LENS

Anatomy

October 15, 2008 Prof Sanjay Shrivastava 1

 Lens
• It is a highly organized transparent
asymmetrical oblate spheroid structure
that has evolved to alter the refractive
index of the light entering in the eye. It
does not posses nerve, blood vessels or
connective tissue.
• Biconvex shape results from the anterior
surface being less convex then posterior
surface.

October 15, 2008 Prof Sanjay Shrivastava 2

 Anatomical Considerations
• Biconvex Lens
• Diameter varies from 8.8 to 9.2
• Lens grow in size continuously throughout
life. Its weight is about 65 mgm at the birth
and upto 258 mgm by 80 years of age.
• Antero-posterior thickness changes with
accommodation. Thickness is 4.75 – 5
mm (un-accommodated) in adults.
• Circumference is known as equator
October 15, 2008 Prof Sanjay Shrivastava 3
 Lens
• Lens is suspended in eye by Zonules
which are inserted on anterior surface and
equatorial lens capsule and attached to
ciliary body. Zonular fibres are series of
fibrillin rich fibre.

October 15, 2008 Prof Sanjay Shrivastava 4

 Lens - Anatomy
• Histologically lens consists of three major
components:
1. Capsule – is a thick collagenese basement
membrane which is transparent, elastic acellular
envelop, thick at anterior pre-equatorial region
(21 micron m), thinnest at the posterior pole (4
micron m). Anterior pole is approximately 14
micron m thick. It contains the epithelial cells
and fibres as a structural unit and allows a
passage of small molecules both into and out of
lens
October 15, 2008 Prof Sanjay Shrivastava 5
 Lens - Anatomy
2. Lens Epithelium – It is a single layer of
cells lining the anterior capsule and
extends to the equatorial lens bow.
Zone of epithelial cells:
a. Central – cells do not actively divide,
they divide under pathological conditions
only.
b. Pre-equatorial germinal zone : cells
rarely divide.
October 15, 2008 Prof Sanjay Shrivastava 6
 Lens - Anatomy
c. Germinal zone: constitute of the
stem cell population. The newly formed
cells from germinal zone are forced into
transitional zone where they elongate and
differentiate to form mass of the lens. The
lens capsule secretes the lens capsule
and also regulate the transport of
metabolite, nutrients and electrolytes to
the lens fibres.
October 15, 2008 Prof Sanjay Shrivastava 7
 Lens - Anatomy
3. Lens substance: It constitute the main
mass of the lens. It is divide into-
a. Nucleus
b. Cortex
Nucleus: consists of
(i) Embryonic nucleus (it contains
primary lens fibres that are formed in lens
vesicle)
October 15, 2008 Prof Sanjay Shrivastava 8
 Lens - Anatomy
(ii) Fetal nucleus: it contains embryonic
nucleus and all fibres added to the lens before
birth
(iii) Infantile nucleus: it contains embryonic ,
fetal nucleus together with all the fibres added
up-to the age of 4 years.
(iv) Adult nucleus: composed of all fibres
added before sexual maturation
The nucleus consists of densely compacted lens
fibres and higher refractive index than cortex.

October 15, 2008 Prof Sanjay Shrivastava 9

 Lens Cortex
• It is located peripherally and is composed
of secondary fibres formed continuously
after sexual maturation. It is further divided
into:
– Deep cortex
– Intermediate cortex
– Superficial cortex

October 15, 2008 Prof Sanjay Shrivastava 10

 Lens - Crystalline
Lens fibres contain high concentrations of
crystalline.
Crystalline represent the major protein of the
lens (constitute 90% of total protein content of
lens). Crystalline has the following
constituents:
Alpha
Beta and,
Gamma
October 15, 2008 Prof Sanjay Shrivastava 11
 Lens - Functions
• The lens serves two major functions:
– Focusing of visible light rays on the fovea
– Preventing damaging ultra-violet radiation
from reaching the retina

October 15, 2008 Prof Sanjay Shrivastava 12

 Lens Cortex
• The region between embryonic and fetal nuclear
core and soft cortex i.e. infantile and adult
nucleus is sometimes referred to as epinucleus.
The region between deep cortex and adult
nucleus is sometimes referred to as Perinuclear
region.
• Lens fibres are held together by interlocking of
lateral plasma membranes of adjacent fibres to
form ball-and-socket and tongue-and-groove
joints.
October 15, 2008 Prof Sanjay Shrivastava 13
 Lens - Sutures
• Are found both at anterior and posterior
poles. They are formed by overlap of ends
of secondary fibres in each growth shell.
Each growth shell of secondary fibres
formed before birth (fetal nucleus) has an
anterior suture shaped as an erect Y and
a posterior suture shaped as an inverted
Y.

October 15, 2008 Prof Sanjay Shrivastava 14

 Lens – Physiology
• Lens function and transparency is
dependant on the supply of appropriate
nutrient to its various structures. Metabolic
needs of a adult lens is met by the
aqueous and vitreous.
• There is continuous transport of ions into
and out of the lens.

October 15, 2008 Prof Sanjay Shrivastava 15

 Lens - Physiology
• Lens function is dependent on the
metabolism of glucose to produce energy ,
protein synthesis and a complex
antioxidant system. Glutathione is found in
high concentration in lens and helps
protect its structure from oxidative
damage.

October 15, 2008 Prof Sanjay Shrivastava 16

 Lens - Physiology
• The transparency is dependent on highly
organized structure of lens, dense packing
of crystalline
• By act of accommodation it changes
focusing power. Accommodation occurs
by increasing the curvature of anterior
surface thereby changing refractive index
of lens. Light transmission and elasticity of
lens decreases with age.

October 15, 2008 Prof Sanjay Shrivastava 17

 Age changes in the Lens
• The lens exhibit age related changes in the
structure, light transmission , metabolic
capacities and enzyme activity.
• Overall light transmission decreases with age,
lens becomes less elastic, reducing its ability to
accommodate which leads to presbyopia.
• Metabolic activity is decreased , reduction in
antioxidant system with age makes lens prone to
oxidative damage.
• Changes in the crystalline are characterized by
aggregation, degradation and increased
insolubility.
October 15, 2008 Prof Sanjay Shrivastava 18
 Anatomy of Lens

Cortex

Capsule

3
4
3 – Adult Nu 5
4 - Infantile Nu 6
5 – Foetal Nu
6 – Embryonic Nu.

October 15, 2008 Prof Sanjay Shrivastava 19

 Cataract
• Any opacity in the lens or its capsule,
whether developmental or acquired is
called cataract.

• Developmental opacities are usually

partial and stationary, whereas acquired
opacities are progressive. They progress
until the entire lens is involved, but
exceptions are well known in both types.
October 15, 2008 Prof Sanjay Shrivastava 20
 Classification of Cataract
1. Developmental
2. Age related (senile)
3. Cataract associated with ocular diseases
4. Cataract associated with systemic
diseases (pre-senile)
5. Traumatic Cataract
6. Drug induced cataract

October 15, 2008 Prof Sanjay Shrivastava 21

 Risk Factors for Cataract
• Senility
• Sunlight (specially UV –A and UV-B component)
• Severe Diarrhoeal dehydration
• Vitamin A,C, E deficiency
• Diabetes
• Smoking
• Corticosteroids
• Genetic

October 15, 2008 Prof Sanjay Shrivastava 22

 Etiology of Cataract
• Senile
• Systemic Diseases – Diabetes,
Hypoglycaemia, Hypoparathyroidism,
Myotonic Dystrophy, Galactosaemia,
Alport Synd., Lowe Synd., Stickler Synd.,
Down Synd.
• Skin Diseases – Atopic Dermatitis,
Ichthyosis
October 15, 2008 Prof Sanjay Shrivastava 23
 Etiology of Cataract
• Physical Factors – Trauma (Blunt / Perforating) ,
Electric Shock, Radiation
• Toxic Agents – Corticosteroids,
Anticholinesterases, Chlorpromazine, Busulfan,
Choroquine, Amiodrone, Cigrette smoker,
Copper, Iron, Gold, naphthalene, lactose,
Galactose, selenite, thallium, Dinitrophenol,
Paradichlorobenzene
• Deficiency – of amino-acids or Riboflavin (B2)

October 15, 2008 Prof Sanjay Shrivastava 24

 Pathogenesis of Cataract
• Caused by degeneration and opacification
of existing lens fibres, formation of
aberrant fibres or deposition of other
material in their place.
• Factors causing disturbance of critical
intra – and extra-cellular equilibrium of
water and electrolyte or deranges the
colloid system within the fibres tends to
bring about opacification.

October 15, 2008 Prof Sanjay Shrivastava 25

 Pathogenesis of Cataract
• Fibrous metaplasia of fibres (in
complicated cataract)
• Epithelial cell necrosis (Glaucomflecken)
• Deposition of abnormal products of
metabolism, drugs or metals.

October 15, 2008 Prof Sanjay Shrivastava 26

 Pathogenesis of Cataract
• Biochemical Processes
– Hydration
– Denaturation of Lens Proteins
– Sclerosis

October 15, 2008 Prof Sanjay Shrivastava 27

 The Pathology of Cataract
• The Changes in the Epithelial Cells and
the Capsule
• Changes in the Lenticular Fibres
• Sclerosis

October 15, 2008 Prof Sanjay Shrivastava 28

 Symptoms of Cataract
1. Blurring of vision
2. Frequent change of glasses due to rapid
change in refractive index of the lens
3. Painless, progressive gradual diminution
of vision due to reduction in transparency
of the lens
4. Second sight or myopic shift in case of
nuclear cataract causing index myopia,
improving near vision.
October 15, 2008 Prof Sanjay Shrivastava 29
 Symptoms of Cataract
5. Loss or marked diminution of vision in
bright sunlight or bright light beam in
central posterior subcapsular cataract.
6. Monocular diplopia or polyopia in
presence of cortical spoke opacities
7. Glare in posterior subcapsular cortical
cataract due to increased scattering of
light
October 15, 2008 Prof Sanjay Shrivastava 30
 Symptoms of Cataract
8. Colored haloes around the light as seen
in cortical cataract due to irregular
refractive index in different parts of the
lens.
9. Color shift , reds are accentuated
10. Visual field loss, generalized reduction in
sensitivity due to loss of transparency

October 15, 2008 Prof Sanjay Shrivastava 31

 Differential Diagnosis of painless
gradual diminution of vision
• Chronic open angle glaucoma
• Macular degeneration
• Optic atrophy
• Corneal dystrophy
• Retinopathy associated with systemic
disorders (hypertension or diabetes)

October 15, 2008 Prof Sanjay Shrivastava 32

 Disturbances in Vision
• Appearance of Block Spots
• Reduction of Visual Fields
• Uniocular Polyopia
• Lenticular Myopia
• Changes in Colour values

October 15, 2008 Prof Sanjay Shrivastava 33

 Etiology of Cataract
Etiological Theories
2. Biological
a. An expression of senility
b. Genetic
2. Immunological
3. Functional, due to strain of excessive
accommodative strain

October 15, 2008 Prof Sanjay Shrivastava 34

 Etiology of Cataract… contd
4. Local Disturbances
a. Nutritional supply
b. Of the chemistry of lens due to
disturbances of permeability
c. Radiational damage due to sunlight

October 15, 2008 Prof Sanjay Shrivastava 35

 Etiology of Cataract… contd
5. General metabolic disturbances
a. changes in blood chemistry
b. toxic states
c. conditions of deficiency
d. endocrine disturbances

October 15, 2008 Prof Sanjay Shrivastava 36

 Experimental Cataract
• Can be produced by:
1. Mechanical injury – concussion, rupture of
capsule
2. Physical causes – Osmotic influences, cold
and heat, acidity, electricity current
3. Radiational Cataract – Micro-wave, thermal,
UV and ionizing radiation

October 15, 2008 Prof Sanjay Shrivastava 37

 Experimental Cataract… contd
1. Decrease in semipermeability of capsule
2. Interference with nutrient supply
3. Anoxia and asphyxia
4. Sugar Cataract – Galactose, xylose,
glucose
5. Deficiency cataract- lack of proteins,
specific amino acids and vitamins

October 15, 2008 Prof Sanjay Shrivastava 38

 Experimental Cataract
9. A low calcium / phosphate ratio in the
blood – parathyroidectomy and tetany
10. Endocrine Cataract
11. Toxic cataract – Naphthaline,
dinitrophenol, paradichlorbenzene,
thallium, cobalt, anti-mitotic agents,
enzyme inhibitors, cataractogenic drugs
11. Due to systemic infections
October 15, 2008 Prof Sanjay Shrivastava 39
 Clinical Examination

October 15, 2008 Prof Sanjay Shrivastava 40