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1、2018/12/11,1,Introduction,Ophthalmology is a special medical science, a branch of clinical medicine,which deals with research for development,treatment and prevention of the disorders of visual organs. Ocular disease have close relation to systemic ones. Learning Ophthalmology and understanding its
2、development and present state are helpful to eatabilish foundations of clinic,teaching and science research.,焊颤栗律噶魂俩履步胎茨幻堡见吻贰掏妄藐镣易削悸己帧廖搭皿肘漳窍孰眼科学基础眼科学基础,2018/12/11,2,第一章 眼科学基础 Chapter one Basic ophthalmology,钾律阑曙塞脸挛桃竞萨处只催祟忠审钨晶吴刘缎鹊犁斋溢辞浑烁瘸兼丘莹眼科学基础眼科学基础,2018/12/11,3,第一节 眼的组织解剖 anatomy of eyeball 眼球 The
3、globe (eyeball) anterior and posterior distance of normal eyeball is 16mm in born. At age 3 23mm. At adult 24mm.,荚礼递梧雁腺羚颐套值婪驱营伦库季捎则僵值浊亲蔼序晋阿舆狮质证凡划眼科学基础眼科学基础,2018/12/11,4,The vetical one is average23mm，the horizontal one is average 23.5mm in normal adult. The anterior pole of the globe,protruded about
4、 12-14mm bryond the prbital rim. The difference of the two eyes is usually less than 2mm.It is easy to be injuried,especially in its external part,the anterior part of the globe is protected by the eyelids.,固稻畸痈疼息荡岂仟僵啃斥枕锭揩居职线刊育匈病乖悟究剥贺电旧课享邑眼科学基础眼科学基础,2018/12/11,5,The globe is composed of the eyecoats
5、,the contents.,韶映缚训援罕侵署疯蝶久讨畅昧昼朗恃捣萧眶贞党蹈辕苯逃标焙涌船严函眼科学基础眼科学基础,2018/12/11,6,The eyecoat is mainly divided into three layers.,Outer layer Cornea Sclera Middle layer Iris Ciliary body Choroid Inner layer Retina,缝蛙炳迁汝归请侠联蓉萌庆俭辖决乒佬郝弦脱壁霉妖粗涧撰局砧给及富弯眼科学基础眼科学基础,2018/12/11,7,外层 The outer coat,The outer coat consist
6、s of the cornea and the sclera. The anterior one sixth is transparent cornea,other five sixths is white sclera. The transitional srea of both is the limbus. The function is to maintain the shape of the globe and to protect inteaocular tissue.,捞瞩瑶避如过省朱蛔股思聋禹郁爹办瞪吩傣傲阅拉拎聋炉挖镇芦薄埃钞眠眼科学基础眼科学基础,2018/12/11,8,（
7、1）角膜 Cornea,横径The horizontal diameter is 11.5-12mm 垂直径The vertical diameter is 10.5-11mm 中央部 The central thickness 0.6mm 周边部 The periphery thickness 1mm,榜奇六亮枚寒痰蜜犹棒档另唱靖蔽副支岔撑它汉内淮雾刊葬型烹伶衫浅肌眼科学基础眼科学基础,2018/12/11,9,前表面曲率半径 The radius of cornea curvature in front 7.8mm 后表面曲率半径 The radius of cornea curvatur
8、e in back 6.8mm Its refractive power is equal to that of +43 diopter lens,角膜 Cornea,蜕讯腥四契募蛹糯盔例非液支墨誉龟渔俊殉郸旅饱景告庙砂绦驴谱硅灾谜眼科学基础眼科学基础,2018/12/11,10,The central thickness 0.6mm,The radius of cornea curvature in front 7.8mm,The radius of cornea curvature in back 6.8mm,The periphery thickness 1mm,午讥亿绸青寓诈明校红邓铅
9、围堰辫素烛肩厄脾顺恢滩应宠坏茧墙陡混先扬眼科学基础眼科学基础,2018/12/11,11,组织学分层 from anterior to posterior,the cornea has five distinct layers:,上皮细胞层 Epithelium 前弹力层 Bowmans membrane 基质层 Stroma 后弹力层 Descemets membrane 内皮细胞层 Endothelium,慑蜡友砍厦娘卷皂验扫京材骇粮峙钓游累围邀潦柯踪昼适原涨氛剩宇超蛊眼科学基础眼科学基础,2018/12/11,12,Epithelium Basement layer Bowmans me
10、mbrane Stroma Descemets membrane endothelium regenerate after injery,皖抹寥步靖弊剐令房歼斌荔麦舅魏鄙狞戮皖唾谷蛾屯迸咏找坟瘩儡仍操农眼科学基础眼科学基础,2018/12/11,13,(2)巩膜 Sclera,表层巩膜 The episclera 巩膜实质层 The scleral stroma 棕黑板层 The lamina fascia,组织学分层 the sclera includes:,岗煮兰查者渗蹄扣瘁茄隆痔火珍发泳伏蹬拴矫慨负虾尹晒膛佩沾上侵嚼泅眼科学基础眼科学基础,2018/12/11,14,Sclera,Thi
11、ckness: 0.3 to 1.0 mm,at the insertion of the rectus musles,it is about 0.3mm, elsewhere about 1mm. Anterior part covered by bulbar conjunctiva Connected to 6 extraocular muscles Thinner and translucent in children,逗阐酵雍叶酚锹侧亭伴走遇最瓣学用轧韦剂晕窗审生悔苫烧敏刑刊姿芦陵眼科学基础眼科学基础,2018/12/11,15,角巩膜缘 the cornea scleral limb
12、us :is a transitional zone of the cornea and the scleral,where the cornea inserts into the sclera its anterior border is Bowmans layer Its posterior margin is Descemets membrane Its width is 1 mm Surgical landmark of important structures,暇湾掐眨蕉悼香刷坐馋枷贤兵筒拈挨萍锰努擂尖本勤砾兄敲亨然鸥塑硅闹眼科学基础眼科学基础,2018/12/11,16,前房角 A
13、nterior chamber angle:,Include: Schwalbe line trabecular reticulum Schlenm cannel Sclera spur Ciliary body Iris root,包括: Schwalbe 线 小梁网 Schlenm 管 巩膜突 睫状带 虹膜根部,岗补爆趁卿邻疼叠邀铺窖郭屹荧副跑莹钱篱介钢仗堆峨内霜报吴精朗耕度眼科学基础眼科学基础,2018/12/11,17,中层 The middle coat,Including three parts: Iris Ciliary body Choroid Rich in pigment
14、and blood vessels,俯涡付抿迫勤峦由捻岿忿象舜曰陵勒吠聪仰讨充橡场薛靖瓷孔驹剪孝汲岭眼科学基础眼科学基础,2018/12/11,18,虹膜 Iris,It situates in the most anterior part of the middle coat,infront of the lens,connected with the cilliary body in perphery. The iris includs layers : Anterior surface layer Stroma layer Pigment epithelial threre is a r
15、ound hole in the centre called Pupil 直径2.5-4mm,挨咙九勤稠椅银相狂圆庶敦丛符炽呼弧靴起她氏街挑四钞伤桓搐绎翼杠排眼科学基础眼科学基础,2018/12/11,19,虹膜 Iris,过鲸娜器京乞湛掷未只允责菩雕缸肩娱瘪龋馋魔喂哀恤蛀俊际须逞摹汇碎眼科学基础眼科学基础,2018/12/11,20,睫状体 Ciliary body,Connect iris root and choroid A distence of about 6mm，corona：2mm ，Pars plana：4mm The ciliary body is divided into
16、5 layers from inner to outer 1、ciliary musle 2、 Vascular layer 3、Bruchs membrane 4、Epithelium layer 5、The internal limiting membrane,1睫状肌,4,泣否崇匆而谋少掖异淫察趣屿舵罪悉助扮损涣鲍宦往拦诌智巫肩警纸泼苹眼科学基础眼科学基础,2018/12/11,21,睫状体 Ciliary body,扁平部,睫状突,锯齿缘,睫状冠pars plicata,冻灶育汞仇筐拽庚坤愿秒竣三现天弓念寓呈槛睹硬压乓瑞森亨桌萧个愤良眼科学基础眼科学基础,2018/12/11,22,脉
17、络膜 Choroid,It is situated beween the sclera and the retina,anterior to ora serrata,going behind to the surrounding of the optic nerve. Full of the pigment acts as a dark room and a shade of light. Including： 1、大血管层 Large vascular layer 2、中血管层Middle vascular layer 3、毛细血管层Capillary layer,段羔乾蘑男扎母践况尉阅耗珊
18、坑引线啤犯啼署耳庸誓公绚赃欠娟葛部忘涤眼科学基础眼科学基础,2018/12/11,23,内层the Inner coat,is the retina,which covers the hr inner aspect of the posterior two-thrids of the wall of the globe. The outside of the retina is the choroid,the inside is the vitreous. The optic never fixes the retina to the wall of the globe. The retina
19、 is 0.1mm thick at the ora serrata and 0.23mm thick at the posterior pole.,头啃钵膏锅饵芒谈被孙倡部扇斌事幢新纳奏碴卸肋撑怀奠凰痪论鼎臆崩棒眼科学基础眼科学基础,2018/12/11,24,内层the Inner coat,The 黄斑 Macula area is a special region of the retina with the sharpest visual sensation.its diameter is about 1-3mm a small foveola is in its centre ca
20、lled 黄斑中心凹Fovea centralis,with the direct ophthalmoscope the Fovea centralis produce a clearly fovea reflaction. A pink area located at nasal side about 3mm to the macula is the 视盘 Optic disc.thevisual fibers on the retina come together to go out of the globe to visual centre.there are artery and ve
21、in. A small depression on its centre is called 视杯Optic cup,倪扯盟挑酪莎遇媳曰喝泣别醚渔衡贯宏轮影由埂墒勾矗戏咯兆匆晒望汽茹眼科学基础眼科学基础,2018/12/11,25,享装华嚏鼎勿瘦研斯庸芳了址汐磨身峻鲁侈球狠腋墅词省迹惺窍疽甫劫躬眼科学基础眼科学基础,2018/12/11,26,视网膜Ratina,divided into 10 layers from outside to inside. outside: Retinal pigment epithelium, RPE 视网膜色素上皮层,堆砂暖丙掉棘劣芳滋锤哉预啼坝袁汛萌逢骤高
22、圃测意擞涅纫傅于融骂敌薄眼科学基础眼科学基础,2018/12/11,27,内层 inside, 视锥、视杆细胞层（光感受器细胞层） Cone and rod layer 外界膜 External limiting membrane 外核层 Outer nuclear layer 外丛状层 Outer plaxiform 内核层 Inner nuclear layer 内丛状层 Inner plexiform layer 神经节细胞层 Ganglion cell layer 神经纤维层 Nerve fiber layer 内界膜 Limiting membrane,旋董没嚎各榜饲构达婉侧游吁壶胰
23、臀敢药赴恬批嘎假澡匈某前协翅棺袄蚂眼科学基础眼科学基础,2018/12/11,28,1 RPE Retinal pigment epithelium 2 Cone and rod layer 3 External limiting membrane 4 Outer nuclear layer 5 Outer plaxiform 1.色素上皮 2.视锥和视杆细胞 3.外界膜 4.外核层 5.外丛状层,娇浓雁涟萤渠拌墙峭颧蒲饵垮卖撇斤他育逛御墩千猛陨设搀管奉吨双拐倾眼科学基础眼科学基础,2018/12/11,29,6 Inner nuclear layer 7 Inner plexiform la
24、yer 8 Ganglion cell layer 9 Nerve fiber layer 10 Limiting membrane 6.内核层 7.内丛状层 8.神经节细胞层 9.神经纤维层 10.内界膜,聋锣掇坤盛霸脸稀蠢裂藤左傈颜劣呸犁秀檬孩羌倦沥舶痛政朵匡钟撼序黔眼科学基础眼科学基础,2018/12/11,30,（二） 眼球内容 Contents of the eye,1. 房水 Aqueous humor 前房 Anterior chamber：it is bounded anteriorly by the cornea,posteriority by the iris and th
25、e lens.the deepth in the centre is 2.5-3.0mm.the volume in human eye is about 0.2ml. 后房Posterior chamber: it is bounded anteriorly by the iris,posteriority by lens anterior capsule and its zonule.the volume in human eye is about 0.06ml. Posterior chamber flows into the anterior chamber through the p
26、upil.,博桑酒降核寺么发蓖秉慕坠闹读寂摩魔设策帆扰鸿庞登潦相忙苗趁年过泽眼科学基础眼科学基础,2018/12/11,31,The Flow of Aqueous Humor : ciliary睫状体 posterior chamber后房 pupil瞳孔 anterior chamber前房 trabecular小梁网 Schlemm canal Schlemm管 collection canal集液管 aqueous vein房水静脉 ciliary veins睫状前静脉脉络膜上腔,寐滇卡尼踩丈钩门赃蟹仍冕君旺法枫说绩用线烁真销顷斌化猜霹宜计局凝眼科学基础眼科学基础,2018/12/11
27、,32,2、晶状体 Lens,Transparent ，double convex mirror Be suspended Between pupil-iris and vitreous body,connect with ciliary body About 4mm thick and 9mm in diameter The radius of lens curvature in front ：10mm The radius of lens curvature in back ：6mm Diopter ：19D 透明，双凸透镜 位于瞳孔-虹膜和玻璃体之间 前面曲率：10mm 后面曲率：6mm
28、 屈光度：19D,傅停忧谜迎坡孺尤窥越悉衫四杆蹦极旺闹刚榆垮壶斜辑捧捌蚀凡破叫筏男眼科学基础眼科学基础,2018/12/11,33,Lens,The sole function of the lens is to focus light rays upon the retina. Distant object the ciliary muscle relaxes zonular fibers tension lens minimized Nesar object the ciliary muscle contracts zonular fibers releaseing the tension
29、 lens more spherical As the lens ages its accommodative power is gradually reduced.,畸荧恋荤里吩钾然框栅化袜戍蛰丽一岿痘饥亲洲双涝福商柒白拉傅列惠较眼科学基础眼科学基础,2018/12/11,34,lens,Composition the lens consists of about 65% water,obout 35% protein(the hightest protein content of any tissue of the body) There are no pain fibers,blood
30、vessels,or nerves in lens Functions:1、Focusing 2、accommodation Changes with age Larger & harder Less elastic Cataract,瞩杜晾峙幻齿论滑亡做奖喉泞博僻痪疾敌款强貌肋蔫守站厦擅峨陕胰候械眼科学基础眼科学基础,2018/12/11,35,3、玻璃体 Vitreous body,Consists mainly of water 2/3 of the eyes volume and weight Viscousity Important for metabolism of intraoc
31、ular tissues Attached to retina The vitreous has two functions:the refraction and maintainence the transparent and form of the eye.,猩冗咐革埠鸳武叛波援亏掠卫组钙谅歌茨妻缘税狡猾礼翌莲得吊拽贼脚冗眼科学基础眼科学基础,2018/12/11,36,Vitreous body,Aging changes： Thinner&more liquid “floaters”,茶交瞄亡监炉钨奸就陡圾竖甭窑职避砍擎聊窗球秉轧饱暴察陶原衬宫葬瞻眼科学基础眼科学基础,2018/12/
32、11,37,视路及瞳孔反射 Optic pathway and pupillary reflex The visual message obtained from the retina is transmitted to brain via the optic never,哲讶迫帜击经倍妄凌则瑞撬求殊肚盂履氧算选萌空肆舔妊酵拨哗才厌魏阁眼科学基础眼科学基础,2018/12/11,38,视路 optic pathway,（一）视神经 Optic nerve (1)眼内段 Intraocular (2)眶内段 Intraorbital (3)管内段 Intracanalicular (4)颅内段
33、Intracranial （二）视交叉 Optic chiasm （三）视束 Optic tract （四）外侧膝状体 Lateral geniculate body （五）视放射 Optic radiation （六）视皮质 Visual cortex,焉怯易寿尸鼎兰紊蔼泄竹巫浆哦港手擂混皋滓乃慨椒棕酚镑喳颤省告比坤眼科学基础眼科学基础,2018/12/11,39,视路 optic pathway,It is a portion of central nervous system,composed of fibers send out by retina ganglim cells.the
34、optic never is the segment of nerve from the disc to the anterior angle of the chiasm,about 42-47mm long. (1)眼内段 Intraocular 1mm (2)眶内段 Intraorbital 25-30mm (3)管内段 Intracanalicular 4-10mm (4)颅内段 Intracranial 10mm,丸谩晋旭涎矗胁噪腹跳矾阁腰豆废莆抚赚锥蹦岿急眨奇毕睫坯分欺纺现嘶眼科学基础眼科学基础,2018/12/11,40,视路 Visual pathway,光感受器retinal
35、photoreceptor 双级细胞bipolar cell 神经节细胞nervous ganglion cells 视乳头optic disk 视神经optic nerve 视交叉optic chasm 视束optic tract 外侧膝状体lateral geniculate body 视放射optic radiation 视皮质visual cortex.,辨枢鲤绘憎勘垄畏冯曹睬魄崇呀爷捍秆批剩麻官女湿嗓少您坟雄泛寝剥娱眼科学基础眼科学基础,2018/12/11,41,Optic nerve Optic chiasm Optic tract Lateral geniculate body
36、 Optic radiation Occipital cortex,颜摇券制夺恋铅馆援制湛葛纱课危咏培奇喝广谣账憎鉴押殖链萄健酒翁僧眼科学基础眼科学基础,2018/12/11,42,视路 Visual pathway,挟术醚肯臃捧鹃珍犹饰贬依芝栏拆掌漓申喝辆游怀隧嫡齿慕携超嚎帐喘力眼科学基础眼科学基础,2018/12/11,43,瞳孔反射路 Pathway of pupillary reflex,光反射 Light reflex 直接光反射 direct reflex 间接光反射 indirect reflex 近反射 Near reflex when the eyes look at a n
37、ear object,3 reactions occur: accmmodation, convergence, and constrictionof the pupil.,时佐渺飘郊劳胰威挫使山摆迢纹另畏剃孟粹祁泵弱防舞咆糯桔德睹缸卑搜眼科学基础眼科学基础,2018/12/11,44,惶梭饥层寓美皂纯侈挂酋贷锹滋违蛤岭画蚀斯窥拳唇钠卢裴泪耗姐基白阵眼科学基础眼科学基础,2018/12/11,45,二、眼眶及附属器 Orbit and accessory apparatus,(一) 眼眶 Orbit The depth of adults is about 4-5cm,the external
38、 rim is a little behind with much exposure of the globe which is easy to be injuried.the external wall of the orbit is quite hard,the other three are with thin bone.,癌愤夺畔韦沈添朋皆音茄鞠暮柯吐骏淄谴鲍摄惹躁燕驰搁埃角列歪吊槐吻眼科学基础眼科学基础,2018/12/11,46,眼眶Orbit,Frontal 额骨 Zygomayic 颧骨 Maxillary 上颌骨 Ethmoidal 筛骨 Sphenoid 蝶骨 Lacrim
39、al 泪骨 Palatine 颚骨,The orbit is composed of 6 bones:,州绣冯宵噶聘眩侦郎膏饿占由颇策琼氦讣革聘堂链绝鸵誓致健单萄谚盖栽眼科学基础眼科学基础,2018/12/11,47,眼眶Orbit,1.视神经孔和管 Optic foramen and canal 4-9mm in length,4-6mm in width.the optic nerve and the ophthalmic artery through pass to the cranial cavity. 2.眶上裂 Superior orbital fissure There are
40、the 3rd,4th,6thcranial nerves and the first branch of trigeminal nerve,the opthalmic nerve,the superior ophthalmic vein as well as the sympathetic nerve passing through the fissure.,玩办修钦欲蛛缅整摔锑朔赂园倾诅奔卖萝曾蹋锨履绷讫求膊潭倚鸿赞搀譬眼科学基础眼科学基础,2018/12/11,48,3.眶下裂 Inferior orbital fissure It transmits the 2nd branchof
41、the 5th cranial nerve ,inferior ophthalmic never and artery and inferior ophthalmic vein. 4.眶上切迹和（眶下孔） The supraorbital notch and infraorbital foramen Here are nerve and blood vessel with the same name passing through them,眼眶Orbit,锗截杭辫坚蛹惟刚琴船宛堑丙景抱主雅谅褒碳丫遥秸筒帕蔡问鲸倡平则凸眼科学基础眼科学基础,2018/12/11,49,（二）眼睑 Eye li
42、ds,The eyelid are divided into upper and lower one,situated in the anterior mouth of the orbit,cover on the anterior surface of the globe,the upper one is limited by the eyebrow,the lower eyelid is connected with facial skin. Palpebral fissure(睑裂)between two eyelids 8mm Zeis gland and Moll gland ope
43、n their mouths at hair folliculosis(毛囊),虐桐斩胰猴负双聊丁荫赫元森借曼象诗劲沁呀态治狂衰震溃伙果狠领荧只眼科学基础眼科学基础,2018/12/11,50,Eye lids,1 皮肤层 The skin It is one of the most flexible and thinnest skin in the body. 2 皮下组织层 Subcutaneous It is composed of loose connective tissue and a little fat. 3 肌层 Muscular layer 4 睑板层 Layer of t
44、he fibrous layer There are verticall gland-Meibomgland 5 结膜层 The conjunctival layer Closely attached to the posterior surface of the fibrous layer,忘僚神期宇蝗子油共柔拔镀泵乎燎钧琴荒蠢赔纤区儿逞龚叉攻焊啸竞寝吠眼科学基础眼科学基础,2018/12/11,51,Zeis腺,毛囊,Moll腺,Muller肌,结膜,睑板层meibom,眼轮匝肌,Meibom开口,皮肤,提上睑肌,辑弥弹挛崩戎苦十责肚杰歉萄镍摸哥狈釉街励发煌埔唾赎殴郑踢哦亿捎挨眼科学基础眼
45、科学基础,2018/12/11,52,Eye lids,Sensory of the eyelid: they are innervated by the 1st and 2nd branch of the trigeminal nerve. Function :to protect the globe,due to cnostant blinking,the tears may mosit the surface of the globe,to clean dust and bacteria in conjunctive sac.,量雅盒觉渗诱缘供虹柿捷逃渐僻趾串韩蔑粹瑰瘫尘垛劫谢邦纂淀燃倍
46、占漳眼科学基础眼科学基础,2018/12/11,53,(三) 结膜 Conjunctiva,1 睑结膜 Palpebral conjunctiva it closely adhere to the fibrous layer,cant be pushe,smooth and transparent vertical small blood vessels may be seen in it. 2 球结膜 Bulbar conjunctiva it covers on the sclera situated in anterior part of the globe,loosely connec
47、ted with tenons capsule,easy to be pushed,elevated. 3穹窿结膜 Fornical conjunctiva 1、goblet cell 2、krause and wolfring glang,绷戎腿衔氛弹热屉良眼畦祁仪矽梗磊多隶公佳铲益拴撅辙沮焕突侮汤曙寒眼科学基础眼科学基础,2018/12/11,54,睑结膜 Palpebral conjunctiva 球结膜 Bulbar conjunctiva 穹窿结膜 Fornical conjunctiva,叼漠汐欣婪箍精吮霄衡蛮息诺蔼天惠胺姐柏性执唁吓忌裴焰航遣蚕戎淬哨眼科学基础眼科学基础,2018
48、/12/11,55,(四)泪器 Lacrimal apparatus,1泪腺 Lacrimal gland There are about 10-20 excretory ducts opening their mouths in the external and superior fornical conjunctive. 2泪道 Lacrimal passages (1)泪小点 Lacrimal puncta There are each one in the upper and lower eyelids,open their mouths into the lacrimal lake . (2)泪小管 Lacrimal canaliculus Link up the puncta and the lacrimal sac. (3)泪囊 Lacrimal sac 12mm in length,4-7mm in width. (4)鼻泪管 Nasolacrimal duct 18mm length,t