Special sense

Dr. Hanan Eltumi

 Special senses
• What are Special senses?
• Vision
• Hearing
• Smell
• Taste
 Vision
Vision is important for (a) Identification of objects.
b) learning through written speech. C) maintenance of equilibrium

Physiological Structure of the eye:

a) Eye ball:
The eye ball is nearly spherical in shape formed of three 3 layers:
i) Outer fibrous layer
ii) Middle vascular layer
iii) Inner layer (nervous)

b) Accessory organ related to eye ball (eye adnexa)

 Physiological structure of eye
Eye ball
-It is the organ of vision, nearly spherical in shape.
-The wall of the eyeball is formed of the following layers:
1)Outer fibrous layer: it is a protective layer formed of:
A) Cornea (anterior 1/6), it is transparent to allow the passage of
light into the eye.
B) Sclera (posterior5/6), formed of fibrous tissue. It is opaque white
layer. It is covered by a thin membrane known as conjunctiva.
Note: the circular corneo-scleral junction is called the limbus, at
which there is an important canal that drain the aquous humor
called the canal of Schlemm.
2) Middle vascular layer , formed of:
a) choroid: lies between sclera and retina. It contains:
- Blood vessels to supply retina.
- Pigment to absorb light and prevent its refraction.

b) Ciliary body: it is formed of:

- ciliary epithelium which secretes aquous humour and forming
ciliary process.
- ciliary muscle which controls the power of the lens

c) iris: it is a circular colored diaphragm in front of the crystalline lens.

it has a central round opening called the pupil. It contains two
muscles which control diameter of pupil. The iris is pigmented and
vascular.
3) Inner nervous layer : it contains retina which contains the
photoreceptors (Rods & Cons). It is part from CNS. It extends
anteriorly & ends just behind the ciliary body at the ora
serrata. It is formed of 10 layers but only two order neurons
of visual pathway (Bipolar cell and ganglion cell layer).

The site at which the optic nerve leaves the retina is called the
optic disc, optic papilla, or blind spot (because it contains no
photoreceptors).
The inner cavity of eye ball contains the following structures:
1) The lens: it lies behind iris attached to ciliary body by
suspensory ligament.

2) Aqueous humour: it is a clear watery fluid fills the cavity

anterior to the lens which divided into anterior chamber
(between the iris & the cornea), and Posterior chamber
(between the iris & the lens). It is secreted by ciliary epithelium
then pass to posterior, after that to anterior champer.

3) Vitreous humour: it is a clear gelatinous material filling the

cavity behind lens
b) Accessory organs related to eye ball:
1) Eye lids: it is movable muco cutaneous folds
covered anteriorly by skin and posteriorly by
conjunctiva. The upper eyelid covers 6th
cornea and iris. The two eyelids met at two
angles.Upper & lower lids contain:
-Eye lashes:
Upper eye lashes Lower eye lashes

longer shorter

More in number Less in number

Directed upwards and laterally Directed down ward & lateral

- Two types of glands:
- i) sweat glands opening into eye lashes
- Ii) meibomian glands which secretes oily substance that
- prevent overflow of tears, so it distributes tears
over cornea and are protective to cornea

- 3 muscles:
i) Orbicularis oculi: it closes eye, and supplies by facial
nerve.
This muscle close (blinking):
Relexy in
Corneal + conjunctival reflex as a response to touch
As a response to bright light
as a response to loud sound.
ii) Levator palpebrae superiors: in upper eye lid. It is involuntary part which
is supplied by sympathetic fibers
iii) Muller’s muscle: push eye ball forward, supplied by sympathetic fibers.

[2]conjunctiva: it is a mucous membrane lining the upper and the upper

eye lids
It contains:
a) Goblet cells which secrete mucous
b) Accessory lacrimal glands
c) Lacrimal apparatus:
Includes: -lacrimal gland in upper lateral cornea of eye
-accessory glands in conjunctiva
- drainage system
The drainage system starts from lacrimal punctum on medial
canthus to lacrimal canaliculi to lacrimal sac to
nasolacrimal duct to opens in nose.
Tears:
It is an isotonic slightly alkaline solution (ph 7.4), volume: 1
ml/ day
Formed in lacrimal glands + accessory lacrimal glands
Function: it protects the eye from microbs and supply oxygen
for cornea, washes the cornea from dust.
- The tear film that covers the surface of the eye (cornea) is
formed of three layers:
1- superficial oily layer from meibomian glands. This
prevents evaporation of tears.
2- middle layer from lacrimal gland. This supply oxygen to
cornea, moistens cornea, antibacterial, lubricates eyelids,
and dilutes any irritants.
3- deep mucous from goblet cells of conjunctiva. It converts
the corneal epithelium from hydrophobic to hydrophilic,
this enables corneal epithelium to be wet easily by tear
fluid.
[3] Extra ocular muscles:
-These are 6 voluntary striated muscles
a) 4 recti (medial, lateral, superior, and inferior)
b) Superior+inferior oblique.
- These muscles rotate the eye ball. They act in harmony, so
that their contraction produce conjugate deviation of
both eyes (movement of both eyes in the same direction).
This leads to falling of the images at the corresponding
points and production of a single visual sensation. Their
contraction follows the role of reciprocal innervations (i.e
when a muscle contracts, its antagonist relaxes and vice
versa).
Note:
The ciliary and pupillary muscles are considered
as the internal ocular muscles. These are
involuntary smooth muscles. The ciliary and
constrictor pupillae muscles are supplied by
parasympathetic fibers from oculomotor
nerve while the dilator pupillae muscle is
supplied by sympathetic fibers.
 Nerve supply of eye
(1) Afferent :
1- optic nerve (special ssense). It carries the visual impulses
from retina
2- trigeminal nerve (general sensation) from eye lids, cornea,
conjunctiva and eyelashes.
2 efferent:
1- somatic (nerve supply to extrinsic muscle of eye)
i- occulomotor nerve (3rd cranial nerve) supplies all extra ocular
muscles except superior oblique and lateral rectus
it also supplies the striated part of levator palpebrae superior.
2- trochlear nerve (4th cranial nerve): supplies superior oblique.
3- abducent nerve (6th cranial nerve) supplies lateral rectus.
2) Autonomic (nerve supply to intrinsic muscles of eye):
i- parasympathetic:
a) Occulomotor (see autonomic) the preganglionic fiber arise from
Edingerr-westfal nucleus in midbrain. They relay in the ciliary
ganglion. The postganglionic fibers pass in short ciliary nerves to
produce contraction of the pupil and contraction of the ciliary
muscle causing accomodation.
b) facial: secretory to lacrimal gland.
Ii- sympathetic nerves:
Arise from the upper 2 thoracic segments and relay in the superior
cervical ganglia, they produce:
-mydriasis and protrusion of eye (exophthamus)
-elevation of the upper eye lid due to contraction of the smooth
muscle part of the levator palpebrae superiors
-vasoconstriction of blood vessels.
Horner syndrome:
It occurs due to lesion in sympathetic
innervations to eye producing unilateral:
-endophthamus
-VD of skin bl. Vessels (red skin)
-Ptosis
-miosis
-anhydrosis
 Principles of optics
- The visible wave-length for human eye range from 4000 to 7250 A (A=
Angstrom=0.1millimicron). Adjacent to the visible zone, there are 2
invisible zones which includes the ultraviolet and infrared rays.
- Light rays travel through air at velocity of about 300.000 Km/sec. But
much slower through transparent solids & liquids e.g. in the glass it is
200.000 Km/sec.
- When light rays strike a surface, they are either reflected, absorbed,
or transmitted through it with or without refraction. The degree of
refraction depends on the refractive index of the substance.
- The refractive index of a transparent substance is the ratio of velocity
of light in air to the velocity in the substance.
- The refractive index of air is 1.
- The refractive index of glass is 1.5.
- The refractive index of water is 1.33.
Refractive media of the eye
- There are 4 refractive media in the eye, which include:
The cornea:
 It has a refractive index 1.38 & power of about 40 diopters.
The aqueous humour:
 It has a refractive index is 1.33.
The crystalline lens:
 Its central part has a refractive index 1.41, while its
peripheral part has an index 1.38.
 As a whole, the refractive index of the lens is about 1.40 &
its power during rest is about 20 dioptres.
The vitreous humour:
 It has a refractive index 1.34
The optic axis:
- This is a straight line that joins the anterior &
posterior poles of the eyeball.
- Upon this axis, the various refractory surfaces of
the eye are centred.
The visual Axis:
- This is a straight line that joins the centre of the
pupil to the fovea centralis.
 The outer fibrous layer of the eye
Cornea:
it is a clear transparent avascular structure in the anterior
transparent 1/6 of the outer layer of the eye ball, with a
convex anterior surface which is kept moist by tears.
Diameter: 11 mm
Thickness: 1 mm at periphery
0.5 mm at center
- It is very sensitive structure
- -It has a refractive index = 1.37 which is more than air
(1.0)
- The cornea is Formed of 5 layers:
1- corneal epithelium
2- Bowman’s membrane and layer
3- substantia propria (90% of cornea)
4- Decemetes membrane, if injured lead to
opacity of cornea
5- flate endothelium
 Function of cornea
1-it allows entry of light into the eye due to its transparency.
2- it is the most important refractive medium in the eye, since it acts as a
convex lens having a diopteric power of 40 diopters (having 70% of the
dioptric power of the eye)
Note: the diopteric power of cornea is high, yet fixed at 40 D.P. in
comparison, the diopteric power of lens is less but not fixed ( it is 32
diopter with accommodation and 22 diopter with out accommodation).
3- its regular curvature leads to formation of sharp retinal image.
4- it protects the delicate inner structure of eye due to:
- It is Formed of tough protecting fibrous tissue.
-it is very sensitive
-Presence of conjunctival and corneal reflexes (touch of cornea or
conjunctiva lead to closure of the 2 eye lids)
- It absorp dangerous ultraviolet rays.
5- it is permeable to isotonic fluids so allows most of eye drops to enter
Corneal nutrition & metabolism:
Normally, the cornea is an avascular structure (but the
corneosclear junction are richly supplied by blood vessels) in
order to maintain its transparency. It obtains the need of
oxygen and nutrient from: aquous humour, its own lymph
vessels, tears, and from capillary at corneosclear junction by
diffusion.
Causes of transparency of cornea
1- anatomical structur of cornea
-regular corneal epithelium
- absence of blood vessels
-the corneal fiber are closely packed and run parallel to surface
-the refractive index of various layers of the cornea are the same
2- the cornea is hypertonic. i.e contains less water.
i.e the presence of excess water interferes with the parallel
arrangement of fibers. Water which pass into the cornea is pumbed
by an active transport process. So, normal cornea is actively
dehydrated.

Corneal reflex:
It is reflex closure of both eyes on touching the cornea of one eye
with any foreign body e.g. cotton.. It is a superficial reflex. This
reflex is primarily protective. However, it is commonly tested
clinically to check (a) the integrity of the 5 th cranial nerve (b) the
depth of anasthesia (Helps to differentiate between the 2 nd and 4th
stages of general anaesthesia)
Pathway of corneal reflex :
 Receptors: corneal receptors.
 Afferent: Sensory nerve fibres of ophthalmic division of the
trigeminal nerve  trigeminal ganglia  trigeminal nucleus in
pons, where they stimulate the facial (7th cranial) nuclei at both
sides.
 Centre: Facial nuclei at both sides.
 Efferent: Facial nerve.
 Effector: Orbicularis oculi muscle.
 Response: Closure of the eyelids bilaterally.

Diseases affecting cornea:

1)Corneal vascularization: cause
- Local disease e.g corneal ulcer
- Genreal diseases as vit. B2 (Riboflavin) deficiency
2) Astigmatism: in which the curvature of cornea is not the same in
all planes.
3) Conical cornea: it is a congenital disease
4) Corneal opacity: if decement membrane is injured.
 Sclera
It white opaque fibrous posterior 5/6 of the outer
layer of the eye. It is formed of thick fibrous tissue
and covered interiorly by conjunctival membrane.
Normally it is white in adults and blue in children
and can change with diseases like jaundice.
Functions:
1- protects the eye.
2- site of insertion of extra ocular muscles.
 The middle vascular layer
The middle layer of the eye is rich in blood vessels & it consists of
the choroid posteriorly, the iris anteriorly & the ciliary body in
between.
Choroid:
It is pigmented vascular layer between the retina and the sclera.
Functions of the choroid:
1-It is a vascular layer which provides blood supply to the eye, Carry
oxygen and nutrients to the retina.
2-It contains melanin pigments which absorb light & prevents its
reflection inside the eye. If light were reflected inside the eye, the
reflection would interfer with vision which cause blurring of vision.
Ciliary body:
It is formed of:
1- ciliary muscle, smooth muscle. It is circular type. It is essential for
accommodation.
2- ciliary process: covered by ciliary epithelium which secrets aquous
humour. It gives attachment to the suspensory ligament.
Iris:
- It is a circular e opaque pigmented layer that lies anterior to the lens.
- It has a central round aperture (opening) called the pupil.
- The iris contains the pigment that gives the eye its characteristic
colour.
- It contains the following 2 types of smooth muscle which control the
size of the pupil (controls light entry to the eye):
Circular muscle fibres:
- Constitute the constrictor pupillae muscle
- Innervated by parasymp. nerves.
Radial muscle fibres:
Constitute the dilator pupillae muscle.
• Functions of the iris:
1- It controls the amount of light which enters into the eye by
regulating the size of the pupil.
2- the pigments of iris absorbs all light entering the eye except
through pupil.
3- It prevents light from falling on peripheral part of lens. Thus,
prevents both spherical & chromatic aberrations.
Spherical aberration: the central part of lens has a more refractive
power than the peripheraln part, so, light rays passing through
central part comes to a point near nearer to the lens than that of
the peripheral part resulting into a blurred image.
Contraction of pupil prevents this.
Chromatic aberration: peripheral part of lens act as prism (red,
orange, yellow, green, blue, and violet) resulting in a colored image.
Pupillary consriction (miosis) prevents this.
3- It protects the retina (by preventing excessive entry of ultraviolet
rays into the eye).
 Pupillary light reflex
Definition:
exposure of one eye to light  pupillary constriction (=miosis)
occurs in this eye (direct reflex) & in the other eye (consensual
reflex).
Nervous pathway:
- Retina  optic nerve  optic chiasma where nasal fibres cross
to opposite side while temporal fibres remain on the same side
 optic tract. Before reaching the lateral geniculate body the
fibres pass to pretectal nucleus (centre of the reflex)  tecto-
nuclear tracts to Edinger-Westphal nuclei on both sides (the
fibres that reach the opposite side cross close to the aqueduct
of Sylvius)  preganglionic oculomotor nerve fibres  ciliary
ganglion  postaganglionic oculomotor fibres in short ciliary
nerves  constrictor pupillae ms.  bilateral miosis.
- This is a poly synaptic reflex
- This reflex does not reach the cortex.
- The function of the light reflex is to help the eye adapt
extremely rapidily to changing light conditions.
- Significance of light reflex:
(1) Physiologically:
 It controls the amount of light entering the eye. So, it is a
protective reflex which prevents over exposure of the retina
to harmful excessive illumination.
(2) Clinically:
1- Localization of the sites of lesions in the visual pathway
2- Diagnosis of certain nervous diseases like : :
a) is important in diagnosis of optic nerve lesion, as it is
positive if the diseased eye is the direct eye and negative if
the diseased eye is the indirect one.
b) In neurosyphilis Argyll Robertson pupil
It is a condition in which the pupil does not react in response
to light reflex & reacts in response to accommodation
reflex. It is due to Lesion in the pretectal area of the
midbrain which results from syphilis.

c) In lesion of LGB and occipital lobe, the eye respond to light

reflex but not the accommodation reflex, this is called
Reverse Argyll Robertson pupil.
d) Diagnosis of toxicity of drugs and head injuries.
E) Diagnosis of Horner syndrome: the show persistant miosis
due to paralysis of the dilatoe pupillae.
3- Determination of the depth of anaesthesia.
Abnormalities of light reflex
1- any damage to afferent component of reflex:
Direct reflex absent while consensual reflex
present
2- any damage to efferent component of reflex:
a)Uncrossed fiber : direct reflex absent while
consensual reflex present
b) Crossed fibers : consensual reflex absent while
direct reflex present
3- if mid brain damaged on both sides : Direct
reflex consensual reflex absent (fixed pupil)
Conditions that cause pupilloconstriction (miosis):
1) Reflexes:
Pupillary light reflex.
Near (accommodation) reflex.
2) Injury of the ocular sympathetic nerve supply: horner’s syndrome
3) During sleep:- Due to:
Predominance of parasympathetic activity.
Release of the Edinger Westphal nucleus from the normal cortical inhibition
(because the cortex itself is depressed).
4) During the 3rd stage (= surgical stage) of anaethesia (see below).
5) Miotic drugs:
1- Parasympathomimetic drugs: these act either:
Directly (by stimulating the muscarinic receptors in the constrictor pupillae
muscle) e.g. policarpine.
Indirectly (by inhibiting the cholinesterase enzyme) e.g. eserine.
2- Morphine: This depresses the cerebral cortex, so the Edinger Westphal
nucleus is released from its inhibitory effect, resulting in miosis.
Conditions that cause pupillodilatation (mydraisis)
1) Reflexes:
Sudden withdrawal of light from the eyes.
During distant vision (i.e. when accommodation is relaxed).
2)Injury of the ocular parasympathetic nerve supply:
3) Conditions associated with sympathetic stimulation:
 During emotions e.g. fear, anger etc.
 Pain sensation.  Asphyxia.
4)During the 2nd & the 4th stages of anaesthesia.
5)Mydriatic drugs:
Parasympatholytic drugs e.g. atropine & hamotropine, Which block the
muscarinic receptors in the constrictor pupillae muscle.
Sympathomimetic drugs (e.g. epinephrine), which stimulate the alpha
adrenergic receptors in the dilator pupillae muscle.
Cocaine: this sensitizes the dilator pupillae muscle to the action of
epinephrine & sympathetic impulses.