OPHTHA 32 22 January 2019

PHYSIOLOGY AND BIOCHEMISTRY OF THE EYE 3.2 Natakneng 2020

Dr. Rosemarie Garganta, DPBO, FPAO Mariano Marcos State University

Outline: Measurements of tear-film thickness have differed widely.

PHYSIOLOGIC ACTIVITIES INVOLVED IN THE NORMAL FUNCTIONING  Original measurements of the precorneal tear film gave an
OF THE EYES average thickness of approx. 8-9 11m, with the aqueous layer
1. Maintenance of clear ocular media constituting nearly all the thickness
A.Tear Film
Three Layers
Lipid or Oily Layer
Aqueous Layer
Mucin Layer
Functions
Tear Secretion
Elimination of Tears
Tear Dysfunction
B. Physiology of the Cornea
Layers
Functions
Transparency
Source of Nutrients
C. Physiology of the Crystalline Lens
Functions
Transparency
Metabolism
Source of Nutrient
Pathway of Glucose Metabolism
Accommodation
D. Aqueous Humor and Maintenance of IOP
Functions
Composition
Barriers
Production, Mechanism
Control of Production
Drainage
Clinical Implications of Breakdown of Barrier
2. Quiz

PHYSIOLOGIC ACTIVITIES INVOLVED IN THE NORMAL

FUNCTIONING OF THE EYES
1. Maintenance of clear ocular media
2. Maintenance of normal intraocular pressure
3. The image forming mechanism
4. Physiology of vision
5. Physiology of normal binocular vision
6. Physiology of pupil
7. Physiology of ocular motility
Three Layers:
MAINTENANCE OF CLEAR OCULAR MEDIA 1. Lipid or oily layer
Structures forming the refractive media of the eye outer most layer; anterior layer of the tear film (approximately
A. Tear Film 100 molecules thick)
B. Cornea contains polar and nonpolar lipids secreted by Meibomian
C. Aqueous Humor glands and glands of Zeis and Moll
D. Crystalline Lens
E. Vitreous Humor Meibomian glands
 located in the tarsal plate of the upper and lower eyelids and
A. TEAR FILM are supplied by parasympathetic nerves that are
The primary functions of the tear film are to: cholinesterase-positive and contain vasoactive intestinal
 provide a smooth optical surface at the air-cornea interface polypeptide (VIP)
 serve as a medium for removal of debris  Upper eyelid - approximately 30-40 Meibomian glands
 protect the ocular surface  Lower eyelid - 20-30 Meibomian glands
Human tears are distributed among the marginal tear strip (or tear  Each gland orifice opens onto the skin of the eyelid margin,
meniscus), the preocular film covering the exposed bulbar between the tarsal gray line and the mucocutaneous junction
conjunctiva and cornea (precorneal tear film) and the conjunctival
sac (between the eyelids and bulbar conjunctiva). The sebaceous glands of Zeis
The precorneal tear film is a trilaminar structure consisting  located at the eyelid margin close to the eyelash roots
conceptually of an outer lipid layer, a middle aqueous layer, and  also secrete lipid, which is incorporated into the tear film
an inner mucin layer.
Chenes, Doc 1 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE
.  supply oxygen to the avascular corneal epithelium
Because the polar lipids are charged compounds (phospholipids),
they are located at the aqueous-lipid interface.
The fatty acids of the phospholipids interact with the other
hydrophobic lipids (cholesterol and wax esters, which make up the
bulk of the lipid layer) through noncovalent, noncharged bonds.
Tear lipids are not susceptible to lipid peroxidation because they
contain extremely low levels of polyunsaturated fatty acids.
Functions:
 Prevents overflow of tears. (It maintains a hydrophobic barrier
(lipid strip) that prevents tear overflow by increasing surface
tension)
 Retards the evaporation
 Lubricates the eyelids thus preventing damage to the eye
margin skin
 Contribute to the optical properties of the tear film because of
its position at the air-tear film interface
2. Aqueous layer
intermediate; bulk of tear film
secreted by main and accessory lacrimal glands
Main Lacrimal Gland
 divided into 2 anatomical parts, the orbital and the palpebral
portions, by the levator aponeurosis
 richly innervated by parasympathetic nerves containing the
neurotransmitters acetylcholine and VIP
The accessory lacrimal glands
 The glands of Krause: constitute two-thirds of the accessory
lacrimal glands; are located in the lateral part of the upper
fornix; also present in the lower fornix
 The glands of Wolfring are variably located along the proximal
margin of each tarsus.
 The accessory lacrimal glands are structurally like the main
lacrimal gland; densely innervated, but the majority of nerves
are unidentified.
mostly water and small quantities of solids like sodium
chloride, sugar, urea, protein, alkaline and salty in taste
- Electrolytes and small molecules regulate the
osmotic flow of fluids between the corneal epithelial
cells and the tear film, buffer tear pH, and serve as
enzyme cofactors in controlling membrane
permeability.
ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///
Doc
- Tear-film solutes include urea, glucose, lactate,
citrate, ascorbate, and amino acid  enter the tear
film via the systemic circulation, and their
concentrations parallel those of serum levels.
- Proteins in the tear film include immunoglobulin A
(IgA) and secretory IgA (sigA).
contain antibacterial substances like lysozyme, betalysin and
lactoferrin
Also present in tears is interferon, which inhibits viral
replication and may be efficacious in limiting the severity of
ulcerative herpetic keratitis.
In addition, tears contain a wide array of cytokines and
growth factors  play a role in the proliferation, migration,
and differentiation of corneal and conjunctival epithelial cells;
also regulate wound healing of the ocular surface.
Functions:
 maintain a constant electrolyte composition over the
ocular surface epithelium
 provide an antibacterial and antiviral defense
 smooth minute irregularities of the anterior corneal
surface
 wash away debris
 modulate corneal and conjunctival epithelial cell function
3. Mucus Layer
thinnest and innermost layer; mucin
secreted by conjunctival goblet cells and the stratified
squamous cells of the conjunctival and corneal epithelia and
minimally by lacrimal glands of Henle and Manz
- Goblet-cell mucin production is 2-3 f.lL/day, which
contrasts with the 2-3 mL/day of aqueous tear production.
- Both conjunctival and tear mucins are negatively charged, high-
molecular-weight glycoproteins.
coats the microplicae of the superficial corneal epithelial cells and
forms a fine network over the conjunctival surface
It contains mucins, proteins, electrolytes, and water.
Functions:
 converts the hydrophobic corneal surface into hydrophilic one,
which is essential for the even and spontaneous distribution of
the tear film
 interact with the tear lipid layer to lower surface tension 
stabilizing the tear film
 trap exfoliated surface cells, foreign particles, and bacteria (by
the loose mucin network covering the bulbar conjunctiva)
 lubricate the eyelids as they pass over the globe
Function of Tear Film
1. Keeps the cornea and conjunctiva moist
2. Provides oxygen to corneal epithelium
3. Washes away debris and noxious irritants. It carries tear
constituents and debris to the puncta.
4. Prevents infection due to presence of antibacterial surfaces
5. Facilitates movement of the lids over the globe
Tear Secretion
tears are continuously secreted throughout the day
Lacrimal secretory system: 2 components
1. Basic Secretion:
 accessory lacrimal glands of Krause and Wolfing
2. Reflex Secretion:
 main lacrimal gland; induced by:
2 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE
a) Physical irritation: superficial corneal and conjuctival sensory
stimulation by mechanical, thermal or chemical means
b) Psychogenic factor
c) Bright light
d) Induction with sensory nerve by a local neural reflex activates
the parasympathetic and sympathetic nerves that innervate
the tear glands and epithelium causing secretion
Elimination of Tears
tears flow downward and medially across the surface of the
eyeball to reach the lower fornix then to the inner canthus
drained to the nasal cavity via the lacrimal passages brought
about by the active lacrimal pump mechanism contributed by the
orbicularis muscle
eyelid movement is important in tear-film renewal, distribution,
turnover, and drainage
when the eyelids close during blink, contraction of the muscles
distends the fundus of the lacrimal sac, creating a negative
pressure which siphons the tears through the punctum and
canaliculi into the sac
when the eyelids open, the muscle relaxes, lacrimal sac collapses
and a positive pressure is created which forces the tear down the
nasolacrimal duct into the nose
Tear Dysfunction
A qualitative or quantitative abnormality of the film may occur as a
result of:
 Change in the amount of tear film constituents
 Change in the composition of the tear film
- The amount or composition of the tear film can change
because of aqueous deficiency, mucin deficiency or
excess (with or without associated aqueous deficiency),
lipid abnormality (Meibomian gland dysfunction), and/or
ocular surface exposure.
- For example, increases in tear-film osmolarity have
been observed in patients with keratoconjunctivitis
sicca (KCS, or dry eye syndrome) or blepharitis and in
those who use contact lenses.
 Uneven dispersion of the tear film because of corneal surface
irregularities
- The preocular tear film is dispersed unevenly with an
irregular corneal or limbal surface (inflammation,
scarring, dystrophic changes) or poor contact lens fit.
 Ineffective distribution of the tear film caused by eyelid-globe
incongruity
- Eyelid-globe incongruity results from congenital,
traumatic, or neurogenic eyelid dysfunction or absent or
dysfunctional blink mechanism.
Diagnostic test for tear dysfunction include:
 Tear breakup time
 Fluorescein staining
 Lissamine green staining
 Rose Bengal staining
 Osmolarity test and
 Schirmer test
B. PHYSIOLOGY OF CORNEA
Cornea forms the main refractive medium of the eye
Transparency of cornea
Nutrients and metabolism of cornea
Permeability of cornea
ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///
Doc
Corneal wound healing
CORNEA
transparent, avascular
a remarkable structure; has a high degree of transparency and
excellent self-protective and reparative properties
has a rich afferent innervations
 long posterior ciliary nerves (branches of V1)
 penetrate the cornea in 3 planes:
o sclera
o episcleral
o conjunctival
 peripherally, approximately 70-80 branches of
the long posterior ciliary nerves enter the
cornea and lose their myelin sheath 1-2 mm
from the limbus
Layers
1. Epithelium
~50 um thick and constitutes 5%- 10% of total corneal
thickness
composed of 4-6 layers
 1-2 layers of superficial squamous cells
 2-3 layers of broad wing cells
 innermost layer of the columnar basal cells
Surface projections (microvilli and microplicae) are present
 coated with glycocalyx
* Mucin glycoproteins - major constituents of
glycocalyx; promote both stability of the tear
film and wettability of the corneal surface
Plasma membrane proteins and the lipids of corneal
epithelial cell
 heavily glycosylated
 play an important role in cell-cell adhesion as well as
in adhesion of the basal cells of the corneal
epithelium
to the underlying basement membrane
 sugar residues play a role in wound-healing
mechanisms
 also have a role in pathogenesis of corneal infection
by serving as attachment sites for microbes
damage to this layer will cause transient, localized edema of
the corneal stroma and will make the Bowman’s membrane
susceptible to infections
2. Bowman’s membrane
Immediately posterior to the epithelial basal lamina
Acellular and it does not regenerate when damaged
Removed in excimer laser surgery (photo refractive
keratectomy or laser sub epithelial keratomileusis):
development of corneal haze post op
3. Stroma
Makes up 90% of the corneal thickness
Keratocytes: stromal cells
There is loss of kertocyte density with age; depending on age,
keratocytes constitutes 10-40% of corneal volume
The narrow and uniform diameter o collagen fibrils and their
regular arrangement are characteristic of collagen of the
corneal stroma and are necessary for the transparency of the
cornea
o When these interactions are disturbed, the ability of
the cornea to remain transparent is profoundly
affected
3 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE

Proteinase Inhibitors of cornea: play a key role in corneal Glucose

protection by restricting damage during corneal inflammation,  primary metabolic substrate for the epithelial cells, stromal
ulceration and wound healing keratocytes, and endothelium
4. Descemet membrane  metabolized in the cornea by all 3 metabolic pathways:
Specialized basement membrane, 10-12 um thick, present  tricarboxylic acid (TCA) cycle
between the endothelium and the posterior stroma  more active in the endothelium than in the
 Secreted by endothelium and comprises an anterior epithelium
bended portion and a posterior nonbended  anaerobic glycolysis
portion  hexose monophosphate (HMP) shunt
5. Endothelium  In the epithelium and endothelium, it breaks down
Single layer posterior to descemet membrane and is 35%- 65% of the glucose
composed of polyglonal cells 20 um in diameter. In young  Keratocytes of the stroma metabolize very little
adults, the normal endothelial cell count is approximately glucose; lacks 6-phosphogluconate
3000/mm2 dehydrogenase, an important enzyme in the
Number of endothelial cells decreases with age and there is HMP pathway
a concomitant spreading and thinning of the remaining cells  Stroma
Functions as permeability membrane between the aqueous  receives glucose primarily from the aqueous humor by
humor and the corneal stroma and as a pump to maintain the carrier-mediated transport through the endothelium
cornea in a dehydrated state by generating the negative  Epithelium
hydrostatic pressure that also serves to hold free corneal  receives glucose by passive diffusion through the
flaps (eg. LASIK flaps) in place stroma
Derives sufficient oxygen from the aqueous humor to  Preocular tear film and limbal vessels
maintain normal pump function  supply approximately 10% of the glucose used by the
If endothelium is injured, healing occurs mainly via cell cornea
migration, reaarangement and enlargement ofthe residual Pyruvic Acid
cells
 the end product of glycolysis, is converted either to carbon
Substantial cell loss or damage results in irreversible edema
dioxide and water (via TCA cycle under aerobic conditions)
because human corneal endothelial cells have limited ability
or to lactic acid (under anaerobic conditions)
to divide after birth
 Production of lactic acid increases in conditions of oxygen
Infiltration of PMNs in response to severe corneals injury
deprivation, as in the case of tight-fitting contact lenses of low
induces endothelial cells to become fubroblastic and to
oxygen permeability
synthesize retrocorneal fibrous membrance (RCFM)
 Accumulation of lactic acid in cornea has detrimental
 RCFM – forms between the descemet membrane
consequences to vision, such as edema (due to an increase
and the corneal endothelium and causes a
in an osmotic solute load) or stromal acidosis, which can
significant decrease in visual acuity
change endothelial morphology and function
Human corneas possess a remarkably high level of aldehyde
2 primary physiological functions
dehydrogenase and transketolase
1. To act as a major refracting medium
 Contribute to the optical properties of the cornea
2. To protect the intraocular contents
 Protect corneal cells against free radicals and oxidative
 Corneal Removal – exposure of intraocular contents
damage by absorbing UVB irradiation
* It must maintain its transparency and replacement of tissues
C. PHYSIOLOGY OF CRYSTALLINE LENS
Cornea transparency is the result of
LENS
1. Peculiar arrangement of the corneal lamellae
Transparent structure playing main role in the focusing
2. Avascularity – no infection going on
mechanism of vision
3. Relative state of dehydration which is maintained by barrier
focuses incident light onto the sensory elements of the retina
effects of epithelium and endothelium and the active
bicarbonate pump of the endothelium  To do so, the lens must be transparent and must have
an index of refraction higher than that of the surrounding
fluids
Source of Nutrients
Maintenance of transparency
1) Solutes: simple diffusion or active transport thru aqueous
 depends on the precise organization of the cellular
humor
structure of the lens
2) Oxygen: derived from air thru the tear film; provided by the
 must be maintained while the lens changes shape
preocular tear film, eyelid vasculature, and aqueous humor
during accommodation
High refractive index – due to the presence of a high
Epithelium and endothelium are most actively metabolizing layers
concentration of proteins especially of the soluble proteins called
of the cornea
crystallins
Epithelium is 10x thicker than the endothelium – because it is
Considering the lens's mode of growth and the stresses to which
more prone to trauma
the lens is chronically exposed, it is remarkable that in most
Epithelium can metabolize glucose aerobically and anaerobically
people, lenses retain good transparency
into CO2 and H2O and lactic acid respectively
 sixth or seventh decade of life – humans typically do
develop visually significant opacities

ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///

Doc
4 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE
Lens Transparency
Factors that play significant role in maintaining outstanding clarity and
transparency of lens
a) Avascularity
b) Tightly packed nature of lens cells
c) The arrangement of lens proteins
d) Semipermeable character of lens capsule
e) Pump mechanism of lens fiber membrane that regulate the
electrolyte and water balance in the lens, maintaining relative
dehydration
f) Auto-oxidation and high concentration of reduced glutathione in
the lens maintains the lens proteins in a reduced state and
ensures the integrity of the cell membrane pump
 Cataract
– lens not transparent
– Senile etiology: still unknown
– DM etiology: Pump Mechanism
In early stages of embryonic development, the lens is opaque,
but as the vascular suppyly is lost, the lens becomes transparent
Absence of the chromophores that absorb visible light
Presence of highly organized structure that gives minimal light
scatter
Coupling of the epithelial layer, cortex and nucleus allows the
control of ion levels, water content, and pH needed to maintain
lens transparency
Basic Mechanism of Transparency Loss
 Loss of transparency of previously clear fibers
 Formation of opaque fibers
 Fibrous metaplasia
 Epithelial opacification
 Accumulation of pigments
 Formation of deposits of extracellular materials
 Loss of lens transparency results in blurred vision
(without pain) for both near and distance vision
Lens Metabolism
Lens requires continuous supply of energy (ATP) for
 active transport of ions and amino acids
 maintenance of lens dehydration
 for continuous protein synthesis
* Most of the energy produced is utilized in the epithelium of lens which
is major site of all active transport process
* 10-20% of the ATP generated is used in protein synthesis
Energy Production
primarily through anaerobic glycolysis in metabolically active cells
in the anterior lens
 this process is necessitated by the fact that the oxygen
tension in the lens is much lower than that in other tissues,
given that oxygen reaches the avascular lens only via
diffusion from the aqueous humor
most of the glucose entering the lens is phosphorylated to
glucose-6-phosphate by hexokinase, the rate-limiting enzyme of
the glycolytic pathway
most glucose-6-phosphate passes through glycolysis  2
molecules of ATP are formed per original molecule of glucose
small proportion of glucose-6-phosphate  metabolized
through the pentose phosphate pathway (HMP)
 This pathway is activated under conditions of oxidative
stress because it is responsible for replenishing the
supply of NADPH that becomes oxidized through the
increased activity of glutathione reductase under such
conditions
ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///
Doc
Carbohydrate Cataracts
associated with diabetes mellitus and galactosemia
True diabetic cataract
 rapidly developing bilateral "snowflake" cataract that
appears in the lens cortex of patients with poorly controlled
type 1 DM
 people with type 2 DM do not typically develop this type of
cataract but have a higher prevalence of age-related
cataract with a slightly earlier onset
Classic galactosemia
 caused by a deficiency of galactose-1-phosphate
 infants develop bilateral cataracts within a few weeks of
birth unless milk (lactose) is removed from the diet
Cataracts are also associated with a deficiency of galactokinase.
Under certain conditions in which sugar levels are elevated
significantly.
Sources of Nutrient Supply
Avascular, it is dependent for its metabolism on chemical
exchanges with the aqueous humor
All nutrients must be obtained from the surrounding fluids
Pathway of Glucose Metabolism
Glucose is very essential for lens metabolism
Metabolism activity of the lens is largely limited to epithelium and
cortex
80% of glucose is metabolized anaerobically by the glycolytic
pathway, 15% by Pentose Hexose Monophosphate and a small
property via oxidative Kreb’s Citric Acid Cycle
Sorbitol Pathway: important in the production of cataract in DM
and galactosemic patients
Accommodation
 In an emmetropic eye, parallel rays of light away from infinity
are brought to focus on the retina, with accommodation being
at best
o Emmetropic – normal vision; good distance on near
and far
 Eyes have been provided with a mechanism by which we can
even focus the diverging res coming from a near object on
the retina in a bid to see clearly: accommodation
 When the eye is at rest (unaccommodated), the ciliary ring is
large and keeps the zonules tense, and the lens is flat
o Lens is suspended 360o by zonules
 Contraction of the ciliary muscle causes the ciliary ring to
shorten and releases zonular tension of the lens capsule.
The lens then alters its shape to become more convex or
conoidal due to the configuration of the anterior lens capsule
which is thinner at the center and thicker at the periphery.
o Ciliary muscle relaxed, zonules are tensed 
unaccommodation
o Ciliary muscle contracted, zonules are relaxed 
accommodation
D. AQUEOUS HUMOR AND MAINTENANCE OF INTRAOCULAR
PRESSURE (IOP)
Aqueous humor is a clear, watery fluid filling the anterior chamber
(0.25 ml) and posterior chamber (0.06 ml)
It is secreted by the nonpigmented ciliary epithelium (NPE) from a
substrate of blood plasma
Role on IOP maintenance
 IOP – pressure of the eyeball; measured by Goldmann Tonometry
5 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE

Important metabolic role by providing substrates and removing that exit through the Schlemm canal, can be
metabolites from the avascular cornea and transparent lens carefully controlled
Because the aqueous humor is devoid of blood cells and of more  pertuberations of these barriers  mixing of blood
than 99% of the plasma proteins, it provides an optically clear and ocular fluids  plasmoid aqueous, retinal
medium for the transmission of light along the visual path. exudates, retinal edema

Physiology Process
 Production
 Drainage
 Maintenance of IOP
Production: Ciliary body
Functions: The formation of aqueous is largely a product of active
1. It maintains a proper IOP secretion by the inner NPE and involves membrane-
2. It plays important metabolic role by providing substrates(eg, associated Na+,K+ -ATPase.
glucose, amino acids) and by removing metabolites (eg,  CA (carbonic anhydrase) II is present in both
lactic acid, pyruvic acid) from the avascular cornea and lens pigmented epithelium (PE) and NPE. Its inhibitors
3. It maintains optical clarity – aqueous humor is essentially reduce the rate of entry of sodium and bicarbonate
protein-free into the aqueous  reduction in aqueous flow.
4. It takes the place of lymph that is absent in the eyeball  Carbonic anhydrase inhibitors and beta-blockers
are used systemically and topically in the treatment
Composition: of glaucoma to reduce the rate of aqueous humor
 Water: 99.9% formation
 Solids: 0.1% The aqueous humor is secreted by the ciliary epithelium at a
 Proteins flow rate of 2-3 f.LL/min.
 Amino acids The ciliary epithelium is a bilayer of polarized epithelial cells
 Non-colloidal contents: glucose, urea, lactic acid, lining the surface of the ciliary body
ascorbate, etc.  NPE (Non-pigmented epithelium)
 *oxygen  faces the aqueous humor through the
cells' basal plasma membrane
 establish the blood-aqueous barrier by
the presence of tight junctions proximal
to the apical plasma membrane 
preventing the free passage of plasma
proteins and other macromolecules from
the stroma into the posterior chamber.
The aqueous humor composition is in dynamic equilibrium,  PE (Pigmented Epithelium)
determined both by its rate of production and outflow and by  faces the stroma, also through the cells'
continuous exchanges with the tissues of the anterior segment basal plasma membrane.
The aqueous contains the following  Considered a leaky epithelium  it
1. Inorganic ions and organic anions: allows solutes to move through the
Inorganic ions - sodium, potassium, magnesium intercellular space between the PE cells.
Organic anions – lactate and ascorbic acid
2. Carbohydrates: glucoe and inositol Mechanism of Production
People with diabetes mellitus have increased
1. Ultrafiltration: plasma substances pass out from the capillary
glucose levels in aqueous  higher concentrations
wall – passive mechanism
in the lens and short-term refractive and longer-
2. Secretion: active transport
term cataract implications
3. Diffusion: passive mechanism
3. Glutathione and urea
4. Proteins: albumin and transferrin  involves the movement of ions such as sodium
5. Growth-modulatory factors: play substantial role in across a membrane toward the side with the most
modulating the proliferation, differentiation, functional viability negative potential
and wound healing of ocular tissues
6. Oxygen and carbon dioxide: the corneal endothelium Control of Aqueous Humor Production
depends critically on the aqueous oxygen supply for the  The diurnal variation in IOP certainly indicates that same
active-fluid transport mechanism that maintains corneal endogenous factors influence the aqueous humor formation
transparency  Ultrafiltration and diffusion are dependent on the level of
blood pressure in the ciliary capillaries, the plasma osmotic
Barriers pressure and the level of IOP
Blood-aqueous or blood-retina (depending on their location in
the eye) Drainage:
 the composition and amounts of all materials  Aqueous humor flows from the posterior chamber into the
entering and leaving the eye, except for materials anterior chamber through the pupil (pupillary aperture)
 From anterior chamber, it is drained out by 2 routes:

ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///

Doc
6 of 7
OPHTHA 32: PHYSIOLOGY AND BIOCHEM OF THE EYE

1. Trabecular (conventional) outflow: 90%

 Free flow occurs from trabecular
meshwork to schelmm’s canal
2. Uveoscleral (unconventional) outflow: 10%
 Passes across the ciliary body into the
subarachnoidal space and drained by the
venous circulation in the ciliary body,
choroid and sclera.

Clinical Implications of Breakdown of the Blood-Aqueous Barrier

With compromise of the blood-aqueous barrier in conditions such as
ocular insult (trauma or intraocular surgery), as well as uveitis and
other inflammatory disorders, the protein content of aqueous humor
may increase 10-100 times, especially in the highmolecular- weight
polypeptides. The levels of inflammatory mediators, immunoglobulins,
fibrin, and proteases rise, and the balance among the various growth
factors is disrupted
 The clinical sequelae include:
fibrinous exudate and clot (with or without a
macrophage reaction and formation of cyclitic
membranes)
synechiae formation (peripheral and posterior), as well
as an abnormal neovascular response, which further
exacerbates breakdown of the barrier.
Chronic disruption of the blood-aqueous barrier is
implicated in the abnormal hyperplastic response of the
lens epithelium, corneal endothelium, trabecular
meshwork, and iris, and in the formation of complicated
cataracts.
Degenerative and proliferative changes may occur in
various ocular structures as well.
The use of anti-inflammatory steroidal and nonsteroidal
drugs, cycloplegics, protease activators or inhibitors,
growth factor and anti-growth factor agents, and even
surgical intervention may be necessary to combat these
events.

Test Your Memory . . .

1. Layers of tear film and the glands that produced (6 pts)
2. Corneal transparency is the result of (2 pts)
3. Functions of Aqueous humor (2 pts)

ζeta Sorority Powerpoint///Fundamentals of Ophtha///Others///

Doc
7 of 7