VISION

Protects eyeballs from foreign object. o Lacrimal Apparatus o Group of structures that produces and drains lacrimal fluid or tears. o Lacrimal Glands Produces 1mL lacrimal fluid/ day Shape and size of an almond Secrete lacrimal fluid. o Excretory lacrimal ducts Empty tears on the surface of the conjunctiva of the upper eyelid. o Lacrimal punctum Two small openings where tears enter after

ANATOMY Eyelids o Palpebrae o Upper eyelid, more movable than the lower eyelid. o Palpebral fissure Space between upper and lower eyelids. Exposes eyeball. o Lacrimal Caruncle 1. Reddish elevation at the medial commissure. 2. Has sebaceous and sudoriferous glands. o Commissures 1. Medial commissure Broader. Near nasal bone. 2. Lateral commissure Narrower. Closer to temporal bone. o Conjunctiva Thin, protective mucous membrane. 2 divisions: Bulbar Conjunctiva Anterior surface of eyeball. o SORE EYES - Dilation and congestion of blood vessesl on this area. Palpebral Conjunctiva Inner aspect of eyelids. o Tarsal Plate Fold of connective tissue. Gives form and support to the eyelids. Embeded in it: Tarsal or Meibomian Glands Modified sebaceous gland Keeps eyelids from adhering to each other - CHALAZION - infection of the tarsal gland o Eyelashes and Eyebrows o Sebaceous ciliary glands (Glands of Zeis) Release fluid at the base of the hair follicles. STYE - infection on this gland. o Eyelashes Project from border of the eyelid. o Eyebrows Arch transversely above upper eyelid.

passing medially over the anterior surface of the eyeball o Lacrimal canals Two ducts that leads to the lacrimal sac o Nasolacrimal duct Duct that carries lacrimal fluid into the nasal cavity o Lacrimation Lacrimal glands over secrete tears if there is irritant present Protective mechanism Tears dilute and wash away irritating substance Tears contains lysozyme(protective bactericidal enzyme), salts and some mucus. Lubricates ,protects and moistens the eyeball. *Colds, obstruction of nasolacrimal ductsand bloacks

drainage of tears. *Crying, response to parasympathetic stimulation. Lacrimal gland produces excessive lacrimal fluid that spill over the edges of the eyelids and fill nasal cavity with fluid (runny nose).

EXTERIOR OF THE EYEBALL Eyeball o 2.5 cm in diameter, anterior 1/6 is exposed o Composed of 3 Layers: 1. Fibrous Tunic Superficial coat of eyeball. Avascular. Anterior cornea Transparent coat, covers colored iris. Focus light onto the retina. Outer surface: nonkeratinized startified

squamous epithlium.

 Middle

surface:

collagen

fibers

and

Parasympympathetic,

bright

fibroblasts. Inner surface: simple squamous epithelium. Scler-= hard. White of the eye. Layer of dense CT (collagen fibers and fibroblasts) Covers entire eyeball except cornea. Give shapes and rigidity to eyeball. Protects inner part. Scleral Venous Sinus Canal of Schlemm - Where aqueous humor drains. 2. Vascular Tunic Uvea Middle layer of the eyeball Has 3 parts: Choroid Posterior portion of vascular tunic. Lines internal surface of sclera. Provides nutrients to the surface of sclera. Anterior: ciliary body. Extends to ora serrata, jagged anterior margin of retina. Ciliary Body A. Cilliary processes Protrusions on the internal surface of the retina. Contains blood capillariessecretes Neural Layer 3. Retina Posterior sclera Pupil

light, iris contract decrease pupil size Hole at the center of Iris. Autonomic reflexes regulate pupil

diameter in response to light levels. Inner and 3 coat of eyeball. Lines posterior of eyeball. Beginning of visual pathway. Optic disc- where optic nerve, central retinal artery and vein exits. Blind spot (no rods or cones). Cosnsists of: - Pigmented layer Sheet of melanin-containing epithelial cells. Melaninlight. Prevent scattering eyeball Location between choroid and neural part of retina. Other cell types: horizontal and amacrine cells. Outgrowth of brain that processes visual data. 3 layers: separated by outer and inner synaptic layer Bipolar cell layer Ganglion cell layer Photoreceptor layer Rods: low light threshold, no color vision Cones: Macula Lutea At the exact center of the posterior portion of retina. Central fovea Small depression at the center of higher threshold, reflection of light and w/in absorbs stray
rd

aqueous humor. Where zonular fibers extends. B. Ciliary muscle Circular band of smooth muscle that alters shape of lens. For adaptation to near and far vision. Iris Colored portion of eyeball. Suspended between cornea and lens. Consists of smooth muscles: - Radial (dilator pupillae) Sympathetic, dim light, iris contract, increase in pupil size - Circular (sphincter pupillae)

produce color vision

macula lutea. Contains only cones. Has the highest visual acuity or resolution.

 Lens o Behind pupil and iris. o Crystallins - make up the lens. o Transparent and lacks blood vessels. o Focus images of retina for clear vision. INTERIOR OF THE EYEBALL Divided in 2 cavities by the lens o Anterior cavity Filled with aqueous humor watery fluid that nourishes lens and cornea. Produce intraocular pressure (16mmhg)-

1-3 new discs are added to the base of outer segment every hour. Cones: Tapered/Cone-shaped. Old discs go at the tip and phagocytized by pigment epithelial cells. o Inner segments Cell nucleus, golgi complex and many

mitochondria. o Proximal end Expands into bulblike synaptic terminals. CONES Center (Macula) Bright Iodopsin 1 ganglion : 1 Form and color (Photopic) RODS Periphery Dim Rhodopsin 2 ganglion : 4 Intensity/Movement (Scotopic) Visual acuity and color Visual firlds, light and dark adaptatiom

maintains shape of eyeball and prevents it from collapsing. Drains at the canal of schlemm and are being replaced. Posterior chamber Behind iris, in front of zonular fibers and lens. Anterior chamber Between cornea and iris. o Vitreous membrane Lies between lens and retina. Has vitreous body. Jelly-like substance , contributes to intraocular pressure. Vitreal floaters Collection of debris, can cast shadow to retina. Harmless, common to old individuals. Hyaloid canal Narrow channel runs through vitreous

perception Photopigments

o Integral colored proteins in the plasma membrane. o Absorption of light leads to chemical changes. o Two parts of photopigments: Opsin Glycoprotein. Different amino acid sequence, different colors are absorbed. Retinal Light-absorbing part. Vitamin A derivative (from carotenoids). o Rods: Rhodopsin Absorbs blue to green light. Pleates pinch off from plasma membrane forming discs. o Cones: 3 different cone photopigments. Absorbs blue, green, yellow orange Blue/Short wavelength (S) Green/Medium wavelength (M) Red/Long wavelength (L)

body from the optic disk to the posterior of the lens. Holds retina flush against choroid For even surface of reception of ear images. Does not undergo constant replacement.

PHOTORECEPTORS AND COLOR BLINDESS Photoreceptors o Outer segments Transduction of light energy into a receptor potential occurs here. They are easily replaced. Rods: Cylindrical/Rod-shaped.

 Plasma membrane folds back and forth in a pleated fashion. Photopigments Visual Transduction o Isomerization Retinal is in bent shape (cis-retinal) fitted to opsin. When it absorbs light, retinal straightens (transretinal). Isomerization is the transformation from cis-totrans retinal. Chemical stability is affected. Leads to receptor potential. o Bleaching Occurs for about a minute. Trans-retinal separates from opsin. Final colorless product. o After bleaching Rods: Half of them regenerate in 5 minutes. Cones: Half of them regenerate in 90 seconds. o Enzyme retinal isomerase An enzyme converting the trans retinal to cis retinal again. o Regeneration Cis retinal back to opsin to form a functional photopigment. In rods, Pigmented layer adjacent to photoreceptors has high quantity of Vitamin A. Regeneration of rods. If retina detaches from pigmented layer, regeneration of rhodopsin is low. In cones, Photopigments regenerate more quickly. Less dependent on pigmented layer. Light and Dark Adaptation o From darks surroundings, light adaptation Visual system adjusts into bright surroundings. Visual system decreases sensitivity. o Into a darkened room, dark adaptation Visual system increases sensitivity over minutes. o When light level increases More photopigments are bleached. In daylight, regeneration of rhodopsin cannot keep up with the bleaching process.

Rods: Contribute little to daylight. Cones: Regenerate rapidly. Cis retinal always present o When light level decreases Increased sensitivity and then more slowly. In complete darkness A threshold, light flash is seen as having a color. Rhodopsin regenerates more slowly,

increasing the visual sensitivity. Even a single photon can be detected. At low light levels, only rods are functioning. Release of Neurotransmitters by Photoreceptors o Photoreceptor in the absence of light Na inflow (dark current) into photoreceptor outer segment. Ligand-gated Na channels. Guanosine monophosphate (cGMP). o Inflow partially depolarizes the photoreceptor. Membrane potential: -30 mV Triggers release of NT at synaptic terminals NT in rods and cones: Amino Acid Glutamate (Glutamic Acid) o Glutamate Between rods and bipolar cells at synaptic terminals. Inhibitory NT Inhibits postsynaptic potentials. Hyperpolarizes bipolar cells. o Photoreceptor in the presence of light Cis retinal goes isomerization. Enzymes are activated leading to breakdown of cGMP. Some closes. Na inflow decreases. Membrane potential: -70 mV Hyperpolarize receptor potential Decrease in release of NT o Dim Lights Cause small and brief receptor potentials. Partial shutdown of some NT release. o Brighter lights Elicit larger and longer receptor potentials. cGMP ligand-gated Na channels

 Complete shutdown of NT release. Color Blindness o Inability to distinguish between certain colors. o Absence or deficiency of one of three cone

Visual Pathway Process RETINA o Receptor potentials arise in rods and cones o Spread through the inner segments to the synaptic terminals. o Neurotransmitter molecules (glutamate) are released. o Neurotransmitters induce local graded local potentials in bipolar cells and horizontal cells. 6 and 600 rods synapse with bipolar cells. Increases the light sensitivity of rod vision but slightly blurs the image perceived. Stimulation of rods by light excites their bipolar cells. Cone more often synapses with just one bipolar cell. Less light sensitivity but has higher acuity due to one-to-one synapses between cones and their bipolar cells. Stimulation of rods by light may either excite or inhibit cone bipolar cells. o Horizontal cells transmit inhibitory signals to bipolar cells in the areas lateral to excited rods and cones. Enhances contrasts in the visual scene between areas of the retina that are strongly stimulated and adjacent areas that are more weakly stimulated. Assist in the differentiation of various colors. o Amacrine cells are excited by bipolar cells, synapse with ganglion cells and transmit information to them. Signals a change in the level of illumination of the retina. o Ganglion cells become depolarized and initiate nerve impulses. OPTIC NERVE o Axons within the optic nerve pass through the optic chiasm. Crossing point of the optic nerves. o Medial half of the axons cross the opposite side and the lateral half of the axons remained uncrossed. o After passing to the optic chiasm, the axons, now part of the optic tract, enter the brain and terminate in the lateral geniculate nucleus in thalamus. THALAMUS o The axons synapse with neurons whose axons form the optic radiations, which project to the primary visual area in the occipital lobes of the cerebral cortex.

photopigments. o Red-green color blindness Most common. Photopigment sensitive to orange-red/ green light is missing. Person cannot distinguish between red and green. o Vitamin A deficiency and consequent below normal amount of rhodopsin o Night blindness/ Nyctalopia. Inability to see well at low light levels. o Deuteranopia Absence of green cones. o Protanopia Absence of red cones. o Tritanopia Absence of blue cones.

VISUAL PATHWAY AND VISUAL FIELDS Neuronal cell types: o Photoreceptors (rods and cones) transmit signals to the outer plexiform layer, where they synapse with bipolar cells and horizontal cells. o Horizontal cells transmit signals horizontally in the outer plexiform layer from the rods and cones to bipolar cells. o Amacrine cells transmit signals in two directions, either directly from bipolar cells to ganglion cells or horizontally from axons of bipolar cells to dendrites of the ganglion cells or to other amacrine cells. o Ganglion cells transmit output signals from the retina through the optic nerve into the brain. o Interproximal cell Transmits signals in the retrograde direction from the inner plexiform layer to the outer plexiform layer. The signals are inhibitory and control lateral spread of visual signlas Help control the degree of contrast in the viual image.

CORTEX o Large number of optic fibers project to the lateral geniculate nucleus of the thalamus, where information from the different ganglion cell types is kept distinct. o Receive input from the brainstem reticular formation and input relayed back from the visual cortex. Control the transmission of information from the retinal to the visual cortex. Involved in our ability to shift attention between vision and the other sensory modalities o Lateral geniculate nucleus sends action potentials to the visual cortex. Processed simultaneously in a number of

o Both surfaces of the lens of the eye further refract the light rays so they come into exact focus on the retina. 25% of focusing power (changes the focus to view near or distant objects) o Image is focused on the retina: upside down and undergo right to left reversal. o Focusing power of the lens: Object is 6 meters (20 feet) or more: light reflected from the object are nearly parallel to one another. The rays must be bent enough to be focused on the retina. Object is closer than 6 meters (20 feet): light rays reflected from the object are divergent. The rays must be refracted more to be focused on the retina. 2. Accommodation o When the eye is focusing on a close object, the lens becomes more curved and refracts the light more. The lens of the eye is convex on both its anterior and posterior surfaces. Increase curvature of lens (for near vision) = Increase focusing power o Near point vision: minimum distance from the eye that an object can be clearly focused with maximum accommodation. Contraction of ciliary muscle

independent ways in different parts of the cerebral cortex. Reintegrated to produce the conscious sensation of sight and the perceptions associated with it. Constriction of pupil. Suprachiasmatic nucleus: establishes pattern of sleep and other activities in response to intervals of light and darkness. Brainstem and cerebellum: coordination of head and eye movements. o Cells are organized to handle information about line, contrast, movement, and color. Form a spatial and temporal pattern of electrical activity. Visual Field o Visual area seen by an eye at a given instant. o Nasal field of vision - area seen to the nasal side. Light rays fall on the temporal half of the retina. o Temporal field of vision - the area seen to the lateral side. Light rays fall on the nasal half of the retina. o Extend farthest on the temporal sides o Limited by: Superiorly Brows Inferiorly Cheeks Medially Nose IMAGE FORMATION 1. Refraction o As light rays enter the eye, they are refracted at the anterior and posterior surfaces of the cornea. 75% of the total refraction of light

Relaxation of zonular fibers Relaxation of lens (becoming more spherical) Near objects brought into focus 3. Constriction o Narrowing of the diameter of the pupil through which light enters. Contraction of the circular muscles of iris to constrict the pupil. o Occurs simultaneously with accommodation. o Prevents light rays from entering the eye through the periphery of the lens.

VISUAL ACUITY AND PUPILARY REACTION TO LIGHT Visual Acuity o Measure of the eyes ability to distinguish object details and shape at a given distance. o Normal Vision Occurs when light is focused directly on the retina rather than in front or behind it. o Far Vision Typically measured at twenty feet. Rays of light from a distant object are practically parallel. Little accommodation is required. o Snellen Chart Numerator: the distance the patient is from the chart Denominator: the distance at which an normal eye could see the optotype on the chart. Visual Acuity Eg. 20/50 A patient sees at twenty feet what the patient with no refractive error or ocular pathology would see at fifty feet. 20/20 visual acuity- normal visual acuity denominator value, the better the acuity; denominator value, the poorer the acuity. 20/40 vision in at least one eye is the vision required to pass the driving test 20/200- legally blind o Hyperopia The eyeball is short relative to the focusing power of the lens and cornea. Timid or lazy lens. Corrected by using eye glasses with convex lens. o Myopia The eyeball is too long relative to the refractive power of the lens and cornea. Enthusiastic lens. Corrected by using eye glasses with concave lens. o Presbyopia Lens loses elasticity and thus its ability to accommodate. Therefore, older people cannot read print at the same close range as can youngsters. Usually begins in the mid-forties. Age 40: 20 cm (8 in) Age 60: 80 cm (31 in)

Pupillary Light Reflex o A reflex that controls the diameter of the pupil, in response to the intensity of light that falls on the retina of the eye. o When light is shown into the eyes, the pupils constrict. o light intensity= intensity of signals transmitted by the bipolar, horizontal, amacrine, and ganglion cells (neural adaptation). o Mechanism of Pupillary light reflex: Optic nerve/ CN II- responsible for the afferent limb of the reflex. It senses the incoming light. Oculomotor nerve- responsible for efferent limb of pupillary reflex. It drives the muscles to constrict. Its pathway begins with retinal ganglion cells, which convey information from photoreceptors to the optic nerve. OCULAR MOVEMENTS Innervated by CN III, IV, VI o Superior Rectus Elevation, adduction and medial rotation of the eyeball o Inferior Rectus elevation, adduction and lateral rotation of the eyeball o Lateral Rectus Abduction of eyeball o Medial Rectus Adduction of eyeball o Superior Oblique Depression, abduction and medial rotation of eyeball o Inferior Oblique ELevation, abduction and lateral rotation of eyeball.

DISORDERS OF THE EYE CATARACT o Clouding of the eye's natural lens. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud area of the lens. o Most common cause of vision loss in people over age 40.

o Principal cause of blindness in the world. Signs and Symptoms o Vision is blurred a little. Note on 1
st

shadowy areas in your central vision or unusually fuzzy or distorted vision. o Slow, painless loss of vision rare case, however, vision loss can be sudden Causes o Hereditary disorders o Infections o Trauma o Tumor o Advancing age o Smoking o High blood pressure o Obesity o Lighter eye color Like in the skin (melanin) Prevention o Diet with high levels of: Antioxidants Omega-3 fatty acids Lutein (eggs, spinach, turnips) o Amsler grid straight lines, with a reference dot in the center Treatment o No satisfactory medical treatment o Optical aids (i.e. glasses) GLAUCOMA o Silent thief of sight Typically cause no pain and produce no symptoms until noticeable vision loss occurs o Excessive pressure build-up in the aqueous humor Producing too much fluid, or it's not draining properly o Results from an interference with normal re-entry of aqueous humor into the blood or from an

bullet. like looking through a cloudy

piece of glass or viewing an impressionist painting o May make light from the sun or a lamp seem too bright or glaring o The oncoming headlights cause more glare than before o Colors may not appear as bright as they once did *A cataract starts out small and at first has little effect on your vision Causes o Advancing of age o Infection o Trauma o Ultraviolet radiation o Diabetes o Smoking o Heavy alcohol consumption Prevention o Regular eye check-up o Wearing of sunglasses o diet high in antioxidants Beta-carotene (vitamin A) Selenium Vitamins C and E Treatment o Severe condition Surgical removal of lens and is replaced with an artificial lens *Plastic intraocular lens (IOL) artificial lens o For impaired vision Visual aids i.e. glasses, bifocals, appropriate lighting MACULA DEGENERATION o Common in older people. o Central vision loss may occur. Signs and Symptoms o Yellowish spots (drusen) form in the back of the eye or retina are an early sign of "dry" macular degeneration. It is believed these spots are deposits or debris from deteriorating tissue. o Early signs

overproduction of aqueous humor Pressure within the eye can close off the blood vessels entering the eye and may destroy the retina or optic nerve, resulting to blindness *Normally, IOP should be below 21 mmHg Signs and Symptoms *The word "glaucoma" came from a Greek word which means, "opacity of the crystalline lens." (Cataracts and glaucoma were not distinguished until c.1705) o Typically, none o In a specific type of glaucoma

 Blurry vision, halos around lights, intense eye pain, nausea and vomiting Prevention o Exercise Lowers OPP or ocular perfusion pressure * OPP is a mathematical value that is calculated using a person's intraocular pressure and his or her blood pressure. o Gonioscopy Make sure the aqueous humor (or "aqueous") can drain freely from the eye In gonioscopy, special lenses are used with a biomicroscope to enable your eye doctor to see the structure inside the eye (called the drainage angle) that controls the outflow of aqueous and thereby affects intraocular pressure. o Visual field testing to determine if you are experiencing vision loss from glaucoma o Imaging technology create baseline images and measurements of the eye's optic nerve and internal structures. o Tonometer measure your intraocular pressure, or IOP Treatment o Depending on the severity glaucoma surgery Lasers medications o Glaucoma eye drops Keeps IOP low