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Module 35.

Now He Sees, Now He Doesnt February 20, 2007

Grou 2. !o"an#sa $law#, Ho%"#lle Mae &on'%as, Mur"y &oyles, Nas"#ba Daud, So"a#l# (a'u#ndab, !ul#us )easar *an
*r#''er +.
Ruben, 50 year old executive sought consult for blindness of his left eye. He was well until a few hours prior to consultation when he
felt a little dizzy and then felt a drape slowly came down his left eye, dimming his vision.
*r#''er 2.
After his physical examination, he was subected to various laboratory tests and procedures. !efore all of them were over, to his
surprise, he regained his left eyesight.
+. Des%r#be ,ono%ular bl#ndness. -"at are t"e oss#ble
%auses o. "#s bl#ndness/ -"ere #s t"e l#0ely s#te o. les#on/
Mono%ular bl#ndness is the loss of vision, not correctable with
lenses in the left or right eye.

)o,,on )auses o. &l#ndness1
!lindness has many causes. "orldwide leading causes
include the following#
$. $ataracts
&. %nchocerciasis &'river blindness'(
). )rachoma
D. *eprosy
%ther cause includes#
$. +itamin A deficiency
&. ,iabetes
). -laucoma
D. macular degeneration
2. accidents &such as chemical burns or inuries from bungie
cords, fishing hoo.s, firewor.s, balls, and similar
F. bloc.ed blood vessels &amaurosis fugax(
G. complications of premature birth &retrolental fibroplasia(
H. complications of eye surgery
3. lazy eye
!. optic neuritis
4. stro.e
(. )ay/0achs disease
M. retinitis pigmentosa
N. retinoblastoma
5. lead poisoning
6. optic glioma
Most 6robable )ause
)he patient has a sudden visual loss. )here is no history ta.en
except for the patient1s account of feeling dizzy ust before he
felt a drape slowly came down his left eye.
$,auros#s .u'a7 or )ransient monocular blindness can be
the possible cause of these visual loss

$M$895S3S F8G$:
0udden visual loss is a common complaint among
patients of different ages with variable presentations. 0ome patients
describe it as a 'ray;bla%0 %urta#n t"at 'radually des%ends,
blurr#n', .o''#n', or d#,,#n' <#s#on. 2t usually lasts a few
minutes but can persist for hours. )he fre3uency varies from a
single episode to many during a day4 it may continue for years but
more often lasts for seconds to hours. 2schemia is the most
common mechanism of acute visual dysfunction and it can affect
any aspect of the visual system.
)auses, #n%#den%e, and r#s0 .a%tors1
Amaurosis fugax is thought to result from a %lot o.
la=ue #n t"e %arot#d artery art#%ularly t"e o"t"al,#% artery off and traveling to the retinal artery in the eye. )his bloc.s
the artery for a time and causes loss of vision in that eye for as long
as its blood supply is cut off.
$t"eros%leros#s o. t"e %arot#d arter#es &in the nec.( is
the main ris. factor for this condition. Ris. factors for
atherosclerosis include heart disease, high cholesterol,,
diabetes, and high blood pressure.
0ymptoms include the sudden loss o. <#s#on #n one
eye. )his usually only lasts se%onds but ,ay last se<eral
,#nutes. 0ome patients describe the loss of vision as a 'ray or
bla%0 s"ade %o,#n' down o<er t"e#r eye.
S#'ns and tests1
)ests include a thorough o"t"al,olo'#%al and
neurolo'#%al e7a,#nat#on. 0ubse3uently, a carotid ultrasound or
an 5RA &magnetic resonance angiography( should be done to
evaluate the amount of bloc.age in the carotid artery.
Routine blood tests such as cholesterol and glucose
should be done to assess ris. of atherosclerosis, which increases
with elevated cholesterol and diabetes.
)reatment depends on the results of the evaluation. 2f
there is evidence of bloc.age of more than 70> o. t"e %arot#d
artery, t"e at#ent ,ay be %ons#dered .or sur'ery to re,o<e t"e
)he decision to do surgery will also be based on the
presence and severity of other medical problems and the general
health of the patient. 2f the patient is not deemed a surgical
candidate, treat,ent w#t" as#r#n or anot"er blood t"#nn#n'
a'ent may be warranted.
(ower#n' %"olesterol, reducing high blood pressure and
cessation of can help decrease the ris. of atherosclerosis.
6ew techni3ues include stenting of the carotid artery and
balloon an'#olasty o. t"e stenos#s &bloc.age( in the carotid
artery. !oth techni3ues aim to open up the region of the carotid
artery that is being bloc.ed by pla3ue. )hese techni3ues are
promising, especially for patients who are not well enough to
undergo maor surgery.
27e%tat#ons ?ro'nos#s@1
Amaurosis fugax may be a s#'n o. #,end#n' stro0e.
)he attac. itself does not result #n any er,anent d#sab#l#ty.
)hough this condition does not result in any permanent
damage, it is a sign of atherosclerotic disease and therefore implies
a ser#ous r#s0 .or stro0e.

7revention of stro.e includes eating a "ealt"y d#et low #n .at,
%ontroll#n' "#'" blood %"olesterol and "#'" blood su'ar as well
as lower#n' blood ressure, doing re'ular e7er%#se, and not

No oss#ble ner<e les#ons but #nstead an #n%o,lete
blo%0a'e on t"e artery suly#n' t"e ret#na, t"e %entral
artery, or on t"e o"t"al,#% artery, or on t"e #nternal
%arot#d artery #s oss#ble resent.
2. Des%r#be t"e 'ross anato,y and role o. t"e eye to #n%lude1
2.+. )ontents o. t"e orb#t and t"e#r des%r#t#ons
59&3*$( 92G35N
%rbits are a pair of bony cavities that contain the eyeballs4
their associated muscles, nerves, vessels, and fat4 and most of
the lacrimal apparatus. )he orbital opening is guided by two
thin movable fold, the eyelids
9yelids are placed in front of the eye, which is protected
from inury and excessive light by their closure
:pper eyelid is larger and more mobile than the lower,
and they meet each other at the ,ed#al and lateral
"hen the eye closed, the upper eyelid completely
covers the cornea of the eye.
)he lower lid lies ust below the cornea when the
eye is open and rises only slightly when the eye is
6alebral .#ssure is the elliptical opening between the
eyelids and is the entrance into the %onBu%t#<al sa%.
0uperficial surface of the eyelids is covered by, and
the deep surface is covered by a mucous membrane
called %onBun%t#<a.
2yelas"es, which are short curved hairs, are present on
the free edges of the eyelids.
Glands o. Ce#s, sebaceous glands, open directly into the
eyelash follicles.
)#l#ary 'lands or glands of 5oll are modified sweat
glands that open separately between adacent lashes.
*arsal 'lands are long, modified sebaceous glands that
pour their oily secretions onto the margin of the lid4 their
openings lie behind the lashes.
)arsal gland secretions prevents overflow of tears
and helps ma.e the closed eyelids airtight.
)he lateral angle of the palpebral fissure is more acute
than the medial angle and lies directly in contact with the
eyeball. )he more rounded medial angle is separated
from the eyeball by a small space called the la%us
)arun%ula la%r#,al#s is a small reddish yellow elevation
found in the center of the lacus lacrimalis.
6l#%a se,#lunar#s, a reddish semilunar fold, lies on the
lateral side of the caruncle
6ear the medial angle of the eye, the eyelashes and the
tarsal glands stop abruptly, and small elevation, the
a#lla la%r#,al#s is present.
6un%tu, la%r#,ale is a small hole present on the
summit of the papilla lacrimalis that leads into the
canaliculus lacrimalis.
)he papilla lacrimalis proects into the lacus, and the
punctum and canaliculus carry tears down into the
)onBun%t#<a is a thin mucous membrane that lines the
eyelids and is reflected at the superior and inferior
fornices onto the superior surfaces of the eyeball.
9pithelium is continuous with that of the cornea.
:pper lateral part of the superior fornix is pierced by
ducts of the lacrimal gland.
)onBu%t#<al sa%, a space formed by the conuctiva
which is open at the palpebral fissure.
Subtarsal sul%us, a groove beneath the eyelid that runs
close to and parallel with the margin of the lid
)his tends to trap small foreign particles introduced
into the conunctival sac and is thus clinically
5rb#tal setu,, a membranous sheet that forms the
fibrous framewor..
Attach to the orbital margin and continuous with the
)hic.ened at the margins of the lids to form
crescentic laminae of dense fibrous tissue called
tarsal lates with the superior tarsal plate being the
(ateral alebral l#'a,ent, a band that attaches
the lateral ends of the plates to a bony tubercle ust
within the orbital margin.
Med#al alebral l#'a,ent, a band that attaches
the media ends of the plate to the crest of the
lacrimal bone.
)he tarsal glands are embedded in the posterior
surface of the tarsal plates
5rb#%ular#s o%ul# ,us%les palpebral fibers cover the
superficial surface of the tarsal plates and the orbital
(e<ator alebrae suer#or#s ,us%le pierces the orbital
septum to reach the anterior surface of the superior tarsal
and the
Mo<e,ents o. t"e eyel#ds
)he position of the eyelids depends of the tone of the
orbicularis oculi and the levator palpebrae superioris
muscles and the position of the eyeball.
)losure is done by the contraction of the orbicularis oculi
and the relaxation of the levator palpebrae superioris.
5en#n' is done by raising the upper lid by the levator
palpebrae superioris
%n upward, the levator palpebrae superioris
contracts and the upper lid moves with the eyeball.
%n downward, both lids move with the eyeball
with the upper lid continues to cover the upper part of the
cornea, and the lower lid pulled downward slightly by the
($)93M$( $66$9$*8S
(a%r#,al Gland
$onsist of a lar'e orb#tal art and a s,all alebral
art, which is continuous with each other around the
lateral edge of the aponeurosis of the levator palpebrae
0ituated above the eyeball in the anterior and upper part
of the orbit posterior to the orbital septum.
About 8; ducts open from the lower surface of the gland
into the lateral part of the superior fornix of the conuctiva.
Ner<e suly
6arasy,at"et#% se%reto,otor ner<e suly derived
from the la%r#,al nu%leus of the facial nerve.
6re'an'l#on#% .#bers reach the tery'oalat#ne
'an'l#on &sphenopalatine ganglion( via nervus
intermedius and its great petrosal branch and via the
nerve of the pterygoid canal.
)he ost 'an'l#on#% .#bers leave the ganglion and oin
the maxillary nerve zygomatic branch and
zygomaticotemporal nerve lacrimal nerve lacrimal
Sy,at"et#% ost'an'l#on#% .#bers travel in the internal
carotid plexus deep petrosal nerve nerve of the
pterygoid canal maxillary nerve zygomatic nerve
zygomaticotemporal nerve lacrimal nerve.
(a%r#,al Du%ts
)ears circulate across the cornea and accumulate in the
la%tus la%r#,al#s.
)ears enter the %anal#%ul# la%r#,al#s through the unta
$analiculi lacrimalis pass medially and open into the
la%r#,al sa% that lies in the lacrimal groove behind the
medial palpebral ligaments and is the upper blind of the
nasolacrimal duct
Nasola%r#,al du%t, about 0.5 inches &8.< cm.( long and
emerges from the lower end of the lacrimal sac.
)he duct descends downward, bac.ward, and laterally in
the osseous canal and opens into the inferior meatus of
the nose.
)he opening is guarded by a fold of mucous membrane
.nown as la%r#,al .old, which prevents air from being
forced up the duct into the lacrimal sac on blowing the
*H2 59&3*
A pyramidal cavity with its base in front and its apex
5rb#tal ,ar'#n
0uperior margin is formed by the frontal bone, which
is notched for the passage of the supraorbital nerve
and vessels.
*ateral margin is formed by the processes of the
frontal and zygomatic bones.
2nferior margin is formed by the zygomatic bone and
5edial margin is formed by the processes of the
maxilla and the frontal bone.
=ormed by the orbital plate of the frontal bone, which
separates the orbital cavity with from the anterior
cranial fossa
(ateral -all
$omposed of zygomatic bone and the greater wing
of the sphenoid
=ormed by the maxilla, which separates the orbital
cavity from the maxillary sinus
Med#al -all
$onsists of &from front to bac.( the frontal process of
the maxilla, lacrimal bone, the orbital plate of the
ethmoid &separates the orbital cavity from the
ethmoid sinuses(, and the body of the sphenoid.
5en#n's #nto t"e 5rb#tal )a<#ty
$. 5rb#tal oen#n' > lies anteriorly, where 8?@ of the eye is
exposed and the remainder is protected by the wall of the
&. Suraorb#tal not%" ?.ora,en@ > situated on the superior
orbital margin and transmits the supraorbital nerve and
blood vessels
). 3n.raorb#tal 'roo<e and )anal > are situated on the floor
of the orbit in the orbital plate of the maxilla and transmit
the infraorbital nerve &continuation of the maxillary nerve(
and blood vessels.
D. Nasola%r#,al )anal > located anteriorly on the medial
wall and communicates with the inferior meatus of the
nose. 2t transmits the nasolacrimal duct.
2. 5rb#tal F#ssure > located posteriorly between
the maxilla and the greater wing of the sphenoid. 2t
communicates with the pterygopalatine fossa. )ransmits
the maxillary nerve and its zygomatic branch, the inferior
ophthalmic vein, and sympathetic fibers.
F. Suer#or 5rb#tal F#ssure > located posteriorly between
the greater and lesser wings of the sphenoid and
communicates with the middle cranial fossa. 2t transmits
the lacrimal nerve, the frontal nerve, the trochlear nerve
and oculomotor nerve &upper and lower divisions(, the
abducent nerve, the nasociliary nerve, and the superior
ophthalmic vein.
G. 5t#% )anal > located posteriorly in the lesser wing of the
sphenoid and communicates with the middle cranial
fossa. )ransmit the optic nerve and ophthalmic artery.
H. Cy'o,at#%ote,oral and Cy'o,at#%o.a%#al Fora,#na
> two small openings in the lateral wall that transmit the
zygomaticotemporal and zygomaticofacial nerves
respectively, which are sensory to the of the face.
3. $nter#or and 6oster#or 2t",o#dal Fora,#na > located
on the medial wall of the ethmoid bone and transmit the
anterior and posterior ethmoidal nerves respectively.
5rb#tal Fas%#a
2t is the periosteum of the bones that form the walls of the
orbit. 2t is loosely attached to the bones and is continuous
through the foramina and fissures with the periosteum
covering the outer surfaces of the bones.
2n superior orbital fissure, optic canal, and the anterior
ethmoidal canal, it becomes continuous with the
endosteal layer of the dura mater.
Mus%le o. MDller or the orb#tal#s ,us%le is a thin layer
of smooth muscle that bridges the inferior orbital fissure.
0upplied by sympathetic nerves and has no .nown
Fas%#al S"eat" o. t"e 2yeball ?*enons %asule@
=ascial sheath surround the eyeball from the optic nerve
to the corneoscleral unction
0eparates the eyeball from the orbital fat and provides it
with a for free movement.
2t is perforated by tendons of the orbital muscles and is
reflected onto each of them as tubular sheath.
)he sheath s for the tendons of the medial and lateral
recti are attached to the medial and lateral walls of the
orbit by triangular ligaments called the ,ed#al and lateral
%"e%0 l#'a,ents.
Susensory l#'a,ent o. t"e eye is the lower part of the
fascial sheath, which passes beneath the eyeball and
connects the chec. ligaments, is thic.ened and serves to
suspend the eyeball.
)hrough this suspensory ligament, the eye is suspended
from the medial and lateral walls of the orbit as if
suspended by a hammoc..
2.2. -allsElayers o. t"e eyeball and t"e#r des%r#t#ons
*H2 2A2
)he eyeball is embedded in orbital fat but is separated from it
by the fascial sheath of the eyeball.
)he eyeball is consists of three coats namely &from the outside
in( the fibrous coat, the vascular pigmented coat, and the
nervous coat.
)oatsE(ayers o. t"e 2yeball
$. F#brous )oat
5ade up of the posterior opa3ue part, the s%lera, and the
anterior transparent part, the %ornea.
S%lera is composed of dense fibrous tissue and is white
2ts posterior is pierced by the optic nerve and is fused
with the dural sheath of that nerve.
(a,#na %r#brosa is the area of the sclera that is pierced
by the nerve fibers of the optic nerve.
A relatively wea. area and can be made to bulge
into the eyeball by a rise of cerebrospinal fluid
pressure in the tubular extension of the
subarachnoid space, which surrounds the optic
2f the intraocular pressure rises, the lamina cribosa
will bulge outward, producing a cupped disc, as
seen through the ophthalmoscope.
)he sclera is also pierced by the ciliary arteries and
nerves and their associated veins and venae vorticosae.
)he sclera is directly continuous in front with the cornea
at the corneoscleral unction or l#,bus
)ornea is transparent and largely responsible for the
refraction of the light entering the eye.
)he cornea is in contact posteriorly with a3ueous humor.
&. Fas%ular 6#',ented )oat
$onsists of &from behind forward( the choroid, the ciliary
body, and the iris.
*"e )"oro#d
$omposed of an outer pigmented layer and an inner,
highly vascular layer.
)#l#ary &ody
)he ciliary body is continuous posteriorly with the choroid
and anteriorly it lies behind the peripheral margin of the
$omposed of the ciliary ring, ciliary processes, and ciliary
)#l#ary r#n' is the posterior part of the body and its
surface has shallow grooves called the %#l#ary str#ae.
)#l#ary ro%esses are radially arranged folds or ridges to
the posterior surfaces of which are connected the
suspensory ligaments of the lens.
)#l#ary ,us%le is composed of meridianal and circular
fibers of smooth muscle.
5eridianal fibers run bac.ward from the limbus to
the ciliary processes, and the circular fibers, which
are fewer in number, lie internal to the meridianal
6erve supply is provided by arasy,at"et#%
.#bers .ro, o%ulo,otor ner<e which pass into the
eyeball in the short ciliary nerves.
$ontraction, especially the meridianal fibers, pulls
the ciliary body forward, which rel#e<es t"e tens#on
o. t"e susensory l#'a,ent, and the elastic lens
becomes more convex increasing the refractive
power of the lens.
*"e 3r#s and 6u#l
)hin, contractile, pigmented diaphragm with a central
aperture, the pupil.
0uspended in the a3ueous humor between the cornea
and the lens
)he periphery is attached to the anterior surface of the
ciliary body.
2t divides the space between the cornea and the lens into
an anter#or and oster#or %"a,ber.
)he muscle fibers of the iris are involuntary and consist of
circular and radiating fibers.
$ircular fibers form the s"#n%ter u#llae and are
arranged around the margin of the pupil.
Radial fibers form the d#lator u#llae and consist of
a thin sheet of radial fibers that lie close to the
posterior surface.
Ner<e suly1 s"#n%ter u#llae is supplied by
parasympathetic fibers from the oculomotor which
pass to the eyeball in the short ciliary nerves.
D#lator u#llae is supplied by sympathetic fibers
which pass forward into the long ciliary nerves.
). Ner<ous )oat1 *"e 9et#na
$onsist of an outer #',ented layer and an #nner
ner<ous layer.
%uter layer is in contact with the choroid, and its inner
surface is in contact with the vitreous body.
)he posterior three fourths of the retina is the receptor
2ts anterior edge forms a wavy ring, the ra serrate and
the nervous tissues ends here.
)he anterior part of the retina is unreceptive and consists
merely of pigment cells, with a deeper layer of columnar
epithelium. )his part covers the ciliary processes and the
bac. f the iris.
At the center of the posterior part of the retina is an oval,
yellowish area, ,a%ula lutea, which is the area of the
most distinct vision. 2ts central depression is called the
.o<ea %entral#s.
)he optic nerve leaves the retina about <mm to the
medial side of the macula lutea by the optic disc.
)he ot#% d#s% is slightly depressed at its center, where it
is pierced by the central artery of the retina.
)here is complete absence of rod and cones in the optic
disc it insensitive to light and is referred to as the
bl#nd sot.
2t is seen as pale pic. in color, much paler than its
surrounding as observed in ophthalmoscopic
2.3. 27trao%ular ,us%les
)hese are the levator palpebrae superioris, the four recti,
and the two obli3ue muscles.
$. (e<ator 6alebrae Suer#or#s
:ndersurface of the lesser wing of the sphenoid
bone, above the optic canal
9nds anteriorly in a wide aponeurosis, which splits
into two lamellae.
0uperior lamella is inserted into the anter#or
sur.a%e o. t"e suer#or tarsal late and into the of the upper lid
2nferior lamella contains smooth muscle fibers which
are attached to uer ,ar'#n o. t"e suer#or
tarsal late
Ner<e suly
5%ulo,otor ner<e. 0mooth muscle receives
sympathetic supply from the superior cervical
sympathetic ganglion.
Raises the upper lid. 0ympathetic stimulation result
in further elevation of the lid.
*esions of the oculomotor nerve cause drooping of
the upper lid &ptosis(, lesion on the sympathetic
supply paralyzes the smooth muscle and also
causes drooping.
&. *"e 9e%t#
)he four recti arise from a fibrous ring called
common tend#nous r#n'. 2t is a thic.ening of the
periosteum surrounding the optic canal and bridges
the superior orbital fissure.
0uperior rectus arises from the lower part of the ring,
the inferior rectus arises from the lower part of the
ring, and the medial rectus from the medial part of
the ring.
)he lateral rectus arises by two heads from the
lateral part of the ring.
)he recti form the muscular cone that encloses the
optic nerve and posterior part of the eyeball.
)he tendon of each muscle pierces the fascial
sheath of the eyeball, and is inserted into the s%lera
about @mm behind the margin of the cornea.
Ner<e Suly
0uperior, inferior and medial recti are supplied by
the o%ulo,otor ner<e.
)he lateral rectus is supplied by the abdu%ent
*ateral rectus rotates the eyeball so that the cornea
loo.s laterally.
5edial rectus rotates the eyeball so that the cornea
loo.s medially
0uperior rectus raises the cornea and rotates the
eyeball medially.
2nferior rectus depresses and rotates the cornea
). Suer#or 5bl#=ue
!ody of the sphenoid bone
2ts slender tendon passes through a cartilaginous
pulley attached to the frontal bone, and then turns
bac.ward and laterally, pierces the fascial sheath of
the eyeball and is inserted into the s%lera beneat"
t"e suer#or re%tus.
Attached to the sclera behind the coronal e3uator of
the eyeball, and the line of the pull of the tendon
passes medial to the vertical axis.
Ner<e Suly
)rochlear nerve
Rotates the eyeball so that the cornea loo.s
downward and laterally.
)ogether with the inferior rectus, the superior
obli3ue will depress the cornea directly downward
D. 5bl#=ue
Anterior part of the floor of the orbit
0clera behind the coronal e3uator and the line of
pull of the tendon passes medial to the vertical axis.
Ner<e Suly
%culomotor nerve
Rotates the eyeball so that the cornea loo.s upward
and laterally.
)ogether with the superior rectus, the cornea can be
raise directly upward.
2.G. &lood and ner<e suly
&(55D $ND (AM6H F2SS2(S 5F *H2 59&3*
5"t"al,#% $rtery
A branch of the internal carotid artery after it emerges
from the cavernous sinus.
7asses forward through the optic canal with the optic
nerve lateral to it.
2t reaches the medial wall of the orbit and then gives off
numerous branches, some of which accompany the
nerves in the orbital cavity
a. )entral artery o. t"e ret#na is a small branch that
pierces the meningeal sheaths of the optic nerve to
gain entrance to the nerve. =rom the optic nerve, it
then enters the optic disc and divides into branches
that are end arteries.
b. Mus%ular bran%"es
%. )#l#ary arter#es can be divided into anterior and
posterior groups. Anterior group enters the eyeball
near the corneoscleral unction, and the posterior
group enters near the optic nerve.
d. (a%r#,al artery supplies the lacrimal gland
e. Suratro%"lear and suraorb#tal arter#es are
distributed into the of the forehead.
5"t"al,#% Fe#ns
Suer#or o"t"al,#% <e#n communicates in front with
the facial vein. o"t"al,#% <e#n communicates through the
inferior orbital fissure with the pterygoid venous plexus.
!oth veins pass bac.ward through the superior orbital
fissure and drain into the %a<ernous s#nus.
(y," Fessels
6o lymph vessels of nodes present in the orbital cavity
N29F2S 5F *H2 59&3*
$. 5t#% ner<e
9nters the orbit from the middle cranial fossa through the
ot#% %anal in which the ophthalmic artery accompanies
)he nerve is surrounded by sheaths of pia mater,
arachnoid mater, and dura mater.
7ierces the sclera at a point medial to the posterior pole
of the eyeball. 2ts meninges fuse with the sclera.
&. (a%r#,al ner<e
Arises from the o"t"al,#% d#<#s#on o. t"e tr#'e,#nal
ner<e in the lateral wall of the cavernous sinus.
)his slender nerve enters the orbit through the upper part
of the suer#or orb#tal .#ssure.
2t passes forward along the upper border of the lateral
rectus muscle.
2t oins a branch of the zygomaticotemporal nerve, and
later leaves it to enter the lacrimal gland &parasympathetic
secretomotor fibers(.
)he lacrimal nerve ends by supplying the of lateral
part of the eyelid
). Frontal ner<e
Arises from the o"t"al,#% d#<#s#on o. t"e tr#'e,#nal
ner<e in the lateral wall of the cavernous sinus.
9nters the orbit through the upper part of the superior
orbital fissure and passes forward on the superior surface
of the of the levator palpebrae superioris, between that
muscle and the roof of the orbit.
,ivides into suratro%"lear and suraorb#tal ner<es.
Suratro%"lear ner<e passes above the pulley for
the superior obli3ue muscle and winds around the
upper margin of the orbital cavity to supply the
of the forehead.
)he larger suraorb#tal ner<e passes through the
supraorbital notch, or foramen, and supplies the
of the forehead lateral to the area supplied by the
supratrochlear nerve. 2t also supplies the mucous
membrane of the frontal air sinus.
D. *ro%"lear ner<e
*eaves the lateral wall of the cavernous sinus and enters
the orbit through the upper part of the superior fissure.
Runs forward and medial across the origin of the levator
palpebrae superioris and enters the superior obli3ue
2. 5%ulo,otor ner<e
Suer#or ra,us leaves the lateral wall of the cavernous
sinus and enters the orbit through the lower part of the
superior orbital fissure within the tendinous ring.
0upplies the superior rectus muscle, then pierces it
and supplies the overlying levator palpebrae muscle ra,us enters the orbit in similar manner as the
superior ramus and gives off branches to the inferior
rectus, medial rectus, and the inferior obli3ue muscle.
)he nerve of the inferior obli3ue gives off a branch
that passes to the ciliary ganglion and carries
parasympathetic fibers to the sphincter pupillae and
the ciliary muscle.
F. Naso%#l#ary ner<e
Arises from the ophthalmic division of the trigeminal nerve
in the lateral wall of the cavernous sinus.
9nters the orbit through the lower part of the superior
orbital fissure, within the tendinous ring.
2t crosses above the optic nerve with the ophthalmic
artery to reach the medial wall of the orbital cavity.
Runs forward along the upper margin of the medial rectus
muscles and divides into anter#or et",o#dal and
#n.ratro%"lear ner<es.
)o,,un#%at#n' bran%" to t"e %#l#ary 'an'l#on
0ensory fibers from the eyeball oin the
nasociliary nerve through this nerve.
)#l#ary ner<es
)wo or three nerves that contain sympathetic
fibers for the dilation of the pupillae muscle.
6oster#or et",o#dal ner<e
7asses the posterior ethmoidal foramen to
supply the ethmoidal and sphenoidal air
3n.ratro%"lear ner<e
0upplies the of the medial part of the
upper eyelid and the adacent part of the nose
$nter#or et",o#dal ner<e
7asses through the anterior ethmoidal foramen
and continues to the nasal cavity supplying an
area of mucous membrane.
Appears on the face as e7ternal nasal bran%"
at the lower border of nasal bone and supplies
the of the nose down as far as th tip.
G. $bdu%ent ner<e
*eaves the cavernous sinus and enters the orbit through
the lower part of the superior orbital fissure, within the
tendinous ring
0upplies the lateral rectus muscle
)#l#ary 'an'l#on
About the size of a pinhead, parasympathetic ganglion
situated in the posterior part of the orbit on the lateral side
of the optic nerve.
Receives its preganglionic fibers from the oculomotor
nerve via the nerve to the inferior obli3ue.
7ostganglionic fibers leave the ganglion in the s"ort
%#l#ary ner<es that pass forward to the bac. of the
0upply the sphincter pupillae and ciliary muscle
A number of sympathetic fibers pass from the internal
carotid plexus into the orbit and run through the ganglion
without interruption.
3. Des%r#be t"e ,#%ros%o#% aearan%e o. t"e eye. -"at
.or,s t"e
2s a complex and highly developed photosensitive organ
7ermits an accurate analysis of the form, light intensity,
and color reflected from obects
8. )ough, fibrous globe &to maintain its shape(
;. *ens system &for image focusing(
<. A layer of photosensitive cells
A. 0ystem of cells and nerves &to collect, process, and
transmit visual information to the brain(
$omposed of < concentric layer#
8. 9xternal layer > cornea and sclera
;. 5iddle layer > choroids, ciliary body and iris
<. 2nner layer > Retina &outer and inner retina proper(
$ontains < compartments#
8. Anterior chamber > space between the cornea and the
iris and lens
;. 7osterior chamber > space between iris, ciliary
process, zonular attachments, and lens
<. +itreous space > behind the lens and zonula
attachments4 surrounded by the retina.
!oth anterior and posterior chambers contain a3ueous
humor &a protein/poor substance( while the vitreous
space is filled with a gelatinous substance called vitreous
3.+. 5uter,ost layer o. t"e eye, %ontents and role
27ternal layer o. *un#%a F#brosa
$onsists of cornea &anteriorly( and sclera &posteriorly(
0upports the eye
S%lera up the opa3ue white posterior 5?@ of the outer wall
of the eye
forms a segment of a sphere approximately ;; mm in
has a tough, dense connective tissue made up mainly of
flat collagen bundles intersecting in various directions
while remaining parallel to the surface of the organ, a
moderate amount of ground substance, and a few
9xternal surface of the sclera
$onnected by a loose system if thin collagen fibers to a
dense layer of connective tissue called )enon1s capsule
$omes into contact with the loose conuctival stroma at
the unction of the cornea with the stroma
)enon1s space &between )eno1ns capsule and sclera( >
allows eyeball to ma.e rotating movements
0uprachorodal lamina &between sclera and choroids, a
thin layer of loose connective tissue rich in melanocytes,
fibroblasts, and elastic fibers(
Relatively avascular
anterior 8?@, colorless and transparent
richly supplied with nerve endings but is avascular
has one of the richest sensory nerve supplies of any eye
consist of 5 layers
a. 2#t"el#u,
0tratified s3uamous, non/.eratinized epithelium
$onsists of 5 or @ layers of cells
$ontain numerous mitotic figures at the basal
part of the epithelium, which are responsible for
the cornea1s regenerative capacity
$ells turnover time# approximately B days
0urface corneal cells show microvilli protruding
into the space filled by the precorneal tear film
$overed by a protective layer of lipid and
glycoprotein, about B pm thic.
b. &ow,ans ,e,brane
!eneath the corneal epithelium
Homogenous layer B/8;pm thic.
$onsists of collagen fibers crossing at random,
a condensation of the intracellular substance,
and no cells
$ontributes greatly to the stability and strength
of the cornea
%. Stro,a
=ormed many layers of parallel collagen
bundles that cross at approximately right
angles to each other
!oth cells and fibers of the stroma are
immersed in a substance rich in glycoproteins
and chondroitin sulfate
7resence of migrating cells are evident even
though the stroma is avascular
d. Des%e,ents ,e,brane
A thic. &5/80pm( homogenous structure
composed of fine collagen filaments organized
in a </dimensional networ.
e. 2ndot"el#u,
A simple s3uamous epithelium
7ossesses organelles for secretion that are
characteristic of cells engaged in active
transport and protein and that may be related to
the synthesis and maintenance of the
,escemet1s membrane
)orneal 2#t"el#u, and 2ndot"el#u,
Responsible for maintaining transparency of the cornea
$apable of transporting sodium ions towards their apical
$hloride ions and water follow passively, maintaining the
corneal stroma in a relatively dehydrated state
)his state, along with regular orientation of the very thin
collagen fibrils of the stroma, accounts for the
transparency of the cornea
)orneos%leral Bun%t#on and l#,bus
7oint where cornea and sclera meet
An area transaction from the transparent collagen
bundles of the cornea to the white opa3ue fibers of the
A highly vascularized, plays an important role in cornea
inflammation processes
)he cornea receives its metabolites by diffusion from
adacent vessels and from the fluid of the anterior
chamber of the eye
)rabecular meshwor. / irregular endothelium/lined
channels4 in the region of the limbus in the stromal layer
0chlemm1s canal / drains fluid from the anterior chamber
of the eye and communicates externally with the venous
=ormed by the merging of trabecular meshwor.
3.2. M#ddle layer o. t"e eye, t"e#r %ontents and role
M#ddle or Fas%ular (ayer, u<ea
$onsist of choroids, ciliary body, and iris collectively
.nown as the uveal tract
A highly vascularized coat
$ontains loose connective tissue between blood vessels
that are rich in fibroblasts, macrophages, lymphocytes,
mast cells, plasma cells, collagen fibers, and elastic fibers
5elanocytes &abundant ( and give its characteristic blac.
$horiocapillary layer > rich in small blood vessels that
nourishes the retinal inner layer of choroids / Has
an important function in the nutrition of the retina, and its
damage causes serous damage to retina
!ruch1s membrane > a thin hyaline membrane &</Apm(
that separates the choriocapillary layer from the retina,
and extends from the optic papilla to the ora serrata
/ =ormed by 5 layers
/ )he central layer is composed of a networ. of elastic
fibers on its ; surfaces with layers of collagen fibers
that are covered on one side and the basal lamina of
the pigment epithelium on the other side
%ptic papilla > region where the optic nerve enter the
!ound to the sclera by the suprachoroidal lamina which is
a loose layer of connective tissue rich in melanocytes
)#l#ary &ody
An anterior expansion of the choroids at the level of the
A continuous thic.ened ring that lies at the inner surface
of the anterior portion of the sclera
2n transverse section, it forms a triangle
%ne of its faces is in contact with the vitreous body,
one with the sclera, and the third with the lens and
the posterior chamber of the eye
$ontains loose connective tissue rich in elastic fibers,
vessels, melanocytes and smooth muscle &ciliary muscle(
$iliary muscle consist of ; bundles of smooth
muscle fibers that insert on the sclera anteriorly and
different regions of the ciliary body posteriorly
%ne of these bundles hast he function of
stretching the choroids
Another bundle, when contracted, relaxes the
tension of the lens
)hese muscular movement are important in
visual accommodation
)#l#ary 6ro%ess
Ridge li.e extensions of the ciliary body
Have loose connective tissue core in and numerous
fenestrated capillaries and ; layers of simple epithelium
%xytalan fibers?zonula fibers
A3ueous humor
=ormed by the inner non pigmented ciliary
Has an inorganic ion composition similar to that of
the plasma but contains less than 0.8C protein
&plasma has about BC protein(
A3ueous humor flows / iris / anterior chamber of the
eye > angle formed by the comea with the basal part
of the iris > limbus, trabecular meshwor. / irregular
0chlemm1s canal
$ommunicates with small veins of the sclera which
the a3ueous humor escapes
5ost anterior and ha the pupil at its center
Has loose connective tissue, smooth muscles &dilator and
sphincter muscle( and melanocytes
)he greater the amount of pigment produced by
melanocytes the is the color of the eye
An extensions of the choroids that partially covers the
lens, leaving a round opening in the center called the
Anterior surface / irregular and rough, with grooves and
7osterior surface > smooth, covered by ; layers of
2nner epithelium > in contact with the posterior
chamber and heavily pigmented with melanin
%uter epithelium > have radially directed tongue li.e
extensions of their basal region and filled with
overlapping myofilaments, creating the dilator
papillae muscle of the iris
Heavy pigmentation the passage of light into interior of
the eye except through the pupil
)he function of the abundant melanocytes or pigment
cells containing melanin several regions of the
eye is to .eep stray light rays from interfering with image
5elanocytes of the stroma of the iris is responsible for the
color of the eye
As the amount of pigment
increase, the iris assumes various of greenish/blue, gray,
and finally brown
,ilator and sphincter muscles
have sympathetic and parasympathetic innervations,
3.3. 3nner,ost o. t"e eye, t"e#r %ontents, and role
3nner (ayer
Has non photosensitive anterior part &contributes the
inner lining of the ciliary body and the posterior part of the
iris( and photosensitive posterior part
*ayers of retina from choroids D inwards, at the posterior
part includes4
8. 7igment epithelium D a layer of cuboidal to columnar
epithelial cells
;. *ayer of photosensitive cells D has outer segments
of rods and cones
<. external 9mitting membrane D unctional complexes
between photoreceptors and bipolar cells
A. outer nuclear layer D has cell bodies of
5. external plexiform layer D has synapse between
photoreceptors and bipolar cells
@. inner nuclear layer D has bipolar cells
B. internal plexiform layer D has a synapse between
bipolar cells and ganglion cells
E. ganglion cell layer D has cell bodies of ganglion cells
F. nerve fiber layer D has axons of ganglion cells that
will form the optic nerve
80. internal limiting membrane D unctional complexes
between 5uller1s c. and ganglion c
,erives from and envagination of the anterior cephalic
vesicle, or prosencephalon
2n adults, the outer wall / pigment epithelium
6eutral retina / the optical or functional part of retina and
is derived from the inner layer
$ytoplasm of pigment epithelial cell has abundant smooth
9R > site of +itamin A esterification and transport to
5elanin granules are numerous in the apical cytoplasm
and microvilli
)he optical part of the retina > posterior or photosensitive
A complex structure containing at least 85 types of
neurons, and these cells form at leastG <E distinct
.inds of synapse with one another
$onsist of the following4
An outer layer or photosensitive cells, the rods
and cones
An intermediate layer of bipolar neurons >
connect the rods cones to the ganglion cells
internal layer of ganglion cells > establish
contact the bipolar cells through their dendrites
and send axons to the brain, these axons
converge at the optic pappillae forming the
optic nerve
9xternal plexiform or synaptic layer > a region
between the layer of rods and cones and the
bipolar cells, where synapses between these
two types of cells occur
2nternal plexiform layer > a region where
synapses between the bipolar and ganglion
cells are established.
Has an inverted structure, for the light will first cross the
ganglion layer and then the bipolar layer to reach the rods
and cones
Rods and cones
Are polarized neuronsH
$an be divided into outer segments &modified cells(,
nuclear region and a synaptic region
!oth pass through a thin layer, the external limiting
6uclear of the cones are generally disposed near the
limiting membrane
6uclear of the rods near the center of the inner segment
9od )ells ?9"odos#n@
)hin elongated cells &50 x <0 pm( composed of two
%uter segment > is separated from the inner segment
%uter segment > site photosensitivity
2nner segment > contains metabolic machinery necessary
for the biosynthetic an energy producing processes of
these cells
)he flattered dis.ed of rods cells contain the pigment
visual purple or rhodopsin, which is bleached by light and
initiates the visual stimulus
9ach human retina has approximately 8;0 million rods
that are extremely sensitive to light and are considered
the used when low levels of light are encountered, such
as at dus. or nighttime
)one )ells ?lodos#n@
9longated neurons &@0 x 85 pm(
9ach human retina has about @ million cone cells
0imilar structures to that of rods, with outer and inner
segments, basal body with cullium, and on accumulation
of mitochondria and polyribosomes
$ones differ from rods in their form &conical( and the
structure of their outer segments
As in rods, this region is composed of stac.ed
membranous dis.s4 how1ve, they are not
independent of the outer plasma membrane but
arise as invaginations of this structure
2n cones, newly synthesized protein is not
concentrated in recently assembled dis.s, as it is
in rods, but is distributed uniformly throughout the
At least 8< function types of cones that can1t be
distinguished by their morphologic characteristics
9ach type contains iodopsin and its maximum sensitivity
is in the red, green, or blue region of the visible spectrum
$ones sensitive only to light of a higher intensity than that
re3uired to stimulate rods, are believed to permit visual
acuity than do rods
5t"ers %ells
*ayer of b#olar %ells consists of ; types diffuse bipolar
cells &which have synapses with ; or more
photoreceptors and monosynaptic bipolar cells &which
establish contact with the axon of only one cone
photorecepetor and only one ganglion cell(
!lind spot of retina, the papilla of the optic nerve, or the
optic nerve head > devoid of receptors
Gan'l#on %ell > typical nerve cells, containing a large
euchromatic nucleus and basophilic 6issi bodies and are
classified as diffuses or monosynaptic in their connectors
will other cells
Hor#Hontal %ells > established contact between different
photoreceptors, exact function is not .nown they may act
to integrate stimuli
$,a%r#ne %ells > are various types neuron that establish
between ganglion cells, their function is also obscure
Suort#n' %ells > are neuroglia that posses large,
extensively ramified cells called 5uller cells &functionally
analogous to neuroglia in that they support, nourish, and
insulate the retina neurons and fibers(.
3.G. 9e.ra%t#<e aaratus o. t"e eye
!iconvex transparent structure held in place by a circular
system of fibers, the zonule, which extends from the lens
into a thic.ening of he middle layer, the ciliary body, and,
by close apposition, to the vitreous body on its posterior
2ris > is an opa3ue pigmented expansion of the middle
layer that partly covers the anterior surface of the lens
7upil > a round hole in the middle of the iris
$haracterized by great elasticity, a feature that is lost with
age as the lens hardens
Has < principal components#
+. (ens %asule
*ens is enveloped by a thic. &80/;0 pm(,
homogenous, refractile, carbohydrate/rich
capsule coating the outer surface of the
epithelial cells
+ery thic. basement membrane and consists
mainly of collagen type 2+ and glycoprotein
2. Sub%asular e#t"el#u,
$onsists of single layer cuboidal epithelial cells
that are present only on the anterior surface
of the lens
)he lens increases in size and grows
throughout life as new lens fibers develop from
cells located at the e3uator of lens
2ts cells exhibit many interdigitations with the
lens fibers
3. (ens .#bers
9longated and appear as thin,
flattened structures
Highly differentiated lose cells
derived form cells of the subcapsular epithelium
)hese eventually lose their nuclei
and other organelles and become greatly
)hese cells are filled with a group of
proteins called crystallins
7roduced throughout life at an ever/
decreasing rate
Held together in place by a radially oriented group of
fibers, the zonule, that inserts on one side on the lens
capsule and on the other on the ciliary body
Ionular fibers are similar to the mirofibrils of
elastic fibers
G. D#s%uss t"e <#sual at"way.
G.+. tra%e se=uent#ally t"e %o,onents o. t"e <#sual

7hotoreceptors &cones J rods(

%ptic nerve

%ptic chiasma

%ptic tract

*ateral geniculate body

%ptic radiation

Area 8B
G.2. des%r#be so,e d#a'nost#% test .or <#sual a%u#ty.
+isual acuity/ refers to the resolving power of
the eye.
/An index of visual loss and
blindness. use of#
0nellen1s chart
*andolt1s chart
-rating test pattern.
0nellen1s chart
*ine 8 > ;00ft
*ine ; > 800ft
*ine < > B0ft
*ine A > 50ft
*ine 5 > A0ft
*ine @ > <0ft
*ine B > ;5ft
*ine E > ;0ft
,uring the test, subects stand ;0ft from the chart. 2f at a
distance of ;0ft, the subect can read line E, then he has a ;0?;0
2f at a distance of ;0ft, the subect can read only up to line
5, he has ;0?A0vision, he has 85C visual lose.
2f at a distance of ;0ft, the patient ca read only up to line
;, he has ;0?800 vision and has 50C visual lose.
G.3. -"at are t"e <#sual .#eld de.e%ts #. a les#on o%%urs #n
any art o. t"e <#sual at"way/
A. anterior to the chiasma
!lindness on the same side
:nilateral blindness.
!. at the chiasma
heteronemous hemianopsia
$. optic tract &posterior(
congruent part, both retina
,. 3uadrant defect
partial lesion of the geniculo/calcarine tract J
area 8B, inverted
9. at the lateral geniculate body
visual field defects
pupils sparred
5. D#s%uss t"e .ollow#n' <#sual .un%t#ons and t"e#r
5.+. Fun%t#ons related to br#'"tness ?"oto#% I s%oto#%
5.+.+. 9e%etors #n<ol<ed and t"e#r d#str#but#on
5.+.2. St#,ul# .or re%etor a%t#<at#on
5.+.3. 6#',ents o. re%etors
5.+.G. Me%"an#s,s o. re%etor a%t#<at#on
7hotoreceptor cells have a tip or outer segment
composed of stac.ed layers of membrane, called discs.
)he discs hold the chemical substances that respond to
7hotoreceptors also have an inner segment that
contains the nucleus, mitochondria, and other
organelles, and the synaptic terminal that connects the
photoreceptor to the next neurons in the retina.
)wo pigmented layers#
8.( $horoid
;.( 7igment epithelium
At the bac. of the retina, absorb
light and prevent its reflection
and scattering bac. through the
rods and cones.
)wo types of photoreceptors are called rods and %ones
because of their light/sensitive outer segments.
Rods are extremely sensitive and
respond to very low levels of
7hotosensitive, outward/directed
process of a rhodopsin/containing
rod cell in the external granular layer
of the retina
2n the low levels of illumination of
the dar.ened room, vision can only
be supplied by the rods.
$ones are considerably less
sensitive and respond only when the
light is bright
)he only photoreceptor in the fovea
centralis and become interspersed
with increasing numbers of rods
toward the periphery of the retina
5ade up of < photoreceptors#
Red cones > respond at
long wavelengths
!lue cones > respond at
medium wavelengths
-reen cones > respond at
short wavelengths
7hotoreceptors contain molecules called photopigments,
which absorb light
)here are A uni3ue photopigments in the retina.
%ne found in rods called rhodopsin.
)hree are found in cones#
$yanolabe &!lue cone(
$hlorolabe &-reen cone(
9rythrolabe &Red cone(
Rhodopsin &visual purple(

Retinene &visual yellowish( K %psin

+itamin A
)he longer the individual stays in a light environment, the
greater the rhodopsin be converted to vit.A.
=rom a light environment L then going to the dar.
environment L the vit.A will reconverted to retinene K
opsin L rhodopsin &this will ta.e A0 minutes(
Dul#%#ty *"eory ?Ma7 S%"ultH@1
0cotopic vision
7hotopic vision
S%oto#% F#s#on
2nvolves vision in a dar. environment with activity of rods
7rocess about A0 minutes after prolonged exposure
to light due to bleaching of rhodopsin
*ight rays absorbed by rhodopsin in rods

Rhodopsin is activated

Rhodopsin activates transduction

)ransduction catalyzes exchange of -,7 to -)7

Activation of c-57 phosphodiesterase

0odium influx

,epolarization of rods
6"oto#% <#s#on
2nvolves cones
"hen you are in a dar. environment, and goes out, your
eyelids will close because of dazzle reflex.
7rocess is immediate but not instantaneous due to the
dazzle reflex
Scientific term for human color vision under normal lighting
conditions during the day.
2n the range above <.A cd?m
, the human eye uses three
types of cones to sense light in three respective bands of
)he pigments of the cones have maximum absorption
values at wavelengths of about AA5 nm &blue(, 5<5 nm
&green(, and 5B5 nm &red(.
Their sensitivity ranges overlap to provide continuous (but not
linear) vision throughout the visual spectrum.
The maximum efficacy is 683 lumens/ at a wavelength of
!!! nm (yello").
#n the range belo" $.$3% cd/m
' the human eye uses scotopic
#n the intermediate range' mesopic vision combines both types.
5.2. Fun%t#ons related to sa%e or t#,e
5.2.+. F#sual a%u#ty
resolving power of the eye
ability of eye to be able to see obect clearly at certain
index of visual loss and blindness
5a.e use of #
o 0nellen1s chart
o *andolt1s chart
o -rating test pattern
Snellens %"art
0tandard chart when subect is at ;0 feet distance
o *ine 8 M ;00 ft.
o *ine ; M 800 ft.
o *ine < M B0 ft.
o *ine A M 50 ft.
o *ine 5 M A0 ft.
o *ine @ M <0 ft.
o *ine B M ;5 ft.
o *ine E M ;0 ft.
,uring the test, the subect stands ;0 ft. from the chart
2f at a distance of ;0 ft., the subect can read line E he has
;0?;0 vision
2f at a distance of ;0 ft. the subect can read only up to
line 5, he has a ;0?A0 vision, and has 85 C visual loss
2f at a distance of ;0 ft. the subect can read only up to
line ;, he has ;0?800 vision and has 50C visual loss.
5.2.2. For, d#s%r#,#nat#on
)he ability of the visual system to aid in the identification
of an obect in space, out of a total number of
possibilities, based on form alone.
Ability to perceive differences among and positional
aspects of obects.
)he child having a problem in this area is unable to
distinguish between similar geometric shapes such as a
s3uare, a rectangle and a diamond, or similar letters such
as , and n, or words such as "ose, "ouse and "orse
5.2.3. Fl#%0er Fus#on o. Fre=uen%y
9ye is subect to a series of flashing light called the
2nterval between flic.ers is shortened until a point is
reached when the flic.ers are seen as a steady light
0erves as the basis for motion pictures
5.3. D#s%r#,#nat#ons based on wa<elen't"
5.3.+. )olor <#s#on and t"eor#es
2 *H25932S1
A.( Noung/Helmholtz )heory
Assumes that there are O fundamental color
sensations corresponding to <
photochemical pigments in < different .inds of cones.
Assumes that the .ind of cone produced is
genetically determined.
Assumes that color blindness results from defects in
one or more of the
$%690# "A+9 *96-)H0# %70260#
!*:9 short $NA6%*A!9
-R996 medium $H*%R%*A!9
R9, long 9RN)HR%*A!9
!.( Hering/Hurvich/Pameson )heory
Asserts that white and yellow are not
compounded colors but are pure
!*:9 opposing color N9**%"
R9, opposing color -R996
&composite of all colors( "H2)9
opposing color !*A$Q &absence of color(
0tates that each sensation its partner as a
negative after image
5.3.2. F#s#ble se%tru,
F3S3&(2 S62)*98M
8ltra<#olet below A50 mu
+2%*9) A00 > A50 mu
!*:9 A50 > 500 mu
-R996 500 > 5B5 mu
N9**%" 5B5 > @00 mu
%RA6-9 @00 > @;0 mu
R9, @;0 > B00 mu
3n.rared above B00 mu
$**93&8*2S 5F )5(59
> the RobviousS name of color.
> the lightness &tint( or dar.ness &shade( of a
> the strength or wea.ness of a color, using a
5unsell chart.
/ the higher the chroma, the more impure the color.
e.g. high shade of yellow > blac.
tightest tint of yellow > white
5.G. 6er%et#on o. det"
5.G.+. 3nteros#t#on
( near obects conceal far obects by
5.G.2. Mono%ular ,o<e,ent aralla7
( when ; obects are located at different
distances in space and then obects or the
observer moves, a change in perspective place from the point of view of the
observer# the distant obect moves slowly, the
nearer obect moves rapidly.
5.G.3. &#no%ular ret#nal d#sar#ty
( the ; eyes are displaced in space by distance
of approximately @5 mm.
( each eye therefore perceives an obect at a
different perspective.
( total retinal retinal images, one in each eye,
are therefore dissimilar, but are perceived
usually as unitary whole.
5.G.G. Stereos%oy
( stereo systems are designed to prevent the
left image to the left eye, and the right image
to the right eye.
/ when presented at the same time to both eyes,
an illusion of depth is
5.G.5. Holo'ra"y
( a variant of stereoscopy.
( records simultaneously multiple views of an
obect in space so that different aspects of the
obect becomes evident as the observer
moves about.
5.5. 5t#%s and re.ra%t#on
Geo,etr#% 5t#%s
study of light as propagated in a homogenous medium
2n a homogenous medium, light is propagated in a
straight line &ray(# incident ray
o 2t continues until it an obect
o As it an obect, the obect casts a shadow
o 2f the obect is illuminated by only one point source,
a sharp, well/delineated shadow is produced
o 2f the obect is illuminated by many point sources, a
diffuse shadow is produced, composed of an umbra
&the inner region( and a penumbra &the outer
partially illuminated region(.
2n the meantime, the ray of light may either be turned
bac. &reflection(4 may pass through and undergo bending
&refraction( or the obect will absorb the incident ray
6"ys#%al 5t#%s
study of light as it propagated in an elastic medium
"ay bac. in 8F0E, )homas Noung has proposed that
when light is transmitted through an elastic medium filled
with particles, it sets the adacent particles into vibration
and so vibratory motion, is transmitted
o )hus light is transmitted as transverse waves
&wavelengths(, and will therefore be described as
wave length &the distance between two successive
wave crests(
*ight wave an obect with a slit#
o *ight passes through the slit and treat the slit as a
new light source
o 2n successive passing of slits, there will be waves
that tend to overlap creating alternating light and
dar. bands > giving rise to defraction pattern
o 9xample# !eam of white light passes through a slit
with a prism# the white light will be bro.en into its
component wavelengths, creating the visible
o Although most of the time, light waves are specified
in terms of wave length, it is best to express light in
terms of fre3uency
o )his is because as light passes through a medium,
the velocity and wave length change proportionally,
but the fre3uency remains the same
o "ave number is the reciprocal of wave length in
*ight is generally described in terms of color, and if it
must be described with precision, the radiant energy is
specified in terms of wave length
)he visual sensation .nown as color is caused by light
with a definite wave length

+iolet M A00 > A50 mT
!lue M A50 > 500 mT
-reen M 500 > 5B5 mT
Nellow M 5B5 > @00 mT
%range M @00 > @;0 mT
Red M @;0 > B00 mT
:ltraviolet M <00 > A00 mT
2nfrared M B00 > E00 mT

"hen light entering the eye consists of more than one
wave length, the sensation produced is caused by the
combination of the wave lengths
may be expressed in the forms of#

a. -a<elen't"
length between ; successive crests
length between ; successive troughs
b. $,l#tude
maximum dispersion of a crest or trough from the
e3uilibrium position
%. Fre=uen%y
the number of cycles per second &Hertz(
d. -a<e Nu,ber
the reciprocal of wavelength in centimeters
wavelengths seldom travel alone
exist in two forms#
2n/7hase# crest of one coincides with crest of
o 0tri.e the retina at the same time# produce
an illumination e3ual to combination of the
two waves
%ut/7hase# crest of one coincides with trough
of another
o 0tri.e the retina at the same time# tend to
cancel out each other &no sensation is
)wo main types of lenses are of value#
+. S"er#%al lenses > those whose surfaces are
segments of spheres
a. )on<e7 lenses ?lus lenses@ > cause rays of
light to converge
b. )on%a<es ?,#nus lenses@ > cause rays of
light to diverge
2. )yl#ndr#%al lenses > possess one meridian &radius(
of curvature
)wo factors determine the focusing power of a lens#
+. )he #nde7 o. re.ra%t#on o. t"e lens
Refraction occurs when light passes from one
medium to another having a different optical
density. )he greater the difference between the
two media, the greater the bending of light.
)hus, the greater the optical density of a lens,
the greater the refraction of light.
2. )he rad#us o. %ur<ature
)he .o%us#n' ower of a lens varies inversely
with the radius of curvature.
)he stren't" o. a lens is measured in terms of
the focal distance
o Fo%al D#stan%e# ability of a lens to refract
light such that light come to a focus a
point after the lens. :sually 800 cm M
principal focus
As the lens bend the rays of light, they come to
a focus at a point called principal focus
)he distance between the lens and the
principal focus is called focal distance. 0uch
focusing power of a lens is called its refractive
power or diopter
o diopter, focusing power
o 0trength of normal human eye# @@.B
)he nodal point is that part of an optical system
where rays of light pass through without
$ompare ! and $#
! has a lesser radius of
curvature4 $ has a greater lesser radius
of curvature4 both has the same
=ocal distance M 8.<<
Here, in terms of radius of curvature,
lens ! has a stronger focusing power
$ompare A and !#
A has a greater focal distance &8.A<(4 6 has a lesser focal
distance &8.<<(4 both has the same radius of curvature
Here, in terms of focal
distance, lens A has a stronger
focusing power
%verall# lens A has the most powerful focusing power
5t#% Med#a
different portions of eye capable of refraction
*ens M 8.<E@
$ornea &anterior surface( M 8.<B@
A3ueous Humor M 8.<<@
+itreous Humor M 8.<<@
the greatest bending occurs at the anterior
o %ptical density of air M 8.000< &carry
lightwaves to cornea(
o Anterior surface of cornea > 8.<B@
Here occurs the greatest bending of
light because of the great different
between optical density of air and the
anterior surface of the cornea
=rom the cornea, light travels to
A3ueous Humor &8.<<@( U *ens
J. Des%r#be t"e anato,y and role o. t"e ear.
J.+. -"at are t"e 'ross anato,#% arts o. t"e ear
J.2. G#<e t"e blood and ner<e suly o. t"e ear
G95SS $N$*5MA
3. 2:*29N$( 2$9
$. $ur#%le
( has a characteristic shape and collects air vibrations
( consists of a thin plate of elastic cartilage covered by
( possess both intrinsic and extrinsic muscles supplied by
the facial nerve
5t"er stru%ture .ound #n t"e $ur#%le1
)ura o. t"e ant#"el#7
)rus o. t"e ant#"el#7
)on%"a o. t"e aur#%le
3ntertra'#% not%"
$ur#%ular tuber%le
*r#a'ular .ossa
(obule o. t"e $ur#%le
&. 27ternal aud#toryEa%oust#% ,eatus
( a curve tube that leads from the auricle to the tympanic
( it conducts sound waves from the auricle to the tympanic
( frame wor. of the outer t"#rd of the meatus is elast#%
%art#la'e and the #nner two;
t"#rds is bone formed by the tympanic plate.
( lined by, its outer third is provided with hairs and
sebaceous and %eru,#nous
'lands &modified sweat glands that secrete
a yellowish/brown wax# the hairs and the
wax ro<#des st#%0y barr#er t"at re<ents
t"e entran%e o. .ore#'n bod#es(.
Sensory ner<e1 auricolotemporal nerve and auricular branch of the
vagus nerve
(y," Dra#na'e1 to the superficial parotid, mastoid, and
superficial cervical lymph nodes.
33. M3DD(2 2$9 ?*AM6$N3) )$F3*A@
( an air/containing cavity in the petrous part of the temporal
bone and is lined with mucous membrane
( it contains the aud#tory oss#%les, whose function is to
transmit the vibrations of the tympanic membrane to the
perilymph of the internal ear.
( is a narrow, obli3ue, slit/li.e cavity whose long axis lies
approximately parallel to the plane of the tympanic
( it communicates infront through the auditory tube with the
nasopharynx and behind with the mastoid antrum.
( has a roo., .loor, anter#or wall, oster#or wall, lateral
wall, and ,ed#al wall.
( a#r and ,us%les such as tensor ty,an# and staed#us
,us%le also are contain in
the middle ear.
$. -alls
( formed by a thin plate of bone the te',en
ty,an#, which is part of the petrous temporal
it separates the tympanic cavity from the
meninges and the temporal lobe of the brain in
the middle cranial fossa.
formed by a thin plate of bone, which may be
deficient and may be partly replaced by fibrous
it separates the tympanic cavity from the superior
bulb of the internal ugular vein.
$nter#or wall
formed below by a thin plate of bone that
separates the tympanic cavity from the internal
carotid artery.
at the upper part of the anterior wall are the
openings into two canals. )he lower
andlar'eroen#n' / leads to the auditory tube
and the uer and s,aller / is the entrance into
the canal for the tensor tympani muscle.
the thin, bony, septum, which separates the
canals, is prolonged bac.ward on the medial wall,
where it forms a shelf/li.e proection.
6oster#or wall
has in its upper part a large, irregular opening, the
ad#tus to the mastoid antrum.
below this is a small, hallow, conical proection,
the yra,#d, from whose apex immerges the
tendon of the staed#us ,us%le.
(ateral wall
( largely formed by the tympanic membrane
*y,an#% ,e,brane
( is a thin fibrous membrane that is pearly gray.
( is obli3uely placed, facing downward, forward,
and laterally
( is circular and measures about 8cm in diameter.
( circumference is thic.ened and is slotted into a
groove in the bone.
6arts o. t"e *y,an#% ,e,brane1
8,bo / concave laterally, and at the depth
of the concavity is a small depression, the
&produced by the tip of the handle of the
*y,an#% sul%us ?'roo<e@, which forms a
notch is deficient superiorly.
=rom the sides of the notch the anter#or and
oster#or ,alleolar .olds pass to the lateral
process of the malleus.
)he small triangular area of the tympanic
membrane that is bounded by the folds is
slac. and is called ars .la%%#da. )he
remainder of the membrane is tense and is
called ars tensa.
)ympanic membrane is extremely sensitive
to pain and is innervated on its outer surface
by aur#%ulote,oral and aur#%ular bran%"
o. t"e <a'us ner<e.
Med#al wall
formed by lateral wall of the inner ear.
the greater part of the wall shows a rounded
proection, t"e ro,ontory, which results from
the underlying first turn of the cochlea.
.enestra <est#bule lies above and behind the
promontory4 is oval shaped and closed by the
base of the stapes.
on the medial side of the window is the perilymph
of the s%ala <est#bule of the internal ear.
below the posterior end of the promontory lies the
.enestra %o%"lea which is round and closed by
the secondary tympanic membrane. %n the
medial side of this window is the perilymph of the
blind end of the scala tympani.
&. $ud#tory oss#%les
( the largest ossicle and possesses a head, a nec.,
a long process or handle, an anterior process,
and a lateral process.
( rounded an articulates posteriorly with the incus
( constricted part below the head
( passes downward and bac.ward and is firmly
attached to the medial surface of the tympanic
Anterior process
( is a spicule of bone that is connected to the
anterior wall of the tympanic cavity by a ligament.
Lateral process
proects laterally and is attached to the anterior
and posterior malleolar folds of the tympanic
( possesses a large body and two processes &short
and long(.
( rounded and articulates anteriorly with the head of
the malleus.
Long process
( descends behind and parallel to the handle of the
( its lower end bends medially and articulates with
the head of the stapes.
Short process
proects bac.ward and is attached to the posterior
wall of the tympanic cavity by a ligament.
has a head, a nec. and two limbs and a base.
small and articulates with the long process of the
narrow and receives the insertion of the stapedius
Two limbs
diverge from the nec. and attach to the oval base.
oval shaped, the edge of the base is attached to
the margin of the fenestra vestibule by a ring of
finrous tissue, the angular ligament.
Mus%les o. t"e oss#%les1
+. *ensor ty,an#
5r#'#n1 from the cartilage of the auditory tube and the
bony walls of its own canal
3nsert#on1 the slender muscle passes bac.ward and ends
in a rounded tendon, which
turns laterally around the processus
cohleariformis and is inserted into the
handle of the malleus.
Ner<e suly# a branch from the nerve to the medial
pterygoid muscle, which is a branch
of the mandibular division of the trigeminal
$%t#on1 reflexly damps down the vibrations of the
malleus by the tympanic
membrane more tense.
2. Staed#us
5r#'#n1 from the internal walls of the hallow pyramid
3nsert#on1 the tendon immerges from the apex of the
pyramid and is inserted into the nec.
of the stapes.
Ner<e suly1 from the facial nerve, which lies behind
the pyramid.
$%t#on1 reflexly damps down the vibrations of the stapes
by pulling on the nec. of that
). $ud#tory tube
( 9xtends from the anterior wall of the tympanic
cavity downward, forward, and medially to the
nasal pharynx.
( 2ts posterior third is bony, and its anterior thirds is
( 2t oins the nasal pharynx by passing over the
upper border of the superior constrictor muscle.
( 2t serves to e3ualize air pressures in the tympanic
cavity and the nasal pharynx.
D. Masto#d antru,
- lies behind the middle ear in the petrous
part of the temporal bone
- it communicates with the middle ear by
the aditus, which may be as l
large as 1cm in diameter.
Anterior wall
- related to the middle ear and contains
the aditus to the mastoid antrum.
Posterior wall
- separates the antrum from the sigmoid
venous sinus and the
Lateral wall
- 1.5 cm thick and forms the floor of the
suprameatal triangle.
Medial wall
- crelated to the posterior semicircular
Superior wall
- thin plate of bone, the tegmen tympani,
which is related to the
meninges of the middle cranial fossa and
the temporal lobe of the
Inferior wall
- perforated with holes, through which the
antrum communicates with
the mastoid air cells.
2. Masto#d a#r %ells
( series of communicating cavities within a process
that is continuous above with the antrum and the
middle ear.
( lined with mucous membrane.
N29F2 S866(A1
*y,an#% ner<e
( arise from the glossopharyngeal nerve, ust below
the ugular foramen
( passes through the floor of the middle ear and
onto the promontory. Here it splits into branches
which form the ty,an#% le7us &supplies the
lining of the middle ear and gives off the lesser
petrousal nerve(.
33. 3NN29 2$9 ?($&A93N*H@
$. &ony labyr#nt"
( consists of three parts#
( &a.( <est#bule &b.( se,#%#r%ular %anals &c.(
( these are cavities situated in the substance of the
dense bone, and is lined by endosteu, and
contain a clear fluid, the er#ly," which is
suspended in the membranous labyrinth.
( central part of the bony labyrinth
( lies posterior to the cochlea and anterior to the
semicircular canals
( in its lateral wall are the fenestra vestibule, which
is closed by the base of the stapes and its anular
ligament, and the fenestra cochlea, which is
closed by the secondary tympanic membrane.
( lodge within the vestibule are the sa%%ule and
utr#%le of the membranous labyrinth.
Se,#%#r%ular %anals
( has superior, posterior and lateral parts which
open into the posterior part of the vestibule.
( each canal has a swelling at one end called the
( the canals open into the vestibule by five orifices,
one of which is common to two of the canals
( lodge within the canals are the semicircular ducts.
( resembles a snail shell structure.
( it opens into the anterior part of the vestibule.
6arts o. )o%"lea1
Mod#olus / it consists of a central pillar, the, around which a hallow
bony tube two and one/half spiral turns.
S#ral la,#na / a spiral ledge that winds around the modiolus and
proects into the
interior of the canal and partially divides it.
&as#lar ,e,brane / stretches from the free edge of spiral lamina
to the outer bony wall, thus dividing the cochlear canal
into the
s%ala <est#bule above and the s%ala ty,an# below.
&. Me,branous labyr#nt"
( lodge within the bony labyrinth.
( filled with endolymph and surrounded by
( consists of the utricle and saccule, which are lodged in the
bony vestibule4 the three semicircular ducts, which lie within
the bony semicircular canals and the duct of the cochlea,
which lies within the bony cochlea.
( larger of the two vestibular sacs
( indirectly connected to the saccule and the du%tus
endoly,"at#%us by the du%tus utr#%ulosa%%ular#s.
( globular and is connected to the utricle
( the ductus endolymphaticus, after being oined by the ductus
utriculosaccularis , passes on to end in a small blind pouch,
the sa%%us endoly,"at#%us, which lies beneath the dura on
the posterior surface of the the petrous part of the temporal
Se,#%#r%ular du%ts
( smaller in diameter than the semicircular canals
but has the same configuration.
( )hey arranged at right angles to each other so
that all three planes are represented.
( "henever the head begins or ceases to move, or
whenever a movement of the head accelerates or
decelerates, the endolymph in the semicircular
ducts changes its speed of movement relative to
that of the walls of the semicircular ducts.
( )his change is detected in the sensory receptors
in the ampullae of the semicircular ducts.
Du%t o. %o%"lea
( triangular cross section and is connected to the saccule by the
du%tus reun#ons.
( )he highly specialized epithelium that lies on the basilar
membrane forms the spiral organ of corti and contains the
sensory receptor for hearing.
N29F2 S866(A1
Fest#bulo%o%"lear ner<e
/ on reaching the bottom of the internal acoustic meatus it divides
+. <est#bular ner<e
/ supply the utricle, saccule,and the ampullae of the semicircular
/ expanded to form the vestibular ganglion.
2. %o%"lear ner<e
( the sensory ganglion the form of an elongated
spiral ganglion
( the peripheral branches of this nerve pass from the
ganglion to the spiral organ of corti.
J.3. G#<e an a%%ount as to t"e ,#%ros%o#% aearan%es
o. t"e arts and stru%tures #n t"e1
J.3.+. 5uter ear
J.3.2. M#ddle ear
J.3.3. 3nner ear
M3)95S)563) $662$9$N)2
*"e 2ar ?Fest#bulo%o%"lear aaratus@
/ functions are related to e3uilibrium and hearing.
$onsist of three parts#
27ternal ear/ receives sound waves
M#ddle ear/ sound waves are transmitted from air to bone
and by bone to the internal ear.
3nternal ear/ vibrations are transduced to specific nerve
impulses that pass via the acoustic nerve to the central
nervous system
/contains the vestibular organ which maintains
3. 2:*29N$( 2$9
+. $ur#%le ?#nna@ > consists of an irregularly
shaped plate of elastic cartilage covered by
tightly adherent on all sides.
2. 27ternal aud#tory ,eatus > somewhat
flattened canal extending from the surface into
the temporal bone.
( its internal limit is the tympanic membrane.
( a stratified s3uamous epithelium continuous with the lines the canal.
( hair follicles, sebaceous glands, and the ceruminous
glands are in the submucosa.
)eru,#nous 'lands
( are coiled, tubular glands that produce the cerumen or ear
waxVa brownish, semi/solid mixture of fats and waxes."a#rs
and %eru,en have probably protective function.
( the wall of the external auditory meatus is supported by
elastic cartilage in its outer third, whereas the temporal bone
provide support for the inner part of the canal.
*y,an#% ,e,brane ?#nner eardru,@
( lies across the deep end of the external auditory meatus.
( external surface is covered with a thin layer of epidermis.
( 2nternal surface is covered with simple cuboidal epithelium
continuous with the lining of the tympanic cavity.
( between the two epithelial coverings is a tough connective
tissue layer composed of collagen and elastic fibers and
( is a structure that transmits soundwaves to the ossicles of the
middle ear.

33. M3DD(2 2$9 ?*AM6$N3) )$F3*A@
( is an irregular space that lies in the anterior of the temporal
bone between the tympanic membrane and the bony surface
of the internal ear.
( $ommunicates anteriorly with the pharynx via the aud#tory
tube ?2usta%"#an tube@ and posteriorly with the air/filled
cavities of the mastoid process of the temporal bone.
( *ined with simple s3uamous epithelium resting on a thin
lamina propria that is strongly adherent to the subacent
( )he simple epithelium that lines the middle ear is gradually
transformed into ciliated pseudostratified columnar eipithelium
near the auditory tube and in its interior.
( 2n the medial bony wall are two membrane/covered oblong
regions devoid of bone4 these are the o<al and round
( )he tympanic membrane is connected to the oval window by a
series of three small bones, the auditory ossiclesVthe
malleus, incus and stapesVwhich transmit the mechanical
vibration generated in the tympanic membrane to the internal
333. 3N*29N$( 2$9
( $omposed of two labyrinths#
+. &ony labyr#nt"
( consists of a series of spaces within the petrous
portion of the temporal bone that house the
membranous labyrinth.
( filled with er#ly," which is similar in ionic
compositions to extracellular fluids elsewhere but
has a very low protein content.
( consists of spaces in the temporal bone.
*"ere #s #rre'ular %entral %a<#ty#
&a.( <est#bule/ houses the saccule and the utricle
&b.( se,#%#r%ular %anals/ encloses the semicircular ducts
&c.( %o%"lea / anterolateral in position4 contains the cochlear
)o%"lea # <5mm in length, two and a half turns around a
bony core .nown as ,od#olus
Mod#olus1 has spaces containing blood vessels and the cell
bodies and the processes of the acoustic branch of the +222 cranial
nerve &spiral ganglion(.
/ lateral from the modiolus is a thin bone ridge, the
osseous spiral lamina.
5sseous s#ral la,#na1 extends farther across the cochlea in the
basal region than it does in the apex.
2. Me,branous labyr#nt"
( is a continuous epithelium/lined series of cavities of
ectodermal origin.
( it derives from the auditory vesicle that is developed
from the ectoderm of the lateral part of the embryo1s
( contains endolymph which is characterized by its
low sodium and protein content and its high
potassium content
( during the embryonic development, this vesicles
invcaginate into the subacent connective tissue,
loses contact with the cephalic ectoderm, and
moves deeply into the rudiments of the future
temporal bone.
( two &;( specialized regions due to the process
&a.( utr#%le ; origin of the se,#%#r%ular du%ts
&b.( sa%%ule ; origin of %o%"lear du%t
( the epithelial lining becomes specialized to form
such sensory structures#
&a.( the ,a%ula of the utricle and saccule
&b.( the %r#stae of the semicircular ducts
&c.( or'an o. )ort# of the cochlear duct
Sa%%ule and 8tr#%le/ made up of thin sheet of connective
( lined with simple s3uamous epithelium
( in the wall# one can observe small regions of macula of
differentiated neuroepithelial cells that are innervated by
branches of vestibular nerve
( macula of the saccule lies in its floor4 the macula of the
utricle occupies the lateral wall so the maculae are
perpendicular to one another
( 5acula# consists of thic.ening of the walls and possesses
two types of receptor cells, some supporting cells, and
the afferent and efferent nerve endings
a. receptor cells &hair cells(/ characterized by the
presence of A0/E0 long rigid stereocilia, which are
actually highly specialized microvilli and one cilium
b. 0upporting $ells/ disposed between the hair cells
are columnar in shape, with microvilli in the apical
Se,#%#r%ular Du%ts/ have the same general form as the
corresponding parts of the bony labyrinth.
( )he receptor areas in their a,ullae have an elongated
ridge/li.e form and are called %r#stae a,ullar#s
( #$ristae are structurally similar to maculae, but their
glycoprotein layer is thic.er4 this layer has a conical form
called %uula and is not covered with otoliths
( )he cupula extends across the ampullae, establishing
contact with its opposite wall
2ndoly,"at#% Du%t and Sa%
( initially has a simple s3uamous epithelial lining and
gradually changes to tall columnar epithelium which is
composed of two cell types as it nears the endolymphatic
sac. )hese cells are responsible for the absorption of
endolymph and for endocytosis of foreign material and
cellular remnants that may be present in the endolymphs.
)o%"lear Du%t
( /a diverticulum of the saccule, is highly specialized as a
sound receptor
( /about <5 mm long and is surrounded by specialized
perilymphatic spaces
( /divided into < spaces#
a. S%ala <est#bule &above( and
b. S%ala ty,an#/ contain perilymph and are in reality
one long tube, beginning at the oval window and
terminating at the round window. )hey communicate
at the apex of the cochlea via an opening .nown as
the "el#%otre,a
%. S%ala ,ed#a ?)o%"lear du%t@; middle
( /contains endolymph, ends at the apex of
H#stolo'#% stru%tures1
a. Fest#bular ?9e#ssners@ Me,brane
( consists of ; layers of s3uamous epithelium,
one derived from the scala media and the other
from the lining of scala vestibule
( cells of both layers are oined by means of
extensive tight unctions that help preserve the
very high ionic gradients across this membrane
b. Str#a Fas%ular#s
( an unusual vascularized epithelium located in
the lateral wall of the cochlear duct
( consists of cells that have many deep infoldings
of their basal plasma membranes where
numerous mitochondria are located
%. 5r'an o. )ort#
( contains special auditory receptors
( contains hair cells that respond to different
sound fre3uencies
( it rests on a thic. layer ground substanceV
basilar membrane
( ; types of hair cells#
o outer "a#r %ells > "/shaped stereocilia
o #nner "a#r %ells > linear stereocilia
o W)he tips of the tallest stereocilia of the
outer hair cells are embedded in the
te%tor#al ,e,brane, a glycoprotein rich
secretion of certain cells of spiral limbus.
d. $ontain a large number of ,#%rotubules that seem to
impart stiffness to these cells. )hey outline a
triangular space between the outer and inner hair
cells; #nner tunnel which is important in sound
7. D#s%uss t"e aud#tory and <est#bular at"ways.
7.+. *ra%e se=uent#ally t"e %o,onents o. t"e1
7.+.+. $ud#tory at"way
9e%etor1 %rgan of $orti
0pinal -anglion
$ochlear nerve
,orsal and ventral cochlear nuclei
3 a%oust#% str#ae#
+. Dorsal a%oust#% str#a
=rom dorsal cochlear nucleus
7asses over inferior cerebellar peduncle
$rosses at trapezoid body
Ascends and oins contralateral lateral lemniscus
2. 3nter,ed#ate a%oust#% str#a
=rom ventral cochlear nucleus
) course similar to dorsal stria
3. Fentral a%oust#% str#a
=rom ventral cochlear nucleus
7asses anterior to inferior cerebellar pudencle
2psilateral and contralateral superior olivary nuclei
and nucleus of trapezoid body
*ateral lemniscus
6ucleus of inferior colliculus or directly to medial geniculate body
Auditory radiation
)ransverse gyrus of Heschl or Area A8
7.+.2. Fest#bular at"way
9e%etor1 $ristae ampularis of semicircular ducts and
5aculae of utricle and sacule
7eripheral process of bipolar cells
+estibular ganglion
+estibular nerve
+estibular nuclear complex
Ascending and descending fibers arise
8.( 0ome fibers go to cerebellum
;.( 0ome fibers go to certain motor cranial nerve nuclei
<.( 0ome fibers descend to cervical segments of spinal
A.( 0ome fibers go to cerebrum via posteromedial ventral
nucleus of thalamus
7.2. -"at are t"e oss#ble ,an#.estat#ons #. a les#on
o%%urs #n any art o. t"e at"way/
A lesion of the right lateral lemniscus, or of the right
anterior transverse temporal gyrus, stops some impulses
from both ears but does not interfere with other impulses
from both ears proecting to the cortex of the left
,eafness in one ear usually signifies damage to the
acoustic &cochlear( nerve, the cochlea, or the sound/
conducting apparatus of the middle ear on that side.
)he hair cells of the cochlea can be damaged bilaterally
by toxic effects of some drugs, notably the
aminoglycosides &antibiotics such as gentamicin and
tobramycin( and salicylates &analgesics such as aspirin(
2nury to the sensory components of the inner ear or to
the fibers of the eighth nerve commonly produces
"ear#n' loss ?sensor#neural dea.ness@ and t#nn#tus
&i.e., ringing or roaring in the ear(
,isease affecting the auditory conducting mechanisms in
the middle ear may also cause hearing loss and tinnitus,
a %ond#t#on ter,ed %ondu%t#<e dea.ness.
Da,a'e to t"e #nner ear or <est#bular ner<e on one
s#de %auses an #,balan%e t"at %an rodu%e nausea,
<ert#'o, ostural #,balan%e, and abnor,al eye
K. D#s%uss t"e "ys#olo'y o. aud#t#on.
K.+. 9e<#ew t"e "ys#%s o. aud#t#on
0ound is the ener'y o. <#bratory ,ot#on. 2t is the ade3uate
stimulus for hearing. 2t originates always at the <#brat#n' sour%e. 2t
must be transmitted from source to ears through air by the
movement of air molecules. )he disturbances of air molecules
ma.e up a sound wave. Sound wa<es consists of regions of
compression, in which air molecules are closed together and
pressure is high alternating with areas of rarefaction, where the
molecules are further apart and the pressure is lower. 2t is by these
disturbances &sound waves( that sound energy is transmitted.
0ounds are classified as either tones or noises. *ones
are regular, periodic vibrations, analyzable, when heard, into
components. No#ses are irregular, random vibrations, cannot be
analyzable when heard, into components.
)ones can be either pure or complex. A pure tone has a
single fixed fre3uency. 9x. )one emitted by a tuning for..
A complex wave form is made up of many fre3uencies of
vibrations. 9x. 0peech
)he wa<elen't"s of sounds are commonly described in
terms of .re=uen%y, expressed in the cycles per second and
designated as Hertz &Hz(, the number of waves passing a given
point in one second. =re3uency multiplied by wavelength e3uals the
<elo%#ty o. sound. 0ounds between 8000 Hz are heard most
.eenly in human ears, but the entire range of fre3uencies audible to
the human beings extends from ;0 to ;0,000Hz. )he fre3uency of
sound is related roughly to #t%". )he faster the vibration is, the
higher the pitch.
)he a,l#tude of the sound is related to its loudness.
0ound intensely levels are measured in power ratios. )he de%#bel
&d!(, 8?80 of the bell, is the ratio unit referring to ust audible to the
sound &threshold value(. )he highest decibel scale &around 8B5 d!(
is given to that produced by the Apollo booster.
5ost tones are complex and cannot be described by a
simple, single sinusoidal curved. )hey appear as complex forms.
See%" has an intensity of about @5d!. )he main
fre3uencies used in speech fall in the range of <00 to <500Hz.
0ounds that exceed 800d! can damage the peripheral auditory
apparatus, and those over 8;0d! can cause pain. As people age,
their ability to hear high fre3uencies decline, a condition called
K.2. Des%r#be t"e nor,al routes o. sound %ondu%t#on.
0ound waves enter the external auditory canal
"aves stri.e the tympanic membrane causing it to vibrate
%ssicular chain is set into motion
=luid vibrations or pressure waves travel within the inner ear are
!asilar membrane vibrates
0timulation o hair cells of the organ of $orte
0timulation of afferent fibers of cochlear division of $6 +222
K.3. 27la#n t"e ,e%"an#s, #n t"e de<elo,ent o.
aud#tory ner<e otent#al.
)he ,e,brane otent#al of the hair cells is about
;J0,F. "hen the stereocilia are pushed toward the Qinocilium, the
membrane potential is decreased to about /50m+. "hen the bundle
of processes is pushed in the opposite direction, the cell is
hyperpolarized. ,isplacing the process in the directions that are
intermediate between these two directions produces depolarization
or hyper polarization that is proportionate to the degree to which the
direction is toward or away from the Qinocilium. )hus, the hair
process provides a mechanism for generating a change in
membrane potential proportionate to the direction and distance the
hair moves.
A t# l#n0s tie the tip of each stereocilium to the side of its
higher neighbors and at the unction are cations channels in the
higher processes that appear to be mechanically sensitive. "hen
the shorter stereocilia are pushed toward the higher, the open rime
of these channels increase Q
the most abundant cations in the
endolymph/ and $a
enter via the channel and produce
)here is still considerable uncertainty about subse3uent
events. However, one hypothesis is that molecular motor in the
higher neighbor next moves the channel toward the base, releasing
tension in the tip lin.. )his causes the channel to close and permits
restoration of the resting state.
,epolarization of hair cells causes them to release
neurotransmitter, probably glutamine, which initiates depolarization
of neighboring afferent neurons.
)he processes of the hair cells proects into the
endolymph whereas the bases bathed in perilymph. )hese
arrangements are necessary for the normal production generator
K.G. Des%r#be t"e ,e%"an#s, #n<ol<ed #n
K.G.+. Mas0#n'
"hen two sounds stimuli are presented simultaneously,
the sensation of one stimulus &,as0ed tone( may be suppressed
by the sensation of the other &,as0#n' tone(. )he mas.ed tone
sensation remains obliterated unless it physical intensity is
increased. is greater when the mas.ed tone fre3uency is
close &but not identical( to the tone fre3uency.
)he effect is almost totally absent when
and mas.ed tones are presented to different ears. does disappear immediately on removal of the tone. )he phenomenon of auditory fatigue occurs, where
the threshold for the mas.ed tone drops gradually to its normal
level. )his is temporary deafness following loud auditory sensations.
K.G.2. (o%al#Hat#on
Auditory localizations depend on two ears and their
displacement, each ear giving a somewhat different &unconscious(
sensation of the same sound source.
0ound waves at two ears emanating from the same
source may differ in three ways. )he differences are the cues for
8. )he #ntens#ty;d#..eren%e is the amplitude differential
between wave forms at the ears. )he difference may
approach Bd! when the source is @0degrees to the
right front of the median plane4 sound waves at the
right ear are Bd! more intense than those of the left
ear. )he effect is most pronounced for high
fre3uency stimuli whose short wave lengths suffer
amplitude loss when traveling around corners.
;. )he t#,e;d#..eren%e is the period between first
stimulus arrival at one ear and second stimulus
arrival at the other. )he difference ranges from <0/
B00 milliseconds.
<. )he "ase;d#..eren%e is the lag between stimulus
wave form at one ear and the stimulus wave form at
the other. =or sinusoidal waves, the stimulus at one
ear may be at a trough while the stimulus of the
other is at the crest. )he differences is most
important for irregular wave forms &as speech( for
when regular wave forms lag enough, they are again
in phase.
K.G.3. 2%"olo%at#on
9cholocation is an unconscious evaluation of reflected
echoes from obects, enabling the individual to find way through
complicated obects pattern. 2t is well developed in blind individuals.

L. D#s%uss t"e "ys#olo'y o. t"e <est#bular syste,.
Fest#bular Syste,s Fun%t#on1
2t operates reflexly to stabilize vision &permits eye to remain
fixed on a point in space as head moves(
$oordinates balance and motion of eyes, head, trun., and
2t provides continual inertial guidance to resist gravity and
avoid falling down during ris.y maneuvers.
L.+. State t"e role layed by t"e <est#bular syste, #n
nor,al ,o<e,ents o. t"e "ead w"en t"e body #s
stat#onary and w"en t"e body #s ,o<#n'.
Fest#bular Syste,s 9ole #n 9otat#onal ?an'ular@ $%%elerat#on
o. t"e Head
)he vestibular system1s role is to .eep the brain always
informed about the head1s movements so that the brain
can performed proper changes in the eye movements
and in the tone of the body1s muscles maintaining
0emicircular ducts are the receptor organs for angular
acceleration of the head.
Rotational acceleration in the plane of a given
semicircular duct stimulated its crista.
"hen the head begins to move, the fluid within the
duct lags behind because of inertia pushing the
%uula in a direction opposite to the direction of
Resulting to stereocilia of hair cells bended,
producing either depolarization or hyperpolarization
o !ending of the stereocilia toward the .inocilium
&same to the direction of the cupula( will
depolarize the hair cells
o !ending of the stereocilia away from the
.inocilium &same to the direction of the cupula(
will hyperpolarize the hair cells
"hen inertia is overcome the fluid follows the
rotation of the duct.
At constant speed of rotation copula swings bac.
into resting position resulting to sterecilia returning to
upright position and the hair cell goes bac. to resting
membrane potential.
"hen rotation stops endolymph pushes the cupula
to the direction of the acceleration, bending the
stereocilia and producing receptor potential again.
$upula returns to midposition in ;5/<0 seconds.
)he ducts are only sensitive to changes in motion
&acceleration(. )hey are insensitive to constant angular
)he ducts wor.s in pairs. "henever one is excited
&depolarized(, the other is inhibited &hyperpolarized(.
)he pairs are# horizontal ducts of right and left side4
and anterior vertical duct of one side and posterior
vertical duct of the other side.
)he uni3ue pattern of activity generated by the ducts is
used by the $60 to interpret the speed and direction of
head movement and to ma.e appropriate adustments in
posture and eye position.
Fest#bulo;o%ular 9e.le7 ?F59@
+estibulo/ocular reflex maintains visual fixation on
stationary points while the head rotates.
0table retinal images are provided almost exclusively by
the +%R4 it does not depend on visual feedbac. and is
present in blind individuals
+%R compensation used smooth/pursuit eye movements
which has two following components#
a. Slow )o,onent
0timulation of the vestibular receptors
eye movement of e3ual magnitude in the
direction opposite to the head.
)his prevents the image from moving off the
fovea4 allows the person to fix his gaze on a
stationary obect even if the head is moving.
9yes can be rotated usually as far as @0Y.
b. Fast or Mu#%0 )o,onent
After the eyes have rotated to its limit, they
rapidly return to the center of the &or er. to the opposite side( and then focus the
obect again.
2f the heads continues to rotate, these er.s will
continue to occur.
)his is important to .eep the fovea from being
Fest#bular Syste,s 9ole #n (#near $%%elerat#on
0till the vestibular system provides information regarding
the head1s movements to the $60.
)he maculas of the utricle and saccule are responsible for
detecting linear acceleration and static position of the
)he otoliths are heavier than the endolymph, and during
movement they exhibit inertial delay and tend to sin. and
bend the stereocilia of the hair cells.
0ince the macula o the saccule is oriented vertically in the
sagittal plane, a change in upward or downward
acceleration results in deformation of stererocilia.
At erect position the macula of the utricle lies in the
horizontal plane, so the gelatinous matrix with
otoliths &otoconia( rests directly on the hair cells.
2f the head tilts or accelerates in the horizontal
plane, the inertia of the otoliths causes the
gelatinous matrix to lag behind the movement of the
s.ull and thereby bens the sterecilia of the hair cells.
"hen the stereocilia bend towards the
.inocilium the cell becomes depolarized.
"hen the stereocilia bend away from the
.inocilium the cell becomes hyperpolarized
)he receptor potential influences the activity at the
synapses between the hair cells and the peripheral
processes of the vestibular ganglion cells
)he arrangement of hair cells is oriented in different
directions. 2n any changes of position of the head, some
cells are depolarized and some are hyperpolarized.
)he maculas also discharge tonically in the absence of
head movement because gravity1s pull on the otoliths.
Fest#bular Syste,s 9ole #n t"e Ma#ntenan%e o. 6osture
)he vestibular receptors provide information about the
position and motion of the head.
And together with visual cues from the eyes and
proprioception of the muscles, afferent signals are sent to
the centers in the brainstem.
!rainstem centers also receive signals from the motor
cortex, basal ganglia, and cerebellum.
9fferent pathways converge on the alpha neurons
innervating the s.eletal muscles especially the proximal
extensor muscles Fantigravity muscles(. Activities of
these muscles are adusted in response to displacement
of the body so as to maintain balance.
L.2. Des%r#be adatat#on and "ab#tuat#on.
Adaptation happens when the effects of movement are no
longer disturbing in a prolonged single exposure.
$an occur if the rate of rotation is less than @/B rpm.
Rotations above 80 rpm, longterm adaptation is
Refers to being accustomed the effects of repeated
angular rotations or acceleration.
5ay occur in tumblers, divers, and figure s.aters.
L.3. Des%r#be nysta',us and #ts ,e%"an#s,
7ersistent stimulation of hair cells in the ampulla of a
semicircular canal causes the eyes to move slowly to one
side until they reach physical limit and then er. to
the opposite side.
)hese movements occur repetitively in rapid succession
and produce tremor/li.e oscillations of the eyes .nown as
6ystagmus is consists of a normal reflex response to
rotation or unilateral &unbalanced( stimulation of one of
the semicircular canals.
!y convention, the movement of nystagmus refers to the
direction of the fast component, although this is opposite
to the movement induced by stimulation from the
semicircular canal.
$linical tests of vestibular function chec.s for nystagmus
on vestibular stimulation
)l#n#%al *est#n' to 2l#%#t Nysta',us
$. 9otat#on test
$an be performed by turning the patient in a
revolving chair with the head tilted forward <0
degrees to bring horizontal canals parallel with the
After 80 or 8; turns, movement stops abruptly.
5omentum causes the endolymph to reverse
direction and to flow in the direction in which the
head had been turning.
)he induced nystagmus, called ostrotatory
nysta',us, lasts about <0 seconds in
neurologically normal persons.
)he slow component of nystagmus follows the
movement of the endolymph, while the fast
component moves to the opposite.
+estibulo/ocular reflex can be evaluated
3uantitatively in response to physiologic rotation at
various different test fre3uencies.
&. )alor#% or *"er,al *est
)his permits testing of the vestibular system of each
side separately.
:sually the examiner places the patient either in
prone with head tilted forward about <0 degrees or
seated with the head tilted @0 degrees.
)his brings the horizontal semicircular canal into the
vertical plane
)hen the patient1s external auditory canal is irrigated
with either warm or cold water.
)his raises or lowers the temperature of the
endolymph closes on the side of the semicircular
canal closest to the middle ear
$onvection current causes deviation of the
ampullary crest, which stimulates the hair cells and
leads to nystagmus.
"arm water irrigation on the right results to
convection current moves superiorly, similar to
the effects of the head rotating to the right in
the horizontal position. &slow component to the
left, and fast component to the right(
2rrigation with cold water causes current to be
reversed, similar to rotating to the left. &slow
component to the right, and fast component to
the left(
)his test can be recorded graphically by placing
recording electrodes on the patient1s face near
the eyes and using appropriate amplification
and recording e3uipment.
+0. D#s%uss t"e se=uent#al %o,onents o. t"e .ollow#n'1
+0.+. 5l.a%tory at"way
+0.2. *aste at"way
++. D#s%uss t"e "ys#olo'y o. ol.a%t#on and taste.
smell and taste are generally classified as <#s%eral
senses because of their close association w?
gastrointestinal fxn
physiologically, they are related
both taste and smell receptors are %"e,ore%etors
that are stimulated by molecules in solution in mucus in
the nose and saliva in the mouth
receptor# ol.a%tory neuron &bipolar neuron(
;sense of olfaction
/substance that can stimulate smell
e..e%t#<e odorant
/should be volatile to reach the olfactory mucosa to smell it
/must be able to be in a solution to be dissolved covering the
olfactory cells
6r#,ary 5l.a%tory Sensat#ons
&odor 3ualities(///&natural stimuli w? these odors(
mus.y or ambrosaire///mus., amber
floral or fragrant///roses, violets, asmine
pepperminty///peppermint, carbonic acid
ethereal or fruity///pears, apples
pungent or burned///vinegar
putrid///rotten eggs, bed bags
)"ara%ter#st#%s o. an 2..e%t#<e 5dorant
8. volatile
;. water soluble to some degree
<. lipid soluble to some degree
Fa%tors $..e%t#n' 5dor 6er%et#on
8. action potential pattern generated in the different olfactory
;. attentiveness
<. state of olfactory mucosa
Wif your olfactory is not functioning?not affective so wont be able to
affect odor perception
A. hunger
5. sex
27%#tat#on o. 5l.a%tory 9e%etor Neurons
odorant &odorivector(

volatize to release odorant molecules &%5(

%5 reach the olfactory mucosa

%5 dissolve in the mucosa

odorant binding proteins bind and concentrate %5 Jfacilitate their

ineraction w? olfactory neurons

%5 bind to binding sites in olfactory cells

activates -/olfactory protein &golf(

golf binds -)7 J stimulate adenyl cyclase to produce $A57

$A57 opens calcium and sodium channels

calcium and sodium influx

calcium opens, chloride efflux
in chloride channels depolarization of cilia

receptor potential

action potential in initial part of neuron


$bnor,al#t#es o. 5l.a%t#on
8. Anosmia/absence of sense of smell
;. Hposmia/diminished olfactory sensitivity
<. ,ysosmia/distorted sense of smell
/part of flavor
/desirable taste includes an element of pain stimulation &e.g. hot
/smell plays an impt. role in the overall sensation produced by food
/temperature of foods also contribute to the flavor
receptor organ# taste buds
found in the papillae
basal cells
sustentacular cells/type 8J; cells
gustatory cells &that ma.e synaptic connections to sensory
nerve fibers(/type < cells
nerve supply#
8. the chorda tympani branch of the .a%#al ner<e ?)N F33@;
supplies the taste buds on the anterior ;?< of the tongue
;. 'losso"aryn'eal ner<e?)N3:@/supplies taste buds on
the posterior 8?< of the tongue
<. <a'us ner<e?)N:@/supplies a few taste buds in the
larynx and upper esophagus
&as#% *aste ,odal#t#es
8. sweet
;. sour
<. bitter
A. salty
5. umami
/triggered by glutamate and particularly by the monosodium
glutamate &50-(
Wit is used to be thpight that the surface of the tongue had special
areas for each of these sensations, but it is now clear that all are
sensed from all parts of the tongue and adacent structures
Wit is now become clear that the afferent nerves to the nucleus
tractus solitaruis contain fibers from all types of taste buds, w?o any
clear localization of types
Me%"an#s, by wE% %"e,#%als %ause an #n%rease release o.
neurotrans,#tter .ro, taste re%etor %ells
8. direct passage of ions through ion channels
/channels are open all the time
ex. salt, sour &acid(
;. bloc.age of ionic channels
ex. acid, bitter via bitter 8 receptor
<. opening of ionic channels
ex. umami/50-
A. activation of ;
messenger systems through ligand
interactions w? membrane
/calcium is released from intracellular
ex. sugar, bitter &3uinine( via bitter receptor(
blends,tastes as one
Wsour, salt, cold
Wsweet, bitter, warm
$bnor,al#t#es o. Gustat#on ?taste@
8. Ageusia/absence of sense of taste
;. Hypogeusia/diminished taste sensitivity
<. ,ysgeusia/disturbed sense of taste
S#'nal *ransdu%t#on
sapid? taste/producing substances

dissolve in saliva

interact w? taste receptor cells

increase free intrecellular calcium

increase neurotransmitter release

action potentials in afferent taste fibers &$6 +22,2Z,Z(

God &less 2<eryoneNNN
February 2007
Grou 2.