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    324 views894 pages

    ADLER - Fisiología Del Ojo Aplicación Clínica PDF

    Uploaded by

    begita

    Copyright:

    © All Rights Reserved
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    ADLER FISIOLOGIA DEL OJO Aplicacién clinica Editado por Paul L. Kaufman, MD Professor and Director of Glaucoma Ser Department of Ophthalmology University of Wisconsin-Madison School of Medicine Hospital and Clinics Madison, Wisconsin Estados Unidos Albert Alm, MD, PhD Professor Department of Neuroscience, Ophthalmology University Hospital Upsala, Suecia ELSEVIER Madrid - Bareslona - Amsterdam - Boston -Filadetfia. Londres = Orlando - Sydney - Tokio = Toronto Es una publicacién ‘Versign en espafil de la 10, edicién de la obra original en inglés ‘Adler's Physiology of the Eye Copyright © MMI, Mosby, Inc, an Elsevier Imprint Revisores: ‘Marfa Jess Méndez Ramos Dra, en Medicina y Cirugia por la Universidad Auténoma de Maca Expecialisa en Oftalmologia Miguel Angel Calvo Arrabal Lie, en Medicina y Ciruata por la Universidad Complutense de Madi Especialista en Oftalmologia (© 2004 Eaicin en espaol Elsevier Espana, S.A. Génova, 17-32 28004 Madrid, Espana. An Elsevier Imprint Fotocopiar es un delito. (Art. 270 C. P.) Para que existan libros es necesario el trabajo de un importante colectivo (autores, traductores, dibujantes, corectore, impresotes,editores...) El principal benefciario de ese esfuerzo es el lector que aprovecha su contenido. (Quien fotocopia un libro, en las circunstancias previstas por la ley, delingue y ‘eoniribuye a la «no» existencia de nuevas ediciones. Ademis, a corto plazo, cencarsce el precio de las ya existntes, Este libro est legalmente protegido por los derechos de propiedad intelectual. ‘Cualquier uso, fuera de los Iimites establecidos por la lepislacién vigente, sin el ‘consentimiento del editor es ilegal, Esto se aplica en particular a la reproduecisn, foracopia, raduccién, grabacién o cualquier oto sistema de recuperacién de almacenaje de informacién, ‘Traduccidn y produccién editorial: Diorki Servicios Integrates de Edicién, ISBN edicion original: 0-323-01136-5 ISBN edicisn espatiola: 84-8174-705-X epésito legal: B-33.122-2003, Impreso en Espafia por Grafos, $.A. Arte sobre papel —~- COLABORADORES Albert Alm, MD, PhD Professor Department of Neuroscience, Ophthalmology University Hospital Uppsala, Sweden, Francisco H. Andrade, PhD Department of Neurology Case Western Reserve University Cleveland, Ohio USA Sten Andreasson, MD, PhD Department of Ophthalmology University Hospital of Lund Lund, Sweden Robert S. Baker, MD Robert Bergen Professor of Ophthalmology Professor of Pediatrics, Neurology, and Neuro- surgery University of Kentucky Lexington, Kentucky USA David C. Beebe, PhD Jules and Doris Stein RPB Professor of Ophthalmology and Visual Sciences Professor of Cell Biology and Physiology ‘Washington University School of Medi St. Louis, Missouri USA David A.R. Bessant, FRCoOphth Clinical Research Fellow Department of Molecular Geneties Institute of Ophthalmology University College London Moorfields Eye Hospital London, England Shomi S. Bhattacharya, MD Department of Molecular Genetics Institute of Ophthalmology University College London Moorfields Eye Hospital London, England David G. Birch, PhD Research Director Retina Foundation of the Southwest Adjunct Professor Department of Ophthalmology University of Texas Southwestern Medical Center Dallas, Texas Usa Jamie D. Boyd, PhD Post-Doctoral Fellow Department of Biological Sciences Simon Fraser University Burnaby, British Columbia Canada Vivien A. Casagrande, PhD Professor Department of Cell Biology, Psychology, and Ophthalmology and Visual Sciences ‘Vanderbilt University Medical School Nashville, Tennessee USA George A. Cioffi, MD Director, Glaucoma Service Department of Ophthalmology Devers Eye Institute Chairman Department of Ophthalmology Legacy Health System Portland, Oregon USA Briggs E. Cook, Jr, MD Charlotte Ophthalmology Clinic Charlotte, North Carolina USA Darlene A. Dartt, PhD Acting Director of Research Senior Scientist Schepens Eye Research Institute Associate Professor Department of Ophthalmology Harvard Medical School Boston, Massachusetts USA Henry F.Edelhauser, PhD Professor of Ophthalmology Director of Ophthalmic Research Department of Ophthalmology Emory University Eye Center Atlanta, Georgia USA Berndt E,J. Ehinger, MD, PhD Professor Department of Ophthalmology University of Lund Hospital Lund, Sweden B’Ann True Gabelt, MS Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine Hospital and Clinics Madison, Wisconsin USA Roberta E. Gausas, MD University of Pennsylvania Scheie Eye Institute 51 North 39th Street Philadelphia, Pennsylvania USA Adrian Glasser, PhD Assistant Professor College of Optometry University of Houston Houston, Texas USA ‘COLABORADORES Elisabet Granstam, MD Department of Neuroscience, Ophthalmology University Hospital Uppsala, Sweden Qiang Gu, PhD Assistant Professor Department of Ophthalmology University of British Columbia Investigator Brain Research Center ‘Vancouver Hospital and Health Sciences Center Vancouver, British Columbia Canada Ronald S. Harwerth, OD, PhD John and Rebecea Moores Professor of Optometry College of Optometry University of Houston Houston, Texas USA Jennifer M. Ichida Department of Psychology ‘Vanderbilt University Nashville, Tennessee USA Chris A. Johnson, PhD Director of Diagnostic Research and Senior Scientist Department of Ophthalmology Discoveries in Sight Research Laboratories Devers Eye Institute Portland, Oregon USA Randy Kardon, MD, PhD Associate Professor Director of Neuro-Ophthalmology Department of Ophthalmology and Visual Sciences University of lowa Hospitals & Clinics owa City, Lowe USA Paul L. Kaufman, MD Professor and Director of Glaucoma Services Department of Ophthalmology and Visual Sciences. University of Wisconsin-Madison School of Medicine Hospital and Clinics ‘Madison, Wisconsin USA CoLanorapones vil Shalesh Kaushal, MD, PhD Assistant Professor Department of Ophthalmology University of Minnesota Medical School ‘Minneapolis, Minnesota USA Don 0. Kikkawa, MD Chief of Ophthalmic Plastic and Reconstructive Surgery Associate Professor Department of Ophthalmology University of California, San Diego School of Medicine La Jolla, California USA Morten la Cour, MD Consultant Eye Department National University Hospital, Rigshospitalet Copenhagen, Denmark Bradley N. Lemke, MD Clinical Professor of Ophthalmic Facial Plastic Surgery Department of Ophthalmology and Visual Sci- University of Wisconsin-Madison School of Medicine Hospital and Clinics Madison, Wisconsin USA Leonard A. Levin, MD, PhD Associate Professor Department of Ophthalmology and Visual Sciences University of Wisconsin-Madison School of Medicine Hospital and Clinics Madison, Wisconsin USA Mark J. Lucarelli, MD Associate Professor Director, Oculoplastics Service Department of Ophthalmology ‘and Visual Sciences, University of Wiscon School of Medicine Hospital and Clinics Madison, Wisconsin USA Madison Henrik Lund-Andersen, MD Professor Department of Ophthalmology Herlev University Hospital Herlew, Denmark, Ruth E, Manny, OD, PhD Professor College of Optometry University of Houston Houston, Texas usa Joanne A. Matsubara, PhD Director of Research, Basic Sciences Department of Ophthalmology ‘The University of British Columbia ‘Vancouver, British Columbia Canada Allison M. McKendrick, PhD Department of Psychology University of Western Australia Crawley, Australia David Mille, MD Associate Clinical Professor of Ophthalmology Department of Ophthalmology Harvard Medical School Massachusetts Eye and Ear Infirmary Boston, Massachusetts USA Anthony M. Norcia, PhD Smith-Kettlewell Eye Research Institute San Francisco, California USA Lance M. Optican, PhD Research Biomedical Engineer Laboratory of Sensorimotor Research National Eye Institute Bethesda, Maryland USA Serge Picaud, PhD Directeur de Recherche INSERM Physiopathologie Cellulaire ¢ Moleculaire de la Retine INSERM EM-igg-18 Strasbourg, France ‘Vesna Ponjavie, MD, PhD Associate Professor Department of Ophthalmology University of Lund University Clinic of Lund Lund, Sweden John D. Porter, PhD ‘The Carl B.Asseff Professor Department of Ophthalmology Case Western Reserve University Scientist The Research Institute University Hospitals of Cleveland Cleveland, Ohio USA Christian Quaia, PhD Post-Doctoral Fellow Laboratory of Sensorimotor Research National Eye Institute Bethesda, Maryland USA David Regan, PhD, DSc Industrial Research Professor in Vision and Aviation Department of Psychology and Biology York University Professor Department of Ophthalmology University of Toronto Ontario, Canada ‘Thomas P. Sakmar, MD Acting President The Rockefeller University Senior Physician ‘The Rockefeller University Hospital ‘New York, New York USA Pamela A. Sample, PhD Professor/Director Visual Function Laboratory Glaucoma Center Department of Ophthalmology University of California, San Diego La Jolla, California USA Cotasorapores Birgit Sander, PhD Department of Ophthalmology Herlev Hospital University of Copenhagen Copenhagen, Denmark Clifton M. Schor, OD, PhD Professor of Optometry, Vision Science ‘and Bioengineering Department of Optometry School of Optometry University of California at Berkeley Berkeley, California USA Rajesh K. Sharma, MD Department of Ophthalmology University of Lund Hospital Lund, Sweden Joseph P. Shovlin, MD Associate in Ophthalmology Department of Ophthalmology Geisinger Medical Center Danville, Pennsylvania Associate in Ophthalmology Department of Surgery Princeton Medical Center Princeton, New Jersey USA Bryan S. Sires, MD, PhD Associate Professor and Vice Chairman Department of Ophthalmology University of Washington Seattle, Washington, USA Rebecca C. Stacy Department of Anatomy and Neurobiology ‘Washington University School of Medicine St.Louis, Missouri USA John L, Ubels, PhD Department of Biology Calvin College Grand Rapids, Michigan Adjunct Professor Department of Ophthalmology ‘Wayne State University School of Medicine Detroit, Michigan USA Gerald Westheimer, PhD Professor of Neurobiology University of California Berkeley, California USA Rachel O. Wong, PhD Associate Professor Department of Anatomy and Neurobiology ‘Washington University School of Medicine St. Louis, Missouri USA CoLasonapones ix Samuel M. Wu, PhD Professor Department of Ophthalmology Callen Eye Institute Baylor College of Medicine Houston, Texas USA ~ vesicula dptica. Las partes interna y externa de las condensaciones mesenquimatosas frontonasales se unen de manera laxa para formar el pliegue superior del parpado; las condensaciones mesenquimatosas maxilares forman clpliegue del parpado inferior El ectodermo superfi- ial cubre ambos lados de los pliegues del parpado para formar a piel en su superficie externa y la con- juntiva en la interna. a separacién de los parpados es completa a los 7- 8 meses de gestacién, Las células musculares proce- den del mesodermo del segundo arco visceral que 10- dea el ojo. La continuidad de este desarrollo muscular facial a partir del mesodermo comiin es evidente en Ia estructura y la funcién de la cara (comentado més adelante en este capitulo) CEJAS Y FRENTE, Las pestafas de los pérpados y ls cejas tienen una fun ion protectora. Las primeras son distintas de los finos pelos de lanugo,residuos del desarrollo embrionario; forman la barrera mas exterior de la superficie ocular Y son titles para proteger el globo ocular de las parti- ‘alas grandes en suspensién en el are. Las pestafias del borde del parpado son muy sensibles y tras estimula- " se ha confirmado la exstencia de un bombeo con pre- siones positivas en los canaliculos durante el cierre pal- pebral. Sin embargo, en otros muchos estudios de investigacién se ha puesto en duda la hipotesis del ‘mecanismo de generacién de presiones negativas en lsaco lagrimal tras el cierre del parpado!™="*, Ro- sengren* intubs el saco lagrimal através del conduc- to nasolagrimal para determinar las presiones en su interior. Este investigador observ un ineremento en la presién del saco al cerrar el pérpado y una dismi- nucién de la misma al abritlo. Asimismo, Maurice y Ploman, Engel y Knutsson* determinaron la presio- nes en el interior del saco a través del sistema cana- Ticular, observando la existencia ce una presidn posi- tiva tras el cierre del parpado. Doane! uiliz6 una técnica fotogrética de alta veloc dad para evaluar el efecto del parpadeo sobre el drenaje lagrimal. Los movimientos del liquido lagrimal se vi- sualizaron mediante la aplicacion de particulas de car- bbon en la pelicula lagrimal. Doane hizo hincapié en la compresion de los canaliculos y del saco lagrimal du- rante el cierte palpebral, Fsteinvestgador senalo que durante el cierre de los parpados se produce un incre- mento de a pesion en los canaliculos y,en menor me- lida, en el sico nasolagrimal. En el modelo de Doane (fig. 3-11), en el sacolagrimal se prodace un mecanis- ‘mo de sifén durante la relajacin del parpadeo y no du- ‘ante el cierre del parpadi, como habia sugerido Jones. Laexistencia de un drenaje lagrimal adecuado tras la dacriocistorrinostomia indica que el bombeo con presién positiva de las ligrimas a lo largo de los ca- naliculos es més importante que la presién negativa enel interior del saco. El péoblema del lagrimeo cons- tante en los pacientes con pardlisis facial subraya la importante contribucién del mtsculo orbicular al flujo de ligrimas. De hecho, se ha demostrado que la pariliss temporal dela parte interna del misculo or- bicular producida por aplicacién de toxina botuli ca reduce el flujo lagrimal, lo que se ha indicado como posible tratamiento complementario en las en- fermedades que cursan con ojo seco”. Rosengren ha determinado un volumen de ligri- ‘mas drenado en cada parpadeo de 1,8 ml y Sahlin y Chen de alrededor de 2,0 ml, Dado que un tinico movimiento de parpadeo puede transportar un volu- men de légrimas mayor que el que tiene lugar me- diante secrecién basica de 1 minuto™, el sistema ex-

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