AQUEOUS HUMOR

(a) Eye maintains its shape by Intraocular Pressure.

(b) Avascular Structure "Lens & Cornea" receive nourishment by Aqueous

Humor( Clear fluid in Ant:Posterior Chamber ,ving refractive index of
1.336+Viscosity 1.025 to 1.040).

(c) Osmotic pressure of Aqueous humor is slightly higher than Plasma &
Contains glucose, urea, proteins, Inorganic salts, Ascorbic Acid, Lactic acid, &
some dissolved O2.

(d) Two Layers of Ciliary Epithelium & Walls of Retinal Capillaries constitute
system of sSemi-permeable membrane, separating blood from Ocular Cavity c/d
"Blood-Aqueous Barrier"( impermeable to large-sized molecules from plasma
cannot pass into eye, necessary for maintenance of Optical Transparency of
Aquesus Humour).

(e) In Trauma this Barrier breaks Result escape of blood or proteinous contents
into aqueous c/d "Plasmoid Aqueous".

(f) Rate of Active Na+ Transport by Na Pump at Ciliary epithelium is directly

proportional to Rate at which water enters the Ocular Cavity.

(g) Energy required for Active transport is derived by Citric Acid Cycle.

(h) Combination of Ultra-filtration (25%) & Active Ciliary Secretory Process

(75%) cause formation of Aqueous Humor.

(i) It,s Circulation is essential for regulation of Intraocular Pressure & Metabolic
Activities of Intra-Ocular Structure.

(j) Aqueous Humor drained out by Two Routes (i) Trabecular Meshwork Route
(ii) Uveo-Scleral Route.
Trabecular Outflow (75 to 90%) ------> formed aqueous humor collected in
Posterior Chamber, flows through Pupil into Ant: Chamber and finally escapes
through drainage channels at Angle of Anterior chamber c/d "Schlemm
Canal"+Aqueous Vein+Efferent Channels drain it into Episcleral vein+Intrascleral
Venous Plexus, respectively.

(i) Approximately 2 μl (1% fluid) drain/min & depends on Opening of Exit

Channel+Venous Pressure just within Sclera.

(ii) Episcleral Vein at Site of Junction with Aqueous Vein Presents Laminated
Appearance due to blood & Aqueous running side by side.

Uveo-Scleral Outflow (10 to 26%) -------> Aqueous passes across Ciliary

Body into Supra-Choroidal space & is drained in Venous Circulation.

(k) Intraocular Pressure/Occular Tension ( normally 12 to 20 mmHg)depends on

Rate of aqueous Production & It,s drainage. Usually "IOP" not vary significantly
b/w 2- Eyes But Consistent difference of 4 to 6 mm Hg b/w two eyes c/d
"Downey’s Sign" indicate Glaucoma.

(l) Center in Hypothalamus maintain "IOP" to it,s Equilibrium by Cervical

Ganglion Sympathetic Fibre cause Diurnal Variations of "IOP"intra-ocular (2 mm
Hg) & it is Raised in Morning hour due to Change in Rate of Aqueous Humor
Production.

(m) "IOP" Alteres by

(i) Variation in Hydrostatic Pressure in Ciliary Capillary ----> Result in rise "IOP".

(ii) Variation in Osmotic Pressure of Blood -----> Alters diffusion across capillary
wall like Hypotonicity induces rise & Hypertonicity fall in IOP.

(iii) Increase in Permeability of Capillaries -----> Result in Formation of

Plasmoid-Aqueous that cause Rise in "IOP".

(iv) Change in Eye Ball Volume ------> Small volumetric change in Eye-Ball
normally compensated by increased drainage mechanism. But Big Tumor,
Intraocular Hemorrhage, Sudden Vasodilatation induce pressure changes dueto
indistensibility of Sclera.

(v) Obstruction in Circulation of Aqueous ---> Blockage at Pupil/Angle of Ant:

Chamber results Rise in "IOP".

(vi) Alteration in Aqueous Formation ------> Hypersecretion/Hyposecretion casue

Raise/Fall in "IOP".

(vii) Changes in pH of blood, Topical/Systemic drugs, general Anesthesia,

Psychological Stress Raise "IOP".

METABOLISM OF OCULAR TISSUE

(a) Ocular Tissue ,ve both vascularized("Iris, Ciliary body, Choroid, Retina not
differ in general metabolic activity from other tissues of body) & Non-
vascularized structures (Lens,Cornea derive energy by phosphorylation+Auto-
Oxidation).

(c) Retina ,ve very high metabolic rate & it rapidly dies if its blood supply is cut
off for short time.

(d) Cornea receive Metabolite by "Perilimbal Capillary, Aqueous Humor, Tear".

Glucose in Aqueus humour enters Cornea by Simple diffusion/ Active Transpor
& Oxygen by Tear film.

(e) Lens ,ve low metabolic rate & derives energy mainly through Carbohydrate.
A.A & F.A oxidized in it,s Epithelial Mitochondria via Citric Acid Cycle.

(f) Lens Meatbolism at Cortex & Central nucleus is more or less inert.---> (i) An-
aerobic Glycolysis (80%) to form "Lactic Acid" (ii) Citric Acid Cycle (20%) ---->
very less/inactive due decrease amount of mitochondria in Lens (iii) HMP Shunt
----> very active in Lens (iv) Sorbitol Pathway (5%) However, itassumes greater
significance in sugar cataract