Fisiologi Penglihatan

Dr. Daniel H.Tjahjono MS.

 Sense of Sight
• Eye: organ containing visual receptors
– Provides vision with assistance of accessory
organs
• Visual accessory organs
– Eyelids, lacrimal apparatus (protects eye),
and a set of extrinsic muscles (move eye)
 Orbital Cavity
• Location of eye and accessory organs
• Pear-shaped
• Lined with the periosteum of various
bones and contains fat, blood vessels,
nerves, and connective tissues.
 Eyelid (4 layers)
• Skin: thinnest skin of body. Covers the lids outer
surface.
• Muscle:
– Orbicularis oculi: acts as a sphincter and closes lid
when it contracts.
– Levator palpebrae superioris: raises the upper lid
• Connective tissue
• Conjunctiva: mucous membrane that lines the
inner surfaces of the eyelids and anterior
surface of eyeball except for the central portion
(cornea).
Sagittal section of the closed eyelids and anterior portion of the eye.
 Lacrimal Apparatus
• Lacrimal Gland: secretes tears continuously.
Located in the orbit and series of ducts that carry
tears into nasal cavity.
– Tears exit lacrimal gland through tiny tubules and flow
downward and medially across the eye.
– Superior and inferior canaliculi collects tears  into
lacrimal sac located in groove of lacrimal bone 
nasolacrimal duct which empties into nasal cavity
– Moistens and lubricates surface of the eye
and lining of lids
– Tears contain lysozome – antibacterial agent
reducing risk of eye infections.

The lacrimal apparatus

consists of a tear-
secreting gland and a
series of ducts.
 Extrinsic Muscles
• Arise from bones of the orbit and attach
(insert) by broad tendons on the eye’s
tough outer surface.
• 6 extrinsic muscles move the eye in
various directions. Eye movements may
utilize more than one muscle.
Extrinsic muscles of the right eye (lateral view)
 Diplopia
• Double vision caused by one eye deviating
from the line of vision.
• If condition persists, brain must suppress
image from deviated eye
 Suppression Amblyopia
• Turning eye becomes blind.
• Treatment early in life with exercises,
eyeglasses and surgery can prevent
monocular blindness (one eye)
 Structure of the Eye
• Hollow, spherical structure 2.5cm in
diameter
• 3 layers: fibrous outer tunic, vascular
middle tunic, nervous inner tunic
• Spaces within eye filled with fluids that
support its wall and internal parts and help
maintain its shape.
 Outer Tunic – Fibrous Tunic
• Cornea
• Sclera
• Optic Nerve: in the back of the eye
• Blood Vessels: pierce sclera
 Cornea
• Anterior 6th of outer tunic
• Bulges forward
• Transparent window of the eye (contains few cells, no
blood vessels, cells and collagenous fibers form
unusually regular patterns)
• Helps focus entering light rays
• Composed largely of connective tissue with a thin layer
of epithelium on its surface.
• Continuous with the sclera (white portion of the eye)
Transverse section of the right eye (superior view)
 Sclera
• White portion of the eye
• Posterior 5/6th of the outer tunic
• Opaque due to many large, disorganized
collagenous and elastic fibers.
• Protects the eye and is an attachment for
the extrinsic muscles
Most Common Cause of Blindness
• Loss of transparency of the cornea
• Corneal Transplant (penetrating
keratoplasty): treat condition by replacing
central 2/3 of the defective cornea with
similar-sized portion of cornea from a
donor eye
– Corneal tissues lack blood vessels,
transplanted tissue usually not rejected
– Success rate of procedure is very high.
 Middle Tunic – Vascular Tunic
• Choroid Coat
• Ciliary Body
• Iris
 Choroid Coat
• Posterior 5/6th of globe of the eye
• Loosely joined to the sclera
• Honeycombed with blood vessels which
nourish surrounding tissues
• Contains many pigment-producing
melanocytes which absorbs excess light
and helps keep the inside of the eye dark.
 Ciliary Body
• Thickest part of the middle tunic
• Extends forward from the choroid coat and forms
an internal ring around the front of the eye.
• Many radiating folds called ciliary processes
• Groups of muscle fibers called ciliary muscles.
• Suspensory ligaments: extend inward from the
ciliary processes and hold transparent lens and
capsule in position.
Lens and ciliary body viewed from behind
 Lens
• Lies directly behind the iris and pupil
• Composed of differentiated epithelial cells
called lens fibers.
 Lens Capsule
• Surrounds the lens
• Clear, membrane-like structure composed
largely of intercellular material
• Elastic nature keeps it under constant
tension. Can assume a globular shape.
• Suspensory ligaments attached to margin
of capsule and the ciliary muscles.
Changing tension changes the shape of
the capsule and lens for focusing.
• Accommodation: the ability of the lens to
adjust shape to facilitate focusing. Close
objects= lens thickens; distant objects=
thinner, less convex
In accommodation, A.) the lens thins as ciliary muscle fibers relax. B.) The lens thickens
as ciliary muscle fibers contract.
 Cataract
• Common eye disorder in older people
• Lens or capsule slowly becomes cloudy and
opaque.
• Without treatment it eventually causes blindness
• Treatment:
– In past, surgical procedure with 2 week recovery
– Now, laser treatment on out-patient basis.
 Iris
• Thin diaphragm composed mostly of connective
tissue and smooth muscle fibers
• The colored portion of the eye
• Extends forward from the periphery of the ciliary
body and lies between the cornea and the lens.
• Divides the space (anterior cavity) into the
anterior chamber (between the cornea and the
iris) and posterior chamber (between iris and
vitreous body containing the lens)
 Aqueous Humor
• Watery fluid secreted by the epithelium on
the inner surface of the ciliary body into
posterior chamber.
 Pupil
• Circular opening in the center of the iris.
Fluid flows through from posterior to
anterior chamber.
• Aqueous humor fills space between
cornea and lens. Nourish these parts and
aids in maintaining shape of the front of
the eye.
– Leaves anterior chamber through veins and
special drainage canal – scleral venous sinus
(canal of Schlemm)
 Glaucoma
• Eye disorder that develops when the rate
of aqueous humor formation exceeds the
rate of its removal.
• Fluid accumulates in anterior chamber of
the eye, fluid pressure rises and is
transmitted to all parts of the eye.
• Building pressure squeezes shut blood
vessels that supply the receptor cells of
the retina.
• Cells robbed of nutrients and oxygen may die
and permanent blindness can result.
• Early diagnosis allows successful treatment with
drugs, laser therapy, or surgery to promote
outflow of aqueous humor
• Early stages typically produce no symptoms.
Discovery of the condition by tonometer, an
instrument that measures intracellular pressure.
 Smooth Muscle Fibers of Iris
• Control size of the pupil through which
light passes as it enters the eye.
• 2 groups
– Circular set: acts as a sphincter. Contracts
smaller, less light enters.
– Radial set: contracts to increase diameter of
pupil allowing more light to enter.
Dim light stimulates the radial muscles of the iris to contract, and the pupil dilates. Bright
light stimulates the circular muscles of the iris to contract, and the pupil constricts.
 Inner Tunic
• Consist of the retina which contains visual
cells (photoreceptors)
• Nearly transparent sheet of tissue that is
continuous with the optic nerve in the back
of the eye and extends forward as the
inner lining of the eyeball
• Ends just behind the margin of the ciliary
body
 Retina
• Thin and delicate. Complex structure with
a number of distinct layers.
– Macula lutea: central region. Yellowish spot
– Fovea centralis: depression in its center.
Region that produces sharpest vision.
– Optic disc: medial to fovea centralis. Nerve
fibers from the retina leave the eye and join
the optic nerve.
• Central artery and vein also pass through optic
nerve and vessels are continuous with the capillary
networks of the retina and with vessels in the
underlying choroid coat.
• Supply blood to cells of inner tunic
• Known as the blind spot of the eye. Lacks receptor
cells.
The retinal consists of several cell layers.
Note the layers of cells and nerve fibers in this light micrograph of the retina.
Retina. A.) Nerve fibers leave the eye in the area of the optic disc (arrow) to form the
optic nerve. B.) Major features of the retina.
 Posterior Cavity
• Space bounded by the lens, ciliary body,
and retina is the largest compartment of
the eye.
• Filled with transparent, jelly-like fluid called
vitreous humor, along with collagenous
fibers it comprises the vitreous body.
• Vitreous body: supports internal parts of
the eye and helps maintain its shape.
 Floaters
• Specks or clumps of gel or deposits of
crystal-like substances that form in the
vitreous humor. Cast shadows on the
retina.
• Person sees small, moving specks in the
field of vision. Most apparent when looking
at a plain background.
• More numerous as a person ages.
 Light Refraction
• When a person sees something, the object is
giving off light or light waves are reflected from
it.
• Light waves enter the eye and an image of the
object is focused on the retina.
• Refraction: bending of light waves to focus them.
• Occurs when light waves pass at an oblique
angle from a medium of one density into a
medium of another density.
A lens with a convex surface causes light waves to converge.
• Convex surface causes light waves to
refract and converge (cornea, lens, fluids)
• If eye shape is normal, light waves focus
sharply on the retina.
– Image is upside down and reversed from left
to right.
– Visual cortex interprets the image in its proper
position.
 Visual Receptors
• Visual receptor cells are modified neurons
of two distinct kinds. (rods and cones)
 Rods
*Long, thin projections at their ends.
*Human eye has 125 million
*Hundreds of times more sensitive
to light than cones.
*Can provide vision in dim light
*Produce colorless vision
*General outlines of objects. Less
precise images because nerve
fibers from many rods converge
their impulses and transmit them to
the brain on the same nerve fiber.
Cones
*Short, blunt projections.
*Human eye has 7 million
*Detect color
*Provide sharp images (higher visual
acuity)
*Convergence of impulses less common.
Brain can pinpoint stimulation more
accurately.
*Fovea centralis: Area of sharpest vision.
*Lacks rods but contains densely
packed cones with few to no
converging fibers.
*To view something in detail, a person
moves the eyes so that the important
part of an image falls on the fovea
centralis.
Rods and Cones. A.) A single sensory nerve fiber transmits impulses from several rods to the brain.
B. Separate sensory nerve fibers transmit impulses from cones to the brain. C.) Scanning electron
micrograph of rods and cones.
• Rods and cones are located in a deep
portion of the retina, closely associated
with the layer of pigmented epithelium.
• Epithelial pigment absorbs waves not
absorbed by receptor cells.
• Along with pigment of choroid coat, it
keeps light from reflecting off surfaces
inside the eye.
• Projections from receptors are loaded with light-
sensitive visual pigments and extend into this
pigmented layer.
• Visual receptors are stimulated only when light
reaches them. A light image focused on an area
of the retina stimulate some receptors and sends
impulses to the brain. This provides only a
fragment of info required for the brain to interpret
a total scene.
Pigmented epithelium and receptor cells
 Visual Pigments
• Both rods and cones contain light-sensitive pigments
that decompose when they absorb light energy.
• Decomposition of the pigments triggers a complex series
of reactions that initiate a nerve impulse
• Pigments are synthesized from vitamin A.
• Night blindness: poor vision in dim light results from
vitamin A deficiency which reduces the supply of retinal
(a type of visual pigment) causing low rod sensitivity.
Treated with Vitamin A supplements.
• Color vision comes from 3 sets of cones
containing different light-sensitive pigments
• Each type of pigment is sensitive to different
wavelengths (colors- red, green, blue) of light.
• The color a person perceives depends on which
set of cones or combination of sets the light in a
given image stimulates. (all three =white;
none=black)
• Different forms of color blindness result from
lack of different types of cone pigments.
 Visual Nerve Pathway
• Axons of retinal neurons leave eyes to form optic nerves.
• X-shaped optic chiasma. Some fibers cross over
• Right and left optic tracts
• A few nerve fibers enter nuclei that function in various
visual reflexes
• The rest enter the thalamus
• Visual impulses enter nerve pathways called optic
radiations which lead to the visual cortex of the occipital
lobes.
The visual pathway includes the optic nerve, optic chiasma, optic tract, and optic
radiations.
Clinical Terms Related to the
Senses
 Amblyopia
• Dim vision due to a cause other than a
refractive disorder or lesion
Amblyopia is the medical term for poor
development of vision in one eye. The word comes
from the Greek. [ambly- (dull) + -opia (vision)]
Amblyopia is often referred to as "lazy eye." It
affects just two to three percent of the population.
Central vision does not develop properly, usually in
one eye, which is called amblyopic. The eye is
anatomically normal, but visual acuity is reduced
even with glasses. Amblyopia develops sometime
between birth and 8 or 9 years of age, the critical
period of time when the visual system develops
and matures. Amblyopia causes more visual loss in
the age group under 40 than all the injuries and
diseases combined.
 Anopia
• Absence of an eye
 Audiometry
• Measurement of auditory acuity for various
frequencies of sound waves
 Blepharitis
• Inflammation of the eyelid margins
 Causalgia
• Persistent, burning pain usually associated
with injury to a limb
Also called complex regional pain
syndrome.Most common between ages 40-
60. Diagnosis through observation,
thermography, and radiography.Treatment
includes physical therapy, corticosteriods,
local anesthetic, vasodilaters and
antidepressants.
 Conjunctivitis
• Inflammation of the conjunctiva

Viruses, bacteria, irritating substances

(shampoo, dirt, smoke, pool chlorine),
sexually transmitted diseases (STDs) or
allergens (substances that cause allergies)
can all cause conjunctivitis. Pink eye
caused by bacteria, viruses or STDs can
spread easily from person to person but is
not a serious health risk if diagnosed
promptly; allergic conjunctivitis is not
contagious.
 Diplopia
• Double vision
 Emmetropia
• Normal condition of the eyes; eyes with no
refractive defects.
 Enucleation
• Removal of the eyeball
 Exophthalmos
• Abnormal protrusion of the eyes

Associated with hyperthyroidism and Grave’s disease. In the case of Graves Disease,
the displacement of the eye is due to abnormal connective tissue deposition in the orbit
and extraocular muscles (Epstein et al, 2003) which can be visualized by CT or MRI.
If left untreated, exophthalmos can causes the eye lids to fail to close during sleep
leading to corneal damage. The process that is causing the displacement of the eye may
also compress the optic nerve or ophthalmic artery leading to blindness
 Hemianopsia
• Defective vision affecting half of the visual
field
 Hyperalgesia
• Heightened sensitivity to pain

Caused by injury, or allergic/inflammatory reaction. One unusual cause is

platypus venom (venomous ankle spurs)
 Iridectomy
• Surgical removal of part of the iris

Treatment for one type of glaucoma

where the iris sags and blocks normal
drainage.
 Iritis
• Inflammation of the iris
Also called anterior uveitis. It is the 3rd leading cause of blindness in the developed
world. White blood cells are shed into the anterior chamber of the eye in the
aqueous humor. These cells can accumulate and cause adhesions between the iris
and the lens. Iritis is associated with over 90 different pathogens and autoimmune
disorders. Some treatments include antibiotics and steroids.
 Keratitis
• Inflammation of the cornea

Symptoms include pain, and profuse tearing. Can be caused by infection, trauma,
dry eyes, UV exposure, contact lens over-wear, degeneration.

Herpes simplex keratitis

 Labyrinthectomy
• Surgical removal of the labyrinth
 Labyrinthitis
• Inflammation of the labyrinth

Usually caused by a viral infection, occasionally bacterial. Symptoms

include reduced hearing or distortion, ringing in the ear, dizziness,
imbalance, nausea and vomiting. Often follows the common cold. Viral
form improves on its own within a few weeks. Anti-nausea medication can
be prescribed.
 Meniere’s Disease
• Inner ear disorder that causes ringing in
the ears, increased sensitivity to sounds,
dizziness, and hearing loss

Meniere’s disease is a problem with the inner ear, the part of the ear responsible
for balance as well as hearing. When you have Meniere’s disease, too much
endolymph (fluid) backs up in the canals, a condition called endolymphatic
hydrops. Extra fluid causes pressure to build up, so the canals swell and can’t
work right. This leads to problems with the ear’s hearing and balance systems.
 Neuralgia
• Pain resulting from inflammation of a
nerve or a group of nerves.

Trigeminal neuralgia
 Neuritis
• Inflammation of a nerve
Optic neuritis is acute visual loss owing
to demyelination of the optic nerve. It
may be an isolated autoimmune
condition or part of multiple sclerosis.
Fortunately, vision recovers to normal or
near normal in over 90% of patients
within six months. No treatment
improves those chances.
Optic neuritis
 Otitis media
• Inflammation of the
middle ear
Bacterial or viral infection occurs in the
fluid buildup after a respiratory illness
 Otosclerosis
• Formation of spongy bone in the inner ear,
which often causes deafness by fixing the
stapes to the oval window
Treatment
In the early stages of otosclerosis, or when the condition
is mild, you might not need any treatment. Hearing aids
are very useful initially. However, as the calcium buildup
on the stapes progresses you will gradually lose your
hearing. Sodium fluoride tablets have been shown to
help prevent the progression of otosclerosis, but only if
the condition has also affected the inner ear.
At some point, most people usually have an operation -
a stapedectomy or stapedotomy - where a tiny piston
replaces the stapes so that sound can travel to the inner
ear. This operation has a high success rate.
 Pterygium
• Abnormally thickened patch of conjunctiva
that extends over part of the cornea
Pterygium occurs more often in people who
spend a great deal of time outdoors, especially
in sunny climates. Long-term exposure to
sunlight, especially ultra-violet (UV) rays, and
chronic eye irritation from dry; dusty conditions
seem to play an important causal role. When a
pterygium becomes red and irritated, topical
eye-drops or ointment may be used to help
reduce the inflammation. If the pterygium is
large enough to threaten sight, is growing or is
unsightly, it can be removed surgically
 Retinitis pigmentosa
• Inherited, progressive retinal sclerosis
characterized by pigment deposits in the
retina and by retinal atrophy
In the progression of symptoms for RP, night blindness
generally precedes tunnel vision by years or even decades.
Many people with RP do not become legally blind until their
40s or 50s and retain some sight all their life. Others go
completely blind from RP, in some cases as early as
childhood. Progression of RP is different in each case.
RP is a group of inherited disorders in which abnormalities of
the photoreceptors (rods and cones) or the retinal pigment
epithelium (RPE) of the retina lead to progressive visual
loss. Affected individuals first experience defective dark
adaptation or nyctalopia (night blindness), followed by
constriction of the peripheral visual field and, eventually, loss
of central vision late in the course of the disease.
 Retinoblastoma
• Inherited, highly malignant tumor arising
from immature retinal cells
Retinoblastoma is a rare cancer of the
retina (the innermost layer of the eye,
located at the back of the eye, that
receives light and images necessary for
vision). About 300 children will be
diagnosed with retinoblastoma this year. It
accounts for 3 percent of childhood
cancers. Treatments include surgery,
radiation, chemotherapy, laser therapy,
phototherapy, thermal therapy, and
cryotherapy.
 Tinnitus
• Ringing or buzzing noise in the ears.

Ringing, buzzing, whistling, or roaring

noises in the ear). These noises may
come and go or may always be present.
The noises may get louder just before a
vertigo attack.
 Trachoma
• Bacterial disease of the eye that causes
conjunctivitis, which may lead to blindness

Trachoma, an infection of the eye caused by

Chlamydia trachomatis, ranks worldwide as the most
common preventable cause of blindness and the
second most common cause of blindness after
cataract. It has been estimated to cause 15% of the
world's blindness.1,20 The disease is endemic in 48
countries in Latin America, Africa, the Middle East,
Asia, and Australasia [see Fig. 1], and is most
prevalent in poor, rural communities with lower
standards of hygiene and sanitation.2 The WHO
currently estimates that 6 million people are blind due
to trachoma, and that an additional 146 million people
have active forms of the disease.
 Tympanoplasty
• Surgical reconstruction of the middle ear
bones and the establishment of continuity
from the eardrum to the oval window.
 Uveitis
• Inflammation of the uvea, the region of the
eye that includes the iris, ciliary body, and
choroid coat.
There are different types of uveitis, depending on
which part of the eye is affected:
When the uvea is inflamed near the front of the iris, it
is called iritis. If the uvea is inflamed in the middle of
the eye, it is called cyclitis. Cyclitis affects the
muscle that focuses the lens.An inflammation in the
back of the eye is called choroiditis.
Eye drops, especially steroids and pupil dilators, can
reduce inflammation and pain. For more severe
inflammation, oral medication or injections may be
necessary.
Uveitis can have these complications: Glaucoma
(increases pressure in the eye); Cataract (clouding of
the eye's natural lens); Neovascularization (growth of
new, abnormal blood vessels).
 Vertigo
• Sensation of dizziness
 Lab Review
• Visual Acuity
• Astigmatism
• Accomodation
• Blind Spot
• Photopupillary Reflex
• Accommodation Pupillary Reflex
• Convergence Reflex
*clinical connection p276