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Physiology

of the eye
Imagine your
eyes as a camera
Sagital View of the eye
1. Image Focusing  Refractive media

• Cornea
• Humor akuos
• Crystallin Lens
• Vitreous Body
Refractive media  CORNEA

• Media refrakta yang


terpenting
• Barrier penting dari isi
bola mata
• Kekuatan refraksi ±
43 Dioptri
• Indeks bias 1.376
Cornea Physiology

• sel epitel dpt hidup


rata-rata 4-8 hr
• epitel dpt
beregenerasi
lengkap dlm 7 hr
• epitel dan LAM 
permukaan optik
halus
• Pompa endotel
mempertahankan
kondisi dehidrasi
relatif
Physiology cont’d

• Innervated by N
V.1 corneal
sensitivity
• Tear film 
maintain the
smooth corneal
surface, and
protection effect
Refractive Media  Aquos Humor

• Produced by the
ciliary body
• Refractive Media
• Nutrition and O2
supply for cornea,
lens etc.
• Maintain the
ocular pressure
• Refractive index
1.336
Refractive Media  The Lens

• biconvex, avascular, and


transparent
• 66% water
•Other  Proteins
• Protein Can be
degenerated  cataract
Other function
1. Accommodations
2. UV absorption
(protecting the retina)
Refractive Media  Vitreous
Body
• Struktur seperti gel
• 80% terdiri air
• Index bias 1.334.
• Beratnya sekitar 4g,
• volumenya 4 cc
• Ukuran sekitar 2/3
dari seluruh volume
bola mata
Refractive Indices of
Refractive Media
Radius Thickness Refractive Position
Element Surface (mm) (mm) Index (mm)
Air 1.000
Cornea Anterior 7.7 0.50 1.376 0.0
Posterior 6.8 0.50
Aqueous 3.10 1.336
Anterior lens Anterior 10.0 0.546 1.386 3.60
cortex

Posterior 7.911
Lens core 2.419 1.406 4.146
Posterior Anterior -5.76 0.635 1.386 6.565
lens cortex

Posterior -6.0 7.20


Vitreous 16.80 1.336
Retina -12.0 24.0
The receiver RETINA
• Transparant,
• Histology 10
layers
• Photoreseptor :
rod & cones
• Supporting :
Glial cells,
amacrine,
Muller cells
Comparison of Rods and Cones

Rods Cones
Used for night vision Used for day vision
Very light sensitive; sensitive to scattered At least 1/10th of the rods light
light (have more pigment than cones) sensitive;sensitive only to direct light

Loss causes night blindness Loss causes legal blindness


Low visual acuity High visual acuity; better spacial resolution

Not present in fovea centralis Concentrated in fovea


Slow response to light, stimuli added over Fast response to light, can perceive more
time rapid change in stimuli

Stacks of membrane-enclosed disks are Disks are attached to outer membrane


unattached to cell membrane

20 times more rods than cones in the


retina
One type of photosensitive pigment Three types of photosensitive pigment in
(monochrome vision) human (color vision)

Confer achromatic vision Confer color vision


• Fovea central for visual acuity
• Perifovea  peripheral vision
The Conversion Phototransduction
• Process of conversion from image in
to neural impulse
The Pathway  Retina into visual cortex

 Start from the retinal photoreceptors , through the


optic nerve, chiasma and optic tract into the LGN
 Ends in the visual cortex

(LGN)

Striate
Cortex
The Pathway Optic Nerve (C.N.II)

• Merupakan
Perpanjangan dari
Otak
• Terdiri dari 4 bagian
• Intra ocular, intra orbita,
intra canalicular, intra
cranial
Cortex visual Visual Perception
Area Visual Primer
Area Visual Sekunder

• Jalur Ventral / What stream V1-V2-V4-Lobus temporal


informasi warna,bentuk&tekstur –mengenali benda
• Jalur Dorsal / where stream V1-V2-V3-V5/MT-lobus parietal.
Informasi pergerakan,orientasi ruang dan lokasi
Optic Nerve field of vision
• Pembagian daerah visual field saat serabut
saraf berjalan ke otak
7
Neural pathways direct reflex

ciliary ciliary
ganglion ganglion

RETINA

CN 3 CN 2
CHIASM

PRETECTAL PRETECTAL
NUCLEUS NUCLEUS

EDINGER EDINGER
WESTPHAL WESTPHAL
NUCLEUS NUCLEUS
8
Neural pathways consensual reflex

Note: Ada 2 tempat ciliary ciliary

dimana information ganglion

RETINA
ganglion

bersilangan
CN 3 CN 2
CHIASM

- the optic chiasm


PRETECTAL PRETECTAL

- the pretectal nucleus NUCLEUS NUCLEUS

.
to the Edinger-Westphal
nucleus EDINGER
WESTPHAL
EDINGER
WESTPHAL
NUCLEUS NUCLEUS
RELATIVE AFFERENT
PUPILLARY DEFECT (RAPD)
Menggambarkan adanya kelainan patologis
pada jalur afferent refleks pupil
Membandingkan refleks pupil 2 mata dengan
melihat r.c.langsung dan tidak langsung
kelainan harus unilateral
Sederhana, mudah dan obyektif
Dapat dievaluasi meskipun pasien dalam
kondisi tidak sadar
BAGAIMANA RAPD TERJADI ?

Penyinaran pada mata yang sakit


penerimaan cahaya kurang pada mata
sakit dan juga ke mata sehat otak akan
menginterpretasikan adanya penurunan
penerimaan cahaya otak merespon
dengan pupil berdilatasi supaya cahaya lebih
banyak masuk ke 2 mata, walau hanya 1
mata yang sakit.
KONDISI DGN PENURUNAN PENGLIHATAN ADA TIDAKNYA RAPD.....:

Neuritis optik Walau neuritis optik yang sedang dan kehilangan


penglihatan yang ringan, memberi RAPD berat.
Ischemic Optic Neuropathies Ada
Glaucoma Akan muncul jika satu mata lebih berat dari yang lain

Traumatic optic neuropathy Ada


Optic Nerve Tumor Ada
Optic Nerve Inflamation (sarcoidosis) Ada

Ischemic Retinal Disease (CRVO,CRAO, etc) Ada


Ischemic Ocular Disease Ada
Chiasmal Disease Jarang
Optic Tractus Disease Ada dan biasanya kontralateral dengan tempat lesi krn
jumlah serabut yang bersilangan lebih banyak.

Retinal Detachment Akan timbul jika makula ablasi atau dua kuadran retina
ablasi
Severe Macular Degeneration Timbul jika keadaan berat atau unilateral
Retinal or Choroidal Tumor Timbul jika keadaan berat
Amblyopia Timbul jika keadaan berat
Refractif Error Tidak ada walau keadaan berat
Cerebral disease Tidak ada
The Supporting structure of the Eye

• Palpebra
• Conjunctiva cover most exposed part of
the eye
• Sclera  the sceleton of the eye
• Uveal Tract  Iris, Ciliary Body and
Choroid Nutrition, circulation, immune
system
• Lacrimal Gland  tear film production
• Extra ocular muscles  Ocular movement
The Extraocular Muscles

• 7 extraoculer
muscles
• 6  Ocular
Movement
Eye Movements

I. Monocular eye movements (ductions)


1. Adduction is movement of the eye nasally.
2. Abduction is movement of the eye temporally
3. Elevation (supraduction) is an upward rotation of the eye.
4. Depression (infraduction) is a downward rotation of the eye.
5. Intorsion (incicloduction)is a nasal rotation of the superior
portion of the vertical corneal meridian.
6. Extorsion (excycloduction) is a temporal rotation of the
superior portion of the vertical cornea meridian

Sherrington’s law Pada gerakkan monookularimpuls syaraf akan dialirkan


secara aktif untuk otot-otot sinergis sedangkan untuk
otot-otot antagonis impuls syaraf akan dihambat.

II. Binocular eye movements (versions)


Innervasi yang seimbang dan simultan
mengalir ke otot-otot yang berpasangan Hering’s law
Parese n.III
right cranial nerve VI palsy
Penutup

• Mata merupakan satu kesatuan sistem


optik
• Jalur penglihatan meliputi pembiasan
cahaya, reseptor, neurotransmisi dan
persepsi
• Keseluruhan struktur bola mata berfungsi
untuk menunjang fungsi visual
Terima kasih
• santy.plw@gmail.com
JALUR NEAR
REFLEKS :
AKOMODASI
KONVERGENSI