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PEDIATRIC OPHTHALMOLOGY
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Vitreous
Development of vitreous is complex; its exact origin is not well under stood. It is said to
be derived from both mesoderm and ectoderm . The ectoderm mostly develops form inner layer
of optic cup in the form of delicate fibrils. The mesodermal tissue forms hyloid vessels.
The development of vitreous is divided into three parts :
1. The Primary Vitreous is presumed to be derived from both mesoderm and ectoderm.
The hyloid vascular system is mesodermal, while fibrils are ectodermal, secreted by inner
layer of optic cup. The surface ectoderm does not contribute to formation of primary vitreous.
Primary vitreous starts developing in first month of intrauterine life. The primary vitreous is
not atrophied. It lies behind the posterior lens capsule as a conical structure. It is surrounded
by secondary vitreous.
2. The Secondary Vitreous starts forming from second month onward replacing primary vitreous that is completely replaced by sixth month, except the Coloquet canal which
also disappears at birth.
3. The tertiary vitreous is the zonule of the lens.
The Cornea
The spot where the optic vesicle touches the surface ectoderm is converted into lens
plate that gives rise to lens vesicle which is pinched off from the surface ectoderm. The remaining part of it gives rise to corneal epithelium. Rest of the cornea is mesodermal. The
mesoderm encroaches in between the surface ectoderm and the lens.
This mesoderm is divided into two distinct parts :
1. Anterior mesoderm that gives rise to stroma and endothelium of the cornea.
2. Posterior mesoderm that gives rise to iris stroma. In the space between the two
layers of mesoderm develops the anterior chamber. The Descemet membrane develops from
endothelium while Bownans membrane develops due to condensation of stroma under the
corneal epithelium.
The Development of Sclera1,2,4
Sclera is fully mesodermal in origin. It develops due to condensation of paraxial mesoderm around the optic cup. Its development is divided in two phases:
1. The development of anterior sclera
2. The development of posterior sclera.
The sclera is fully differentiated by fifth month. Initially, the limbus is farther back
near the future equator where the extra ocular muscles get attached later. By 12th week the
posterior condensation encircles the optic nerve and the lamina develops.
The scleral spur develops by 16th week and the Tenons capsule by 12th week along
with insertion of recti muscles.
The sclera plays little part in development of globe that depends upon development of
retina. In contrast to this sclera plays an important part in growth of orbit. At birth the sclera
is thin and gets a bluish tinge due to under lying uvea.
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3. The retinal circulation. Exact mode of development of retinal circulation is controversial. Most widely accepted hypothesis is that central retinal artery buds from the posterior
end of hyloid artery at the level of optic cup but does not atrophy like rest of the hyloid system
and then branches off as temporal and nasal branches that divide into superior and inferior
branches.
Development of Lid, Conjunctiva and Lacrimal System
1. The Lid. The lid has dual origin, the main mass of the lid is formed by mesoderm
while the skin and conjunctiva develop from surface ectoderm. At about 18mm stage, the
mesoderm condenses outside the optic vesicle in the form of lid fold. The upper lid develops
from frontonasal process in two parts i.e. smaller medial and larger lateral part, while the
lower lid develops from maxillary process.
Fault in fusion of medial and lateral frontonasal mesoderm results in coloboma of
upper lid that may very from a simple notch at the lid margin to extensive loss of tissue. The
upper and lower lids are fused between third and sixth month then they separate. Separation
is completed well before birth. Failure to separate will result in ankyloblepharon of various
degrees.
2. The Conjunctiva. The conjunctiva, cilia, meibomian gland, lacrimal gland and accessory lacrimal glands also develops from surface ectoderm and are associated with development of the lid.
3. Development of lacrimal system7.
(a) The lacrimal gland. Lacrimal gland develops from the superior temporal conjunctival fornix, as solid cords of ectodermal cells 8-10 in number which are surrounded by mesoderm that develop into connective tissue of the gland. The ectodermal cords gradually canalise
and ramify.
(b) The Lacrimal Passage. The lacrimal passage develops in the groove between the
maxillary proces and lateral nasal process, the groove or cleft is converted in to a tube. The
surface ectoderm gets buried in the mesoderm and progress upwards, at the same time a
similar cord of ectoderm develops from the nasal cavity. The upper end will form the two
canaliculi, puncta and sac. Subsequently the two cords i.e. the upper and nasal will join
each other to form a continuous structure. During third month the central cells of the cord
begin to disintegrate and form the nasolacrimal duct. The disintegration is patchy in nature
but ultimately becomes continuous. The upper part thickens and dilates to form the lacrimal
sac.
Development of the Orbit
The walls of the orbit develop from the mesoderm around the eye. The floor and lateral
walls develop from maxillary mesoderm. The medial wall develops from the lateral nasal process. The roof differs little from these walls, it develops from the mesoderm covering the forebrain.
By 14th week the boundaries of orbit are well differentiated. Up to 28th week the orbital
margin is at the level of developing equator of the globe, there after it grows rapidly and the
rim occupies more anterior position than the globe. The size of orbit is so small at this stage
that its walls are snug with the globe. At birth the orbital rim is almost circular, its diameter
is relatively large as compared to face.
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associated with Chroroideal effusion syndrome13 that may follow any intra ocular surgery
or injury to the globe.
(b) Colobomatous microphthalmos. colobomatous microphthalmos is a congenitally
small eye that have associated failure of embryonic fissure. These eyes have multiple
colobomatous defects at the site of fusion of embryonal fissure, mostly in uvea and or retina.
These eyes are small in all dimensions, the coloboma may range from a small notch in iris to
coloboma extending up to optic nerve.
(c) Complicated microphthalmos. Is a term used to denote a congenitally small eye
that develops cataract, iridocorneal defects, defects in iris, retina and vitreous. These are due
to
(i) Failure of development of primary optic vesicle.
(ii) Arrest of development after the primary optic vesicle has formed.
(d) Microphthalmos with cyst. In case only retinal tissue protrudes through the embryonic cleft a cystic eye ball with coloboma results. The colobomatous cyst may have an
almost normal eye with a small indistinguishable cyst or the cyst may be so large that the
small eye is not visible. In between are the cases where a formed eye is associated with
colobomatous cyst.
(e) Microphthalmos associated with various syndromes. There is a long list of
conditions that are associated with microphthalmos most of which are cranio facial or mandibulo
facial anomalies.
BUPHTHALMOS
This condition is just reverse of microphthalmos it is a large eye associated with various
types of congenital glaucoma.
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REFERENCES
1. Duke Elder.S. ; System of Ophthalmology, Vol-III, Part-I, First edition, Henry
Kimpton, London, 1964.
2. Mann Ida ; Development of Human Eye, Third Edition, British Medical Association,
London, 1964.
3. Barber A.N. ; Embryology of Human Eye, The C.V. Mosby St. Louis 1955.
4. Kozart D.M. ; Embryology of the human Eye in Text Book of Ophthalmology, Ninth
Edition p79-92, Edited by Schcie H.G., and Albert D.M., W.B. Saunders Company, London, 1977.
5. Vaughan D and Asbury T. ; General ophthalmology, Ninth Edition p9-13, Lange
medical publication, California 1980.
6. Hamming Nancy and Apple D. ; Anatomy and embryology of the eye in Principles and
Practice of Ophthalmology, Vol-I, p3-20, First Indian edition. Edited by Peyman
G.A., Sander D.R. and Goldberg M.F. Jay. Pee Brothers, New Delhi, 1987.
7. Buffam F.V. ; Lacrimal diseases in Text book of ophthalmology, Vol-4, Edited by
Podos S.M. p7.1 to 7.3, Gower Medical Publication, London 1993.
8. Nema H.V. Singh V.D and Nema N. ; Congenital anomalies of the eye and its adnexa in
Anatomy of the Eye and its Adnexa. Second edition. p162-165, Jay Pee Brothers,
New Delhi 1991.
9. Duke Elder.S. ; System of Ophthalmology, Vol-III, Part-2, First Edition p415-495,
Henry Kimpton London,1964.
10. Schaffer D.B. ; Abnormalities of the eye as a whole in Text Book of Ophthalmology
Ninth Edition., p209-293, Edited by Scheie H.G. and Albert D.M., W.B. Saundes Company, Philaddphia 1977.
11. Dutta L.C. ; Uveal effusion syndrome in Ophthalmology, First Edition p-122-123
Current Books International, Kolkota 1995.
12. Shields M.B. ; Nanophthalmos in Text Book of Glaucoma, Fourth Edition, p-280,
William and Wilkins Philadelphia 1999.
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