ANATOMI ANATOMI

PALPEBRAPALPEBRA

Fungsi PalpebraFungsi Palpebra

Pelindung mekanik bola mata.Pelindung mekanik bola mata.Menghasilkan komponen lipid untuk Menghasilkan komponen lipid untuk

tear filmtear filmMembantu membasahi kornea.Membantu membasahi kornea.

THE LIDSTHE LIDS

THE LIDS ARE COVERED THE LIDS ARE COVERED

ANTERIORLY BY SKIN ANDANTERIORLY BY SKIN AND

POSTERIORLY BY MUCOUSPOSTERIORLY BY MUCOUS

MEMBRANE - MEMBRANE - THE CON-THE CON-

JUNGTIVA TARSIJUNGTIVA TARSI. THEY. THEY

CONTAIN MUSCLES,CONTAIN MUSCLES,

GLANDS, BLOOD VESSELS,GLANDS, BLOOD VESSELS,

AND NERVES. ALL BOUNDAND NERVES. ALL BOUND

TOGETHER BY CONNECTIVE TOGETHER BY CONNECTIVE

TISSUE WHICH IS PARTI-TISSUE WHICH IS PARTI-

CULARY DENSE AT THECULARY DENSE AT THE

POSTERIOR PART WHERE IT POSTERIOR PART WHERE IT

FORMS A STIFF PLATE - FORMS A STIFF PLATE -

THE TARSUSTHE TARSUS

THE SKIN OF THE LIDS IS PECULIAR IN ITS THINNES AND ITS LOOSE ATTACH-MENT

THE CILIA OR EYELASHES ARE STRONG SHORT CURVED HAIRS, ARRANGED IN TWO OR MORE CLOSELY SET ROWS

THE SEBACEOUS GLANDS ARE CALLED ZEISS’S GLANDS AND THE SWEAT GLANDS ARE KNOWN AS MOLL’S GLANDS

THE TARSUS CONSISTS OF DENSE FIBROUS TISSUE; IT CONTAINS NO CARTILAGE, EMBEDDED IN IT ARE SOME ENORMOUSLY DEVELOPED SEBACEOUS GLAND : THE MEIBOMIAN GLANDS

THE ORBICULARIS PALPEBARUM OCCUPIES THE SPACE BETWEEN THE TARSUS AND THE SKIN

THE MAIN CENTRAL BOND OF THE LEVATOR PALPEBRAE SUPERIORIS IS INSERTED INTO THE UPPER BORDER OF THE TARSUS

THE THIRD NERVE SUPPLIES THE LEVATOR PALPEBRAE

THE SEVENTH SUPPLIES THE ORBICULARIS

Batas-Batas PalpebraBatas-Batas Palpebra

Batas superior : daerah alis Batas superior : daerah alis dan rima orbita superior.dan rima orbita superior.

Batas inferior : dari rima Batas inferior : dari rima orbita inferior sampai ke kulit orbita inferior sampai ke kulit nasojugal dan lipatan malar.nasojugal dan lipatan malar.

Lebar horizontal fisura =30 Lebar horizontal fisura =30 mm vertikal 8-10 mm.mm vertikal 8-10 mm.

Lipatan Palpebra SuperiorLipatan Palpebra Superior

(Lid crease) :terbentuk dari perlekatan (Lid crease) :terbentuk dari perlekatan serabut aponeurosis levator di lapisan serabut aponeurosis levator di lapisan subkutan.subkutan.

Lokasi: 7-11 mm di atas margo palpebra.Lokasi: 7-11 mm di atas margo palpebra.

Posisi Primer PalpebraPosisi Primer Palpebra

Margo palpebra superior, 1-2 mm di Margo palpebra superior, 1-2 mm di bawah limbus superior.bawah limbus superior.

Margo palpebra inferior pada limbus Margo palpebra inferior pada limbus inferior.inferior.

Margo Palpebra Margo Palpebra (1/2)(1/2)

Gray Line :Pertemuan Gray Line :Pertemuan antara antara epitel berlapis gepeng epitel berlapis gepeng

berkeratin di berkeratin di anterioranterior, , epitel berlapis gepeng epitel berlapis gepeng

tak berkeratin dan epitel tak berkeratin dan epitel berlapis silindris di berlapis silindris di posteriorposterior..

Panjang 25-30 mm dan lebar 2 mm. Panjang 25-30 mm dan lebar 2 mm. Papila lakrimal: 6 mm lateral dari sudut Papila lakrimal: 6 mm lateral dari sudut

kantus medialkantus medial

Margo Palpebra Margo Palpebra (2/2)(2/2)

Bagian anterior margo palpebra terdapat Bagian anterior margo palpebra terdapat otot Riolan.otot Riolan.

Palpebra superior:cilia uk.8-12 mm jumlah Palpebra superior:cilia uk.8-12 mm jumlah 100-150.100-150.

Palpebra inferior:silia ku.6-8 mm, jumlah Palpebra inferior:silia ku.6-8 mm, jumlah 50-75.50-75.

Kel sebasea Zeiss dan kel Apokrin Moll.Kel sebasea Zeiss dan kel Apokrin Moll.

7 Lapisan Palpebra7 Lapisan Palpebra

Kulit & jaringan Kulit & jaringan subkutan.subkutan.

Otot protraktor.Otot protraktor. Septum orbita.Septum orbita. Lemak orbita. Lemak orbita. Otot retraktor.Otot retraktor. Tarsus.Tarsus. Konjungtiva.Konjungtiva.

Lipatan Palpebra : Lipatan Palpebra : Occidental vs OrientalOccidental vs Oriental

Kulit & Jaringan SubkutanKulit & Jaringan Subkutan

Sangat tipis dan elastis.Sangat tipis dan elastis.Tidak mempunyai lapisan lemak subkutanTidak mempunyai lapisan lemak subkutanLapisan dermis:Lapisan dermis:

jaringan ikat longgar yang mengandung serat jaringan ikat longgar yang mengandung serat

elastin,pemb darah,limfe dan sarafelastin,pemb darah,limfe dan saraf..Lapisan subkutan: Lapisan subkutan: folikel rambut & kelenjar folikel rambut & kelenjar

sebacea.sebacea.

Otot PalpebraOtot Palpebra

Otot Protraktor. Otot Protraktor. Otot Retraktor.Otot Retraktor.

Otot Protraktor PalpebraOtot Protraktor Palpebra

M.Orbikularis okuli, melingkari fisura orbit.M.Orbikularis okuli, melingkari fisura orbit.Dipersyarafi saraf otak VII.Dipersyarafi saraf otak VII.Tiga bagian : Tiga bagian :

OrbikularisOrbikularis orbital, orbital,OrbikularisOrbikularis preseptal, preseptal,OrbikularisOrbikularis pretarsal pretarsal..

Otot Orbicularis OrbitalOtot Orbicularis Orbital

Terbesar dan tertebal, melapisi rima Terbesar dan tertebal, melapisi rima orbita.orbita.

Berbatasan dengan Berbatasan dengan otot frontalis,otot frontalis,proserus,proserus,korugator superfisialis korugator superfisialis temporalis.temporalis.

Otot Orbikularis PreseptalOtot Orbikularis Preseptal

Terletak di atas septum orbita.Terletak di atas septum orbita. Fungsi: menutup palpebra & berperan dalam Fungsi: menutup palpebra & berperan dalam

pompa lakrimalis.pompa lakrimalis. Serabut otot preseptal atas dan bawah Serabut otot preseptal atas dan bawah

membentuk tendon di raphe palpebra lateral.membentuk tendon di raphe palpebra lateral.

Otot Orbikularis PretarsalOtot Orbikularis Pretarsal

Bagian terkecil.Bagian terkecil. Fungsi: saat refleks mengedip dan berperan Fungsi: saat refleks mengedip dan berperan

pada pompa lakrimal.pada pompa lakrimal. Dibagi 4 bagian: bagian atas dan bagian bawah Dibagi 4 bagian: bagian atas dan bagian bawah

@superfisial dan dalam @superfisial dan dalam Otot tensor tarsi Horner.Otot tensor tarsi Horner. Dilateral bersatu membentuk tendon kantus Dilateral bersatu membentuk tendon kantus

lateral.lateral.

Septum orbitaSeptum orbita

Jaringan ikat berlapis berasal dari Jaringan ikat berlapis berasal dari periosteum pada rima orbita superior-periosteum pada rima orbita superior-inferior di daerah arkus marginalis.inferior di daerah arkus marginalis.

Fungsi:sebagai barier antara orbita dan Fungsi:sebagai barier antara orbita dan palpebra.palpebra.

Lemak OrbitaLemak Orbita

Normal: letak di posterior septum orbita Normal: letak di posterior septum orbita dan anterior dari aponeurosis levator.dan anterior dari aponeurosis levator.

Dapat mengalami herniasi ke palpebra.Dapat mengalami herniasi ke palpebra.Bantalan lemak sentral penting untuk Bantalan lemak sentral penting untuk

operasi palpebra elektif dan repair laserasi operasi palpebra elektif dan repair laserasi palpebra.palpebra.

Otot Retraktor PalpebraOtot Retraktor Palpebra

Otot rektraktor palpebra superior: m. Otot rektraktor palpebra superior: m. levator dan aponeurosisnya dan levator dan aponeurosisnya dan m.tarsalis superior (muller).m.tarsalis superior (muller).

Otot retraktor palpebra inferior: fasia Otot retraktor palpebra inferior: fasia kampsulopalpebral dan m.tarsalis kampsulopalpebral dan m.tarsalis inferior.inferior.

Dipersarafi: saraf simpatis.Dipersarafi: saraf simpatis.

Otot Retraktor Palpebra Superior Otot Retraktor Palpebra Superior (1/2)(1/2)

M.Levator palpebra : otot utama dan M.Levator palpebra : otot utama dan berfungsi mengangkat palpebra superior berfungsi mengangkat palpebra superior sekitar 15 mm.sekitar 15 mm.

M.Muller : fungsi memberi tambahan tonus M.Muller : fungsi memberi tambahan tonus dan hilang bila kelelahan atau paralisis dan dan hilang bila kelelahan atau paralisis dan palpebra turun 2 mm.palpebra turun 2 mm.

Bila mengalami overstimulasi : terjadi Bila mengalami overstimulasi : terjadi retraksi 2-3 mm di atas normal.retraksi 2-3 mm di atas normal.

Otot Retraktor Palpebra Superior Otot Retraktor Palpebra Superior (2/2)(2/2)

Origo m Levator: di atas anulus Zinn.Origo m Levator: di atas anulus Zinn. Komponen otot 20mm dan komponen Komponen otot 20mm dan komponen

aponeurosis 14-20 mm.aponeurosis 14-20 mm. Lig.Whitmall: letak di daerah transisi Lig.Whitmall: letak di daerah transisi

m.levator dan aponeurosis levator.m.levator dan aponeurosis levator. Fungsi lig.Whitmall:pendukung palpebra Fungsi lig.Whitmall:pendukung palpebra

superior dan jaringan orbita superior.superior dan jaringan orbita superior.

Otot Retraktor Palpebra InferiorOtot Retraktor Palpebra Inferior(1/2)(1/2)

Palpebra inferior membuka secara pasif Palpebra inferior membuka secara pasif karena tarikan m.rektus inferior.karena tarikan m.rektus inferior.

Fasia kapsulopalpebral analog dengan Fasia kapsulopalpebral analog dengan aponeurosis levator.aponeurosis levator.

Dua bagian kepala kapsulopalpebra Dua bagian kepala kapsulopalpebra membentuk lig.Lockwood.membentuk lig.Lockwood.

Otot Retraktor Palpebra Inferior Otot Retraktor Palpebra Inferior (2/2)(2/2)

M.Tarsalis inferior analog dengan m M.Tarsalis inferior analog dengan m Muller.Muller.

Ligamentum suspensorium forniks.Ligamentum suspensorium forniks.

Tarsus Tarsus (1/2)(1/2)

Terdiri dari jaringan padat.Terdiri dari jaringan padat. Berfungsi sebagai rangka palpebra.Berfungsi sebagai rangka palpebra. Ukuran tarsus superior: lebar 10 mm di Ukuran tarsus superior: lebar 10 mm di

sentral,panjang 25-29mm dan tebal 1 mm.sentral,panjang 25-29mm dan tebal 1 mm. Ukuran tarsus inferior: lebar 3.5-4 mm di Ukuran tarsus inferior: lebar 3.5-4 mm di

sentral,panjang 25-29 mm dan tebal 1 mm.sentral,panjang 25-29 mm dan tebal 1 mm.

Tarsus Tarsus (2/2)(2/2)

Mengandung kelenjar Mengandung kelenjar Meibom: 30-40 di Meibom: 30-40 di palpebra palpebra superior ,20-30 di superior ,20-30 di palpebra inferior.palpebra inferior.

KonjungtivaKonjungtiva

Konjungtiva palpebra.Konjungtiva palpebra.Konjungtiva forniks.Konjungtiva forniks.Konjungtiva bulbi.Konjungtiva bulbi.Plika semilunaris.Plika semilunaris.

VaskularisasiVaskularisasi

Suplai vaskular padat dan banyak sirkulasi Suplai vaskular padat dan banyak sirkulasi kolateral.kolateral.

Mempercepat penyembuhan.Mempercepat penyembuhan.Mudah terjadi perdarahan saat prosedur Mudah terjadi perdarahan saat prosedur

operasi.operasi.

Vaskularisasi ArteriVaskularisasi Arteri

Dari a.karotis Interna melalui Dari a.karotis Interna melalui a.oftalmika dan a.infraorbita.a.oftalmika dan a.infraorbita.

A.karotis eksterna melalui A.karotis eksterna melalui a.fasialis dan a.temporalis a.fasialis dan a.temporalis superfisialis.superfisialis.

Membentuk sirkulasi kolateral Membentuk sirkulasi kolateral yang besar.yang besar.

Vaskularisasi VenaVaskularisasi Vena

Terdiri dari arkade palpebra Terdiri dari arkade palpebra superior dan arkade palpebra superior dan arkade palpebra inferior.inferior.

Vena palpebra superior dan Vena palpebra superior dan inferior menuju v.angularis di inferior menuju v.angularis di kantus medial.kantus medial.

Vena angularis membentuk Vena angularis membentuk anastomosis dengan sinus anastomosis dengan sinus kavernosus.kavernosus.

Sistim LimfatikSistim Limfatik

Menuju nodus limfatikus Menuju nodus limfatikus preaurikular dan submandibular.preaurikular dan submandibular.

Menerima drainase dari sistem Menerima drainase dari sistem superfisial dan profunda.superfisial dan profunda.

Pleksus superfisial : menerima Pleksus superfisial : menerima aliran limfa dari kulit dan otot aliran limfa dari kulit dan otot orbikularis.orbikularis.

Pleksus profunda : dari tarsus dan Pleksus profunda : dari tarsus dan konjungtiva.konjungtiva.

Sistem LimfatikSistem Limfatik

Aspek medial palpebra superior Aspek medial palpebra superior inferior,sentral palpebra inferior dan inferior,sentral palpebra inferior dan konjungtiva menuju nodus limfatikus konjungtiva menuju nodus limfatikus submandibularis.submandibularis.

Palpebra superior,aspek lateral Palpebra superior,aspek lateral palpebra inferior dan konjungtiva palpebra inferior dan konjungtiva menuju nodus imfatikus preaurikularmenuju nodus imfatikus preaurikular

Persarafan Persarafan (1/2)(1/2)

2 saraf motorik untuk gerakan palpebra.2 saraf motorik untuk gerakan palpebra.N.III: mempersarafi m.levator palpebra N.III: mempersarafi m.levator palpebra

untuk mengangkat palpebra superior untuk mengangkat palpebra superior dan m.rektus inferior.dan m.rektus inferior.

N.VII mempersarafi m.orbikularis okuli.N.VII mempersarafi m.orbikularis okuli.

Persarafan Persarafan (2/2)(2/2)

N.V :untuk sensasi palpebraN.V :untuk sensasi palpebraPalpebra superior dipersarafi Palpebra superior dipersarafi

oleh cab.1 n.oftalmikusoleh cab.1 n.oftalmikusCabang utama n. oftalmikus: Cabang utama n. oftalmikus:

n.lakrimalis, n.supraorbita, n.lakrimalis, n.supraorbita, n.supratroklearis, dan n.supratroklearis, dan n.infratroklearis.n.infratroklearis.

THE EXTRA OCULAR MUSCLESTHE EXTRA OCULAR MUSCLES

A TEAM OF A TEAM OF SIX MUSCLESSIX MUSCLES CONTROLS THE MOVE-CONTROLS THE MOVE-MENT OF EACH EYEMENT OF EACH EYE THE RECTUS MUSCLETHE RECTUS MUSCLE

- THE MEDIAL RECTUS- THE MEDIAL RECTUS- THE LATERAL RECTUS- THE LATERAL RECTUS- THE SUPERIOR RECTUS- THE SUPERIOR RECTUS- THE INFERIOR RECTUS- THE INFERIOR RECTUS

THE OBLIQUE MUSCLETHE OBLIQUE MUSCLE- THE SUPERIOR - THE SUPERIOR OBLIQUEOBLIQUE- THE INFERIOR - THE INFERIOR OBLIQUEOBLIQUE

Gambar extraocular muscleGambar extraocular muscle

THE RECTUS MUSCLES HAVE THE GENERAL ACTION OF ROTATING THE EYE IN FOUR CARDINAL DIRECTIONS : UP, DOWN, OUT AND IN

THE OBLIQUE MUSCLES HAVE THE PRIMARY FUNCTION OF ROTATION OF THE GLOBE

THE MEDIAL RECTUS IS INSERTED INTO THE SCLERA, ABOUT 5 MM TO THE NASAL SIDE OF THE CORNEO-SCLERAL MARGIN.

THE INFERIOR RECTUS 6 MM BELOW

THE LATERAL RECTUS 7 MM TO THE TEMPORAL SIDE

THE SUPERIOR RECTUS 8 MM ABOVE

THE LACRIMAL APPARATUS

THE LACRIMAL APPARATUS CONSISTS OF•THE LACRIMAL GLANDS•THE LACRIMAL PASSAGES

THE LACRIMAL GLAND OF EACH EYE CONSISTS OF :

• THE SUPERIOR OR ORBITAL GLAND• THE INFERIOR OR PALPEBRAE GLAND• THE ACCESSORY LACRIMAL GLANDS OR KRAUSE’S GLANDS

THE LACRIMAL PASSAGES CONSISTS OF :

• THE LACRIMAL PUNCTA• THE CANALICULI• THE LACRIMAL SAC• THE NASAL DUCT

ANATOMY OF THE GLOBEANATOMY OF THE GLOBE

ANTERIOR SEGMEN

POSTERIORSEGMEN

IRIS PLANE

ANATOMY OF THE EYE BALLANATOMY OF THE EYE BALL

THE WALL OF THE EYE BALL IS COMPOSED OF A DENSE, THE WALL OF THE EYE BALL IS COMPOSED OF A DENSE, IMPER-FECTLY ELASTIC SUPPORTING MEMBRANEIMPER-FECTLY ELASTIC SUPPORTING MEMBRANE

THE ANTERIOR PART OF THE MEM-BRANE IS THE ANTERIOR PART OF THE MEM-BRANE IS TRANSPARENT TRANSPARENT THE THE CORNEACORNEA

THE ANTERIOR PART OF THE SCLERA IS COVERED BY THE ANTERIOR PART OF THE SCLERA IS COVERED BY MUCOUS MEMBRANE MUCOUS MEMBRANE THE THE CONJUNGTIVACONJUNGTIVA

THE CORNEA CONSIST OF FIVE LAYERS : - EPITHELIUMEPITHELIUM - - BOWMAN’S MEMBRANEBOWMAN’S MEMBRANE - - STROMA OR SUBSTANTIA PROPIASTROMA OR SUBSTANTIA PROPIA - - DESCEMET’S MEMBRANEDESCEMET’S MEMBRANE - - ENDOTHELIUMENDOTHELIUM

• THE EPITHELIUM REGARDED AS THE CONTINUATION OF THE CONJUNGTIVA OVER THE CORNEA

• THE SUBSTANTIA PROPIA REGARDED AS THE CONTINUATION FORWARD OF THE SCLERA

• THE STROMA FORMING 90 % OF THE TOTAL CORNEAL THICKNESS

• DESCEMET’S MEMBRANE IS A THIN ELASTIC MEMBRANE, COVERED ON ITS POSTERIOR BY ENDOTHELIUM

• THE PRIMARY MECHANISME CONTROLLING STROMAL HYDRATION IS A FUNCTION OF THE CORNEAL ENDOTHELIUM

• ENDOTHELIAL CELLS BECOME LESS IN NUMBER WITH AGE AND INDIVIDUAL CELL ENLARGE TO COMPENSATE

• THE CORNEA IS SET INTO THE SCLERA LIKE A WATCH GLASS SO THAT THE LATTER OVER- LAPS THE CORNEA ALL AROUND THE PERI- PHERY; THE JUNCTION OF THE TWO TISSUES IS KNOWN AS THE LIMBUS

•THE CORNEA IS VERY RICHLY SUPPLIED WITH NERVE FIBERS DERIVED FROM THE TRIGEMINAL AND IT HAD NO BLOOD VESSEL

LINING THE INNER ASPECT OF THE SCLERA ARE TWO STRUCTURES :

• THE HIGHLY VASCULAR UVEAL TRACT CONCERNED CHIEFLY IN NUTRITION OF THE EYE

• A NERVOUS LAYER, THE TRUE VISUAL NERVE ENDING ONCERNED IN THE RECEPTION AND TRANSFORMING OF LIGHT STIMULL CALLED THE RETINA

THE UVEAL TRACT CONSIST OF THREE PARTS, WHICH THE TWO POSTERIOR, THE CHOROID, AND CILIARY BODY, WHILE THE ANTERIOR FORMS A FREE CIRCULAR DIAPHRAGM : THE IRIS

THE APERTURE OF THE DIAPHRAGM IS THE PUPIL

SITUATED BEHIND THE IRIS AND IN CONTACT WITH THE PUPILLARY MARGIN IS THE CRYSTALLINE LENS

THE ANTERIOR CHAMBER IS A SPACE FILLED WITH FLUID, THE AQUEOUS HUMOR; IT IS BOUNDED IN FRONT BY THE CORNEA, BEHIND BY THE IRIS AND THE PART OF THE ANTERIOR SURFACE OF THE LENS WHICH IS EXPOSED IN THE PUPIL

ITS PERIPHERAL RECESS IS KNOWN AS THE ANGLE OF THE ANTERIOR CHAMBER, BOUNDED POSTERIORLY BY THE ROOT OF THE IRIS AND THE CILIARY BODY AND ANTERIORLY BY THE CORNEOSCLERA

IN THE INNER LAYER OF THE SCLERA AT THIS PART THERE IS A CIRCULAR VENOUS SINUS, CALLED THE CANALIS SCHLEMM - GREAT IMPORTANT - IN THE DRAINAGE OF THE AQUEOUS HUMOR

AT THE PERIPHERY OF THE ANGLE BETWEEN THE CANAL SCHLEMM AND THE RECESS OF THE ANTERIOR CHAMBER THERE LIES A LOOSELY CONSTRUCTED MESHWORK OF TISSUES, THE TRABECULAR MESHWORK

THERE ARE TWO UNSTRIPED MUSCLE WHICH CONTROL THE MOVEMENTS OF THE PUPIL

• THE SPHINCTER PUPILAE A CIRCULAR BUNDLE RUNNING ROUND THE PUPILLARY MARGIN; IS SUPPLIED BY MOTOR NERVE FIBERS DERIVED FROM THE OCULOMOTOR NERVE

•THE DILATATOR PUPILLAEARRANGED RADIALLY NEAR THE ROOT OF THE IRIS. THE MOTOR NERVE FIBRES ARE DERIVED FROM THE CERVICAL SIMPHATHETIC CHAIN

THE INNER SURFACE OF THE CILLIARY BODY IS DIVIDED INTO TWO REGION

• THE PARS PLICATATHE ANTERIOR PART WHICH IS CORRUGATED WITH A NUMBER OF FOLDS

• THE PARS PLANATHE POSTERIOR PART WHICH IS SMOOTH

THE CHIEF MASS OF THE CILLIARY BODY IS COMPOSED OF THE UN-STRIPED MUSCLE FIBERS - CALLED - THE CILLIARY MUSCLE

THE CILLIARY BODY EXTENDS BACK WARD AS FAR AS THE ORA SERRATA, AT WHICH POINT THE RETINA BEGINS ABRUPTLY

THE CHOROID IS EXTREMELY VASCULAR MEMBRANE IN CONTACT EVERY WHERE WITH THE SCLERA. THERE IS A POTENTIAL SPACE BETWEEN THE TWO STRUCTURE - CALLED - THE EPICHOROIDAL SPACETHE INNER SIDE THE CHOROID IS COVERED BY A THIN ELASTIC MEMBRANE - CALLED- THE LAMINA VITERA OR MEMBRANA OF BRUCH

THE RETINA CONSISTS OF 10 LAYERSTHE RETINA CONSISTS OF 10 LAYERS

1. 1. PIGMEN EPITHELIUMPIGMEN EPITHELIUM

2. 2. LAYER OF ROD AND CONESLAYER OF ROD AND CONES

3. 3. EXTERNAL LIMITING EXTERNAL LIMITING

MEMBRANEMEMBRANE

4. 4. OUTER NUCLEAR LAYEROUTER NUCLEAR LAYER

5. 5. OUTER PLEXIFORM LAYEROUTER PLEXIFORM LAYER

6. 6. INNER NUCLEAR LAYERINNER NUCLEAR LAYER

7. 7. INNER PLEXIFORM LAYERINNER PLEXIFORM LAYER

8. 8. GANGLION CELL LAYERGANGLION CELL LAYER

9. 9. OPTIC NERVE FIBER OPTIC NERVE FIBER

LAYERLAYER

10. 10. INTERNAL LIMITING INTERNAL LIMITING

MEMBRANEMEMBRANE

AT THE POSTERIOR POLE OF THE EYE WHICH IS SITUATED ABOUT 3 MM TO THE TEMPORAL SIDE OF THE OPTIC DISC, A SPECIALLY DIFFEREN-TIATED SPOT IS FOUND IN THE RETINA, THE FOVEA CENTRALIS, A DEPRESSION OR PIT, AND IN HERE ONLY CONES ARE PRESENT IN THE NEURO EPITHELIAL LAYER

THE FOVEA IS THE MOST SENSITIVE PART OF THE RETINA, AND IT IS SURROUNDED BY A SMALL AREAS, THE MACULA LUTEA OR YELLOW SPOT. WHICH ALTHOUGH NOT SO SENSITIVE, ITS MORE SENSITIVE THAN OTHER PARTS OF THE RETINA

AT THE OPTIC DISC THE FIBERS OF THE NERVE-FIBER LAYER PASS INTO THE OPTIC NERVE

THE LENS IS A BICONVEX MASS OF PECULIARLY DIFFERENTIATED EPITHELIUM, IT IS SURROUNDED BY A HYALINE MEMBRANE, THE LENS CAPSULE, IT IS HELD IN PLACE BY THE SUSPENSORY LIGAMENT OR ZONULES OF ZINNI CONSISTS BUNDLE OF STRANDS WHICH PASS FROM THE SURFACE OF THE CILLIARY BODY TO THE CAPSULE

THERE IS A TRIANGULAR SPACE BETWEEN THE BACK OF THE IRIS AND THE ANTERIOR SURFACE OF THE LENS AND ITS BOUNDED ON THE OUTER SIDE BY THE CILLIARY BODY - CALLED - THE POSTERIOR CHAMBER AND CONTAINS AQUEOUS HUMOR

BEHIND THE LENS THERE IS LARGE VITREUS CHAMBER CONTAINING THE VITREUS HUMOR, A JELLY LIKE MATERIAL, CHEMICALLY OF THE NATURE OF INNERT GEL CONTAINING A FEW CELLS AND WANDERING LEUCOCYTES

DURING ACCOMODATION

THE CILIARY MUSCLES CONTRACTS

DRAWING TOWARD THE CHOROID

RELAXING THE SUSPENSORY LIGAMENT

DIMINISHES THE TENSION OF LENS CAPSULE

INCREASE THE CONVEXITY OF THE LENS

PHYSIOLOGY OF THE EYEPHYSIOLOGY OF THE EYE

MECHANISM OF ACCOMODATION.

THE LENS IS AN ELASTIC STRUCTURE WHEN RELASE FROM THE FLATTENING INFLUENCE OF ITS SUSPENSORY LIGAMENT TENDS TO ASSUME A SPHERICAL SHAPE

CIRCULATION OF THE CIRCULATION OF THE AQUEOUS HUMORAQUEOUS HUMOR

AS THE GREATER AS THE GREATER PART OF FLUIDS IS PART OF FLUIDS IS FORMED IN THE FORMED IN THE CILLIARY REGION, IT CILLIARY REGION, IT IS SECRETED INTO IS SECRETED INTO POSTERIOR POSTERIOR CHAMBER, IT FLOWS CHAMBER, IT FLOWS FROM THE FROM THE POSTERIOR POSTERIOR CHAMBER THROUGH CHAMBER THROUGH THE PUPIL INTO THE THE PUPIL INTO THE ANTERIOR CHAMBER ANTERIOR CHAMBER AND ESCAPES AND ESCAPES THROUGH THE THROUGH THE DARINAGE DARINAGE CHANNELS AT THE CHANNELS AT THE ANGLE, AND THEN ANGLE, AND THEN INTO THE INTO THE EPISCLERAL VEINEPISCLERAL VEIN

THE INTRA OCULAR THE INTRA OCULAR PRESSURE (IOP)PRESSURE (IOP)

PROLONGED CHANGES ARE ESSENTIALLY PROLONGED CHANGES ARE ESSENTIALLY

CAUSED BY TWO FACTORSCAUSED BY TWO FACTORS : : AN ALTERATION IN THE FORCES AN ALTERATION IN THE FORCES

DETERMINING THE FORMATION OF THE DETERMINING THE FORMATION OF THE AQUEOUS AQUEOUS

ALTERATIONS IN THE RESISTANCE TO ITS ALTERATIONS IN THE RESISTANCE TO ITS OUTFLOWOUTFLOW

FROM THE CLINICAL POINT OF VIEW, THE FROM THE CLINICAL POINT OF VIEW, THE

LATTER IS THE MORE IMPORTANTLATTER IS THE MORE IMPORTANT

A RISE IN THE IOP MAY BE CAUSED BY AN INCREASE IN THE PRESSURE IN THE EPISCLERAL VEIN OR BY ANY PROCESS WHICH BLOCKS THE SEEPAGE OF AQUEOUS INTO THE CANAL OF SCHLEMM, SUCH AS SCLEROSIS OF THE TRABECULAE OR THEIR OBSTRUCTION BY EXUDATES OR ORGANIZED TISSUE GLAUCOMA

THE IOP NORMALLY THE IOP NORMALLY VARIES FROM 10 TO VARIES FROM 10 TO 20 MM HG20 MM HG

•IT IS ACCURATELY MEASURED BY A MANOMETER•CLINICALLY BY TONOMETRY

THE IOP PRESSURE