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1、2019/6/22,1,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 d
2、evelopment and present state are helpful to eatabilish foundations of clinic,teaching and science research.,2019/6/22,2,第一章 眼科学基础 Chapter one Basic ophthalmology,2019/6/22,3,第一节 眼的组织解剖 anatomy of eyeball 眼球 The globe (eyeball) anterior and posterior distance of normal eyeball is 16mm in born. At age
3、 3 23mm. At adult 24mm.,2019/6/22,4,The vetical one is average23mm，the horizontal one is average 23.5mm in normal adult. The anterior pole of the globe,protruded about 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
4、external part,the anterior part of the globe is protected by the eyelids.,2019/6/22,5,The globe is composed of the eyecoats,the contents.,2019/6/22,6,The eyecoat is mainly divided into three layers.,Outer layer Cornea Sclera Middle layer Iris Ciliary body Choroid Inner layer Retina,2019/6/22,7,外层 Th
5、e outer coat,The outer coat consists 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.,2019/6/22,8,（1）角膜 Corn
6、ea,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,2019/6/22,9,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 curvature in back 6.8mm Its refractive power is equal to that
7、 of +43 diopter lens,角膜 Cornea,2019/6/22,10,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,2019/6/22,11,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 Bowm
8、ans membrane 基质层 Stroma 后弹力层 Descemets membrane 内皮细胞层 Endothelium,2019/6/22,12,Epithelium Basement layer Bowmans membrane Stroma Descemets membrane endothelium regenerate after injery,2019/6/22,13,(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 includ
9、es:,2019/6/22,14,Sclera,Thickness: 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,2019/6/22,15,角巩膜缘 the cornea scleral limbus :is a transiti
10、onal 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,2019/6/22,16,前房角 Anterior chamber angle:,Include: Schwalbe line trabecular reti
11、culum 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,2019/6/22,17,中层 The middle coat,Including three parts: Iris Ciliary body Choroid Rich in pigment and blood vessels,2019/6/22,18,虹膜 Iris,It situates in the most anterior part of the middle coat,infront o
12、f the lens,connected with the cilliary body in perphery. The iris includs layers : Anterior surface layer Stroma layer Pigment epithelial threre is a round hole in the centre called Pupil 直径2.5-4mm,2019/6/22,19,虹膜 Iris,2019/6/22,20,睫状体 Ciliary body,Connect iris root and choroid A distence of about 6
13、mm，corona：2mm ，Pars plana：4mm The ciliary body is divided into 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,4,2019/6/22,21,睫状体 Ciliary body,扁平部,睫状突,锯齿缘,睫状冠pars plicata,2019/6/22,22,脉络膜 Choroid,It is situated
14、 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,2019/6/22,23,内层the Inner coat,is the r
15、etina,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 is 0.1mm thick at the ora serrata and 0.23mm thick at the posterior
16、pole.,2019/6/22,24,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 called 黄斑中心凹Fovea centralis,with the direct ophthalmoscope the Fovea centralis produce a clearly fovea reflaction.
17、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 vein. A small depression on its centre is called 视杯Optic cup,2019/6/22,25,2019/6/22,26,视网膜Ratina,divided into 10 la
18、yers from outside to inside. outside: Retinal pigment epithelium, RPE 视网膜色素上皮层,2019/6/22,27,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
19、Nerve fiber layer 内界膜 Limiting membrane,2019/6/22,28,1 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,2019/6/22,29,6 Inner nuclear layer 7 Inner plexiform layer 8 Ganglion cell layer 9 Nerve
20、 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,2019/6/22,30,（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 the lens.the deepth in the centre is 2.5-3.0mm.the volume in human eye is about
21、 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 pupil.,2019/6/22,31,The Flow of Aqueous Humor : ciliary睫状体 posterior chamber后房
22、 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,2019/6/22,32,2、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
23、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 屈光度：19D,2019/6/22,33,Lens,The sole function of the lens is to focus light rays upon the retina. Distant object the ciliary muscle relaxes zonular fibers tension len
24、s minimized Nesar object the ciliary muscle contracts zonular fibers releaseing the tension lens more spherical As the lens ages its accommodative power is gradually reduced.,2019/6/22,34,lens,Composition the lens consists of about 65% water,obout 35% protein(the hightest protein content of any tiss
25、ue of the body) There are no pain fibers,blood vessels,or nerves in lens Functions:1、Focusing 2、accommodation Changes with age Larger & harder Less elastic Cataract,2019/6/22,35,3、玻璃体 Vitreous body,Consists mainly of water 2/3 of the eyes volume and weight Viscousity Important for metabolism of intr
26、aocular tissues Attached to retina The vitreous has two functions:the refraction and maintainence the transparent and form of the eye.,2019/6/22,36,Vitreous body,Aging changes： Thinner&more liquid “floaters”,2019/6/22,37,视路及瞳孔反射 Optic pathway and pupillary reflex The visual message obtained from the
27、 retina is transmitted to brain via the optic never,2019/6/22,38,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 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,2
28、019/6/22,39,视路 optic pathway,It is a portion of central nervous system,composed of fibers send out by retina ganglim cells.the 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 Intracana
29、licular 4-10mm (4)颅内段 Intracranial 10mm,2019/6/22,40,视路 Visual pathway,光感受器retinal 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.,2019/6/22,41,Optic nerve Optic chi
30、asm Optic tract Lateral geniculate body Optic radiation Occipital cortex,2019/6/22,42,视路 Visual pathway,2019/6/22,43,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 near object,3 reactions occur: accmmodation, conve
31、rgence, and constrictionof the pupil.,2019/6/22,44,2019/6/22,45,二、眼眶及附属器 Orbit and accessory apparatus,(一) 眼眶 Orbit The depth of adults is about 4-5cm,the external 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 oth
32、er three are with thin bone.,2019/6/22,46,眼眶Orbit,Frontal 额骨 Zygomayic 颧骨 Maxillary 上颌骨 Ethmoidal 筛骨 Sphenoid 蝶骨 Lacrimal 泪骨 Palatine 颚骨,The orbit is composed of 6 bones:,2019/6/22,47,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 th
33、rough pass to the cranial cavity. 2.眶上裂 Superior orbital fissure There are 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.,2019/6/22,48,3.眶下裂 Inferior orbital fissure
34、 It transmits the 2nd branchof 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,2019/6/22,49,（二）眼睑 Eye lids,The eyelid
35、 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 open their mouth
36、s at hair folliculosis(毛囊),2019/6/22,50,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 the fibrous layer There are verticall gland-Meibomgland 5
37、结膜层 The conjunctival layer Closely attached to the posterior surface of the fibrous layer,2019/6/22,51,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,2019/6/22,52,Eye lids,Sensory of the eyelid: they are innervated by the 1st and 2nd branch of the trigeminal nerve. Function :to protect th
38、e globe,due to cnostant blinking,the tears may mosit the surface of the globe,to clean dust and bacteria in conjunctive sac.,2019/6/22,53,(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 see
39、n in it. 2 球结膜 Bulbar conjunctiva it covers on the sclera situated in anterior part of the globe,loosely connected with tenons capsule,easy to be pushed,elevated. 3穹窿结膜 Fornical conjunctiva 1、goblet cell 2、krause and wolfring glang,2019/6/22,54,睑结膜 Palpebral conjunctiva 球结膜 Bulbar conjunctiva 穹窿结膜 F
40、ornical conjunctiva,2019/6/22,55,(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
41、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,the secretion is 0.9-2.2mm each eye.,2019/6/22,56,1泪腺 Lacrimal gland 2泪道 Lacrimal passages (1)泪小点 Lacrimal puncta (2)泪小
42、管 Lacrimal canaliculus (3)泪囊 Lacrimal sac (4)鼻泪管 Nasolacrimal duct,2019/6/22,57,(五) 眼外肌 Extraocular muscles,4条直肌 Rectus 上直肌 superior recti muscles 下直肌 inferior recti muscles 内直肌 medial recti muscles 外直肌 external recti muscles 2条斜肌 Oblique muscle 上斜肌 superior oblique muscles 下斜肌 Inferior oblique musc
43、les,2019/6/22,58,4条直肌 Rectus 上直肌 superior recti muscles 下直肌 inferior recti muscles 内直肌 medial recti muscles 外直肌 external recti muscles 2条斜肌 Oblique muscle 上斜肌 superior oblique muscles 下斜肌 Inferior oblique muscles,上直肌,上斜肌,外直肌,内直肌,下直肌,下斜肌,2019/6/22,59,四、眼球的血液循环和神经分布 Blood circulation and innervation o
44、f the globe,（一）血液循环 Blood circulation 动脉 Artery 1、视网膜中央血管系统 the central retinal vascular system 2、睫状血管系统 the ciliary vascular system,2019/6/22,60,1.视网膜中央血管系统 The central retinal vascular system 视网膜中央动脉 Central retinal artery, CRA,2019/6/22,61,视网膜中央血管系统 The central retinal vascular system,2019/6/22,6
45、2,2. 睫状血管系统 the ciliary vascular system,(1)睫状后短动脉 Short posterior ciliary artery (2)睫状后长动脉 Long posterior ciliary artery (3)睫状前动脉 Anterior ciliary artery,2019/6/22,63,(1)睫状后短动脉 Short posterior ciliary artery (2)睫状后长动脉 Long posterior ciliary artery (3)睫状前动脉 Anterior ciliary artery,睫状后长动脉,睫状后短动脉,睫状前动脉,2019/6/22,64,静脉 Vein,1. 视网膜中央静脉 Central retinal vein CRV 2. 涡静脉 Vortex vein 3. 睫状前静脉 Anterior ciliary vein,2019/6/22,65,1. 视网膜中央静脉 Central retinal vein CRV 2. 涡静脉 Vortex vein 3. 睫状前静脉 Anterior ciliary vein,视网膜中央静脉,涡静脉,睫状前静脉,2019/6/22,66,visual organ,2019/6/22,67,