 186 β-adrenoceptors, 14, 15, 23, 24 Anhydrotic ectodermal dysplasia, 326

Anterior uvea

distribution of neurotransmitters, t 1.1 peripheral innervation, 2–11, f 1.1 parasympathetic, 8–11

sensory, 2–5 sympathetic, 5–8

Antigen presenting cells (APCs)

in corneal graft rejection, 240, f 8.3 Aqueous deficient dry eyes, 325 Aqueous humour, 20–8, 225

formation

effect of adrenergic agents, 23–24 parasympathetic regulation, 25–26 physiology, 20–22, 184, 185 regulation, 18–26

sympathetic regulation, 22–25 secretion

signalling pathways, 26–28 Astrocytes

in retina, 193

Blinking, 319, 324 Blood vessels

and ATP, 198 Blood-retinal barrier, 196 Blur, 123, 126, 127, 128, 137

Bowman’s membrane, 226, 317 Bruch’s membrane, 239

Index 344

Calcitonin gene-related polypeptide (CGRP)

and corneal nerves, 54, 56–57, 68–70, 80, f 2.11 and ocular sensory nerves, 4, 14

and retina, 160

Canal of Schlemm, 28, 231, f 6.4 Capsaicin

effects on cornea, 63–65, 80 Cataracts, 231, 236, 237 Central retinal artery

innervation, 160 Cerebellum, 134 Cholecystokinin (CCK)

and ocular sensory nerves, 5, 14 Cholinergic nerves

anterior uvea, 9

cornea, 74–77, f 2.20, f 2.21 Choroid

vascular innervation, 157 Choroid blood flow

role of Edinger-Westphal nucleus, 143–147 Choroid blood supply, 195

Chromatic aberration, 125 –6 Ciliary body

blood vessels, 5 innervation, 1–11

Ciliary epithelium anatomy, 18–19, f 1.2

ion transport pathways, 20–22, f 1.3 nonpigmented, 18, 19, 27, 185, 186 pigmented, 18, 19, 185, 186

Ciliary ganglion, 2, 8, 158 –9 projections to iris, 217

Ciliary process, 1, 5, 6, 225, 231, 232 –3 anatomy, 18–19

Congenital alacrima, 325 Conjunctiva, 225

abnormal products in disease, 271 Conjunctival epithelium

anatomy, 258 Consensual response

in pupillary light reflex, 220 Cornea

anatomy, 181, 257–258, 263, f 6.3 motor innervation, 264 parasympathetic innervation, 264 sensory innervation, 263–264 sympathetic innervation, 264

Index 345

Corneal epithelium anatomy, 257–258 embryology, 259

innervation, 49–51, f 2.5, f 2.6 ion pumps, 184

origin, 259–260

persistent epithelial defect, 284 physiology, 259, 260

response to loss, 260 Corneal grafts

clinical outcomes, 236–237 humoural response, 238–239 indications, 236

matching blood groups, 245 matching HLA, class I & II, 244–245

Corneal graft rejection

antigen presenting cells (APCs), 240, f 8.3 clinical management, 248

clinical types, 245–247

endothelial rejection, 247, 249, 250, f 8.4–8.6 epithelial rejection, 245, 246

inflammatory damage, 239–240 rejection response, 237–238 risk factors, 248

role of Langerhans cells, 241 role of macrophages, 239–240 stromal rejection, 247

Corneal nerves

adrenergic, see corneal nerves, sympathetic cholinergic, 74–77, 183

parasympathetic, 44 sensory

anatomical organisation, 44–53 conduction velocities, 61 development, 77–80, f 2.23 electrophysiology, 59–63 epithelial terminals, 49–54

epithelial terminals, postnatal maturation, 78–79

epithelial terminals, remodelling under physiological conditions, 52–53, 54, 56 innervation density, 51

modulation by cholinergic system, 77 neurochemistry, 54–59, 68–70, 80 origins in trigeminal ganglion, 42–44 receptive fields, 60–61

stromal axon distribution, 45–47 stromal axons transduction functions, 47 trophic functions, 63–69

types (modality specific), 59–63

Index 346

ultrastrucrure, 53–54 wound healing, 65, 73–74

sympathetic

anatomical organisation, 47–49 development, 80

functions, epithelial cell proliferation and mitosis, 72–73 functions, epithelial wound healing, 73–74

functions, ion transport, 70–72 functions, trophic effects, 74 interactions with sensory nerves, 74 ultrastructure, 49

Corneal sensitivity quantification, 263–264 sympathetic, 51–52, 183

Corneal transplantation see Corneal grafts Cosensuality, 122

Crocodile tears, 328

Cytidine 5′-triphosphate (CTP), 229, 246

Depth of field, 118, 120 Descement’s membrane, 226 Diabetes

association with cataracts, 191 Diplopia, 247

Dry eyes

anti-inflammatory treatment, 282 aqueous deficient, 266

clinical management, 279–283, f 9.3 of complications, 283–286

clinical tests, 273–276, f 9.1, t 9.1 diagnostic approach, 271 environmental aspects, 281 excess mucus, 283–284

ocular examination, 278–279 surgical management, 287–288

Ecto-5′-nucleotidase, 241, 244 Edinger-Westphal nucleus

accommodation-related inputs, 138–142, f 4.15, f 4.16 adrenergic neurons, 148

cytoarchitecture

birds, 119–121, f 4.1 cats, 125

fish, 126 primates, 121–125 rabbits, 125 reptiles, 125–126

enkephalergic neurons, 148

Index 347

influence on choroidal blood flow, 144–145 modulation of information flow, 148–149 output projections, 220

projections from OPN, 217, f 7.2 pupil-related inputs, 130–133, f 4.9, f 4.10 role in accommodation, 110, 134–135, f 4.11 serotonergic neurons, 148

Electroretinogram (ERG), 265, 281 Enkephalins

in anterior uvea, 8

in ciliary ganglion, 119, f 4.2 in corneal nerves, 57–59

in Edinger-Westphal nucleus, 148 Erythema multiforma, 326 Extraocular muscles, 225, 247

Facial nerve

in regulation of aqueous humour, 25, 26 Filamentary keratitis, 344

Galactosaemia

association with cataracts, 191 Galanin

corneal nerves, 57–59 ocular sensory nerves, 5

Glands of Moll, 321

Glands of Zeis, 321 Glaucoma, 28, 231, 247 Glial cells

of retina, 192, 193 Goblet cells, 321, 322, 323

Guanosine 5′-triphosphate (GTP), 229, 246

Histamine

in lens, 190 Histocompatibility antigens,

see also Minor histocompatibility antigens in corneal graft rejection, 242 human leucocyte antigens (HLA), class I, 242

human leucocyte antigens (HLA), class II, 242, 243 Horner’s syndrome

effects on corneal physiology, 74 Human leucocyte antigens (HLA)

in corneal graft rejection, 242 laboratory testing, 243

matching for corneal grafts, 244–245 matching in non-ocular transplants, 243

Inflammation, 237

Index 348

Inosine 5′-triphosphate (ITP), 229, 245 Intracerebral transplantation, 272 Intraocular pressure, 22, 25, 231, 233, 247

modulation by adenosine, 187

role of sympathetic nervous system, 187 Intraretinal transplantation, 264, 280

Iris

innervation, 1–12 Iris dilator muscle

parasympathetic regulation, 16–17 sympathetic regulation, 15–16

Iris muscles

anatomy, 11–12, 185 Iris sphincter, 6, 231

sphincter muscle

parasympathetic regulation, 12–13 sensory regulation, 14–15 sympathetic regulation, 13–14

Iris-ciliary body anatomy, 185

role of purines, 185–186

Keratitis neuroparalytic, 63–68

Keratoconjunctivitis sicca, 324, 325

Lacrimal glands accessory, 262, 263 control of secretion, 265 main, 262, 263

Lacrimation, 327 Lamina cribrosa, 199 Langerhans cells

role in corneal graft rejection, 241 Lateral geniculate nucleus, 227 Lateral interparietal sulcus (LIP), 128 Lateral suprasylvian cortex, 131 Lens

adenosine receptors, 189 anatomy, 187–188

role of ATP and nucleotides, 188–189 in birds, 188

in fish, 188

in humans, 188 Limbal epithelium

anatomy, 258

Limbus and Limbal plexus, 55–7, f 2.2 innervation, 45

Index 349

Meibomian glands, 320, 321 disease, 270

Midbrain, 136

Minor histocompatibility antigens, 299 Müller cells

of retina, 192, 193, 195

NADPH-diaphorase in retina, 161, f 5.1

Neurogenic inflammation and corneal nerves, 70

Neuroparalytic keratitis, 78–85, f 2.14 Neuropeptide Y (NPY)

in anterior uvea, 8

in corneal sympathetic nerves, 57, f 2.12 in iris, 16

in retina, 160

Nitric oxide (NO), 199–203, 244, 245 synthase (NOS), 161, f 5.2

Nociceptors corneal, 59–63, 77

Non-adrenergic, non-cholinergic

(NANC) transmission, 173, 178, 184, 185 Nonpigmented ciliary epithelium (NPE), 20, 29, 231, 232 Noradrenaline (NA)

as cotransmitter with ATP, 178 in lens, 190

as neurotransmitter, 6, 24, 57 Nucleotides

as neurotransmitters, 185

Nucleus of posterior commissure, 270

Nucleus reticularis tegmenti pontis (NRTP), 132, 133, f 3.6

Ocular accommodation, see Accommodation Ocular cictricial pemphigoid (OCP), 326 Ocular surface

anatomy, 257–258 clinical tests, 277–278 impression cytology, 278 motor innervation, 264

parasympathetic innervation, 264 Rose Bengal staining, 277–278 sensory innervation, 263–264 sympathetic innervation, 264 toxicity of topical medication, 282

Ocular transplantation in amphibians, 213

Index 350

Oculomotor nerve, 231

Olivary pretectal nucleus (OPN) anatomy, 219, 224

effect of lesions, 226, f 7.5

mediation of pupillary light reflex, 218 neural projections, 217, f 7.2

outputs to Edinger-Westphal nucleus, 217, 220 in retinal transplantation, 224

secondary projections, 219 Opioid neuropeptides

(see also Enkephalins) anterior uvea, 8

Optic nerve, 226 replacement, 214, 230

P2 receptors, 218 –23 in the lens, 189

in the retina, 195–197

P2X receptors, 218, 220, t 6.2 in the retina, 196

P2Y receptors, 218, 220–2, t 6.3

P2Y1 receptors on vascular endothelium, 198, 200, 201 P2Y2 receptors

in the lens, 190, 191 in the retina, 197

Palpebral aperture motor innervation, 264

Parasympathetic innervation of anterior uvea, 8–11

Parietal cortex, 128

Photoreceptors, 225, 239, 242, 264, 269 initiation of pupillary reflex, 218

Pigmented ciliary epithelium (PE), 19, 20, 231, 232 Pituitary adenylate cyclase-activating peptide (PACAP)

in corneal nerves, 57

Pretectal olivary nucleus (PON), 132 Prostaglandins

in iris regulation, 17–18 Pterygopalatine ganglia, 9 Ptosis, 247

Punctate keratopathy, 343 Pupillary deficits, 159

Pupillary light reflex, 158–61, 265 basic biology, 216–217 consensual response, 220 development after graft, 223 effects of graft rejection, 223 graft-mediated, 221, 222, f 7.3

Index 351

initiation by photoreceptors, 218

measurement in experimental animals, 215–216, f 7.1 normal development, 222

polysynaptic pathway, 216, 226, f 7.2

response of Edinger-Westphal neurons, 128–129, f 4.7 role of retinal ganglion, 218

in transplant conditions, 224, 230 transplant-mediated, 214–215

pupilloconstriction, 160 –1 response in retinal transplantation

effect of host optic nerve section, 225 interaction with host optic input, 224

role of the Edinger-Westphal nucleus, 127–128 Purine receptors, 218 –23

see also Adenosine receptors, P2 receptors, P2X receptors, P2Y receptors Purinergic transmission, 216 –8

Purines

as neurotransmitters, 8 trophic actions, 200

Retina

amacrine cells, 161, 180 astrocytes, 157, 165 blood supply, 156

cones and rods, 180, 192, 196 endothelial cells, 156, 157, 158 ganglion cells, 161 organisation, 192–193, f 6.5 pericytes, 157, 158

photoreceptor cells, 180, 192, 196 purinergic transmission, 193–198 source of nucleotides, 197

Retinal blood flow, 195, 197 autoregulation, 159

Retinal ganglion

participation in pupillary light reflex, 218 Retinal oligodendrocytes

nucleotide receptors, 197

Retinal pigment epithelium (RPE), 195, 196, 197, 225, 239, 241, 242 deficiency, 214

detachment, 198 Retinal receptor cells

(see also Photoreceptors) cones, 180

rods, 180

Retinal transplantation effect of host age, 227 intracranial, 213

Index 352

pupilloconstriction response, 224 of whole retinae, 213

Retinal vasculature and adenosine, 198 and ATP, 199

extrinsic innervation, 159

intrinsic innervation, 160, 161, 166 Retinitis pigmentosa, 244 Riley-Day syndrome, 328

Sarcoidosis, 326 Schirmer’s tests, 320, 334 Sclera, 225

Seborrheic blepharitis, 329 Sensory innervation

anterior uvea, 2–6

Sensory mechanisms in accommodation, 124 – Serotonin

and corneal nerves, 57

and Edinger-Westphal nucleus, 148 Sjogren’s syndrome, 324, 325 Staphylococcal blepharitis, 330

Static stimulus-response relationship in accommodation, 120–2, 125 Strabismus, 247

Stroma, 227, 230 Stromal plexus, 55 –7 Substance P (SP)

in corneal nerves, 57, 71

in Edinger-Westphal nucleus, 147 in ocular sensory nerves, 4, 14

in retina, 160, 161, 164–167

Superior cervical ganglia (SCG), 6, 229, 231 Superior colliculus, 131 –2

Sympathetic innervation anterior uvea, 5–8

of guinea-pig cornea, f 2.4 and intraocular pressure, 187 iris dilator muscle, 15–16

Tachykinin receptors

and corneal nerves, 54, 56–57, 68–70, 80 Tear film

anatomy of the adnexal elements, 262–263 clinical tests, 276–277

break up times, 276 evaporation rates, 277 lactoferrin levels, 276 Shirmer’s test, 260, 275

Index 353

tear function index, 276 tear osmolarity, 275–276

physiology, 261 preservation, 283 regulation, 264–265 regulation, neural, 265

structure and characteristics, 260–261, t 9.1 supplements, 281

Tear film disease, 324–6, 327 –8 anhydrotic ectodermal dysplasia, 267 aqueous deficient dry eyes, 266 congenital alacrima, 266

erythema multiforme, 267 keratoconjunctivitis sicca, 265, 266 lipid deficiency, 269–270

mucin deficiency, 269 neurological disease

aqueous defects, 268 crocodile tears, 268–269

peripheral nervous system lesions, 268 Riley-Day syndrome, 269 supranuclear and nuclear lesions, 268

ocular cictricial pemphigoid (OCP), 267 sarcoidosis, 267

Sjogren’s syndrome, 265, 266 vitamin A deficiency, 269

Tear function index, 335 Tear osmolarity, 334 –5 Tonic accommodation, 122

Trabecular meshwork, 231, f 6.5 Trigeminal ganglion, 2, 5

and corneal epithelium, 68 Trophic actions

of purines, 200 Tyrosine hydroxylase

in anterior uvea innervation, 6

in corneal innervation, 42, 57, f 2.4

Uridine 5′-triphosphate (UTP), 242, 243, 246 UV light

protective role of ATP and nucleotides, 189 Uveitis, 237

Vascular ophthalmic pathologies, 246 –7 Vasoactive intestinal polypeptide (VIP)

in corneal innervation, 48–49 in iris dilator muscle, 17

in retina, 160

Index 354

in uveal blood vessels and choroid, 11 Vasopressin (VP)

in anterior uvea, 5

Ventral lateral geniculate body, 270 Vergence-accommodation, 126, 127 Visual cortex

role in accommodation, 103–105

Wound healing corneal nerves, 59

role of corneal nerves, 65, 73–74