W 2 1010 Analyzing the Eye WEB

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From Registration to Accounts Receivable ± The Whole Can of Worms

2007 UBO/UBU

Conference

2007 UBO/UBU

Conference

1

Briefing: Introduction to

Anatomy of the Eye

Date: 21 March 2007

Time: 1010 ± 1100



2007 UBO/UBU Conference

From Registration to

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Objectives

By the end of this presentation you will be able to: ± Recognize major components of the eye

± Have a basic understanding of how the eye works

± Understand how eye disease affects the

components of the eye







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The Eye

When you look at any object

Light waves from that object enter the eye first through

the cornea, which is the clear dome at the front of theeye

Light waves progress through the pupil, the circular

opening in the center of the colored iris

Immediately behind the iris (and pupil) is the crystalline

lens, and light passes through that also







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The Eye





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The Eye

The light impulses are changed into electricalsignals, then sent through the optic nerve along the

visual pathway to the occipital cortex, or posterior

(back), of the brain

This is where the electrical signals are seen by the

brain as a visual image

When light entering the eye is bright enough, the

pupils will get smaller (constrict) due to pupillary light

response





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The Eye

Extraocular Muscles





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The Eye

All of the extraocular muscles, with the exception of the inferior oblique, form a ³cone´ within the bony orbit

The apex of the cone is in the posterior aspect (back)

of the orbit, while the base of the cone is the

attachment of the muscles around the midline of the

eye. This conic structure is referred to as the ³annulus

of Zinn,´ and within this cone runs the Optic nerve

(cranial nerve H)

Within the optic nerve are the ophthalmic artery and

the ophthalmic vein





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The Eye

The superior oblique muscle is different from the

others, because before it attaches to the eye, it passes

through a ring-like tendon, the trochlea, which acts

like a pulley in the nasal portion of the orbit

The inferior oblique muscle (not a member of the

annulus of Zinn) arises from the lacrimal fossa in the

nasal portion of the bony orbit and attaches to the

inferior portion of the eye





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The Eye

The primary muscle that moves an eye in a given

direction is known as the agonist

A muscle in the same eye that moves the eye in thesame direction as the agonist is known as a synergist

A muscle in the same eye that moves the eye in the

opposite direction of the agonist is the antagonist





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The Eye

Cardinal positions of gaze ± Up/right

± Up/left

± Right

± Left ± Down/right

± Down/left

In each position of gaze, one muscle of each eye is theprimary mover of that eye, and is ³yoked´ to the

primary mover of the other eye





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The Eye

A ³vergence´ or ³disconjugate´ movement involves

simultaneous movement of both eyes in the opposite

directions

There are two principal vergence movements

± Convergence ± both eyes moving nasally or inward

± Divergence ± both eyes moving temporally or

upward





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The Eye

Strabismus

Usually when we see an object, the lines of sight are both

eyes intersecting at the object, or both eyes are pointing

at the object being viewed. An image of the object is

focused upon the macula of each eye and the brain

merges the two retinal images into one

When there is an extraocular muscle imbalance, one eye

is not aligned with the other eye, which results in a

strabismus





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The Eye

Strabismus, (cont¶d)

With strabismus, while one eye is fixating on a particular

object, the other eye is turned in another direction, either

inward (cross-eyed), outward (wall-eyed), upward, or

downward

As a result, the person either experiences ³diplopia´

(double vision) or the brain learns to turn off (suppress)

the image of the strabismic eye to maintain single vision

The angle of deviation of the strabismus is measured in

prism diopters





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Diseases of the Eye

Diabetic RetinopathyThis is a complication of diabetes mellitus in which long-

term exposure to high glucose levels in the blood has

damaged retinal blood vessels. This results in new

growth of abnormal blood vessels, fluid buildup in themacula (macular edema), inadequate blood supply to the

retina and possibly blood and fluid leakage into the retina

and the vitreous body





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Diseases of the Eye

A cataract is a clouding of the eye's natural lens,

which lies behind the iris and the pupil

The lens is mostly made of water and protein. The

protein is arranged in a precise way that keeps the

lens clear and lets light pass through it. But as we

age, some of the protein may clump together andstart to cloud a small area of the lens. This is a

cataract, and over time, it may grow larger and

cloud more of the lens, making it harder to see





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Diseases of the Eye

Researchers are identifying factors that may cause

cataracts such as:

± People with diabetes

± Users of steroids, diuretics, and major tranquilizers

± Users of a lot of salt

± Cigarette smoke

± Air pollution

± Heavy alcohol consumption





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Diseases of the Eye

Glaucoma

Glaucoma represents injury to the optic nerve

secondary to elevated pressure inside the eye.

However, there are exceptions to this definition

Some patients with sustained high intra-ocular

pressure never develop any of the signs of optic nerve

damage and therefore, do not truly have glaucoma.

These patients are said to have ocular hypertension

Other patients may progressively lose vision and

become blind, even though they never exhibit "high"eye pressures. These patients have low tension

glaucoma (also called normal tension glaucoma)





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Diseases of the Eye

Glaucoma (cont¶d)

Most patients with glaucoma do have elevated

intraocular pressure. Along with the eye pressure,

other parameters are evaluated in the search for

glaucoma, such as peripheral vision, visual contrast

sensitivity, optic nerve cupping (a hollowing out of the

center of the optic nerve head in the back of the eye),

and gonioscopy (visualizing the anatomy of the filtering

angle of the eye, where the cornea and the iris join)





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The Eye

Miscellaneous tidbits about the eyes

Anterior chamber ± refers to the fluid filled (aqueous

humor) space between the cornea and the iris/pupil

Posterior chamber ± refers to the fluid filled (aqueous

humor) ring-shaped space between the iris/pupil and

the lens and ciliary body

Anterior segment ± refers to the intraocular portion of

the eyeball and holds the anterior and posterior

chambers of the eye

Posterior segment ± refers to the large vitreous-filledspace between the retina and the lens and where the

optic nerve comes into the eye





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The Eye

Miscellaneous tidbits about the eyes (cont¶d)

A newborn¶s eyeball is about 18 millimeters in

diameter, from front to back. It grows gradually to a

length of approximately 24-25 millimeters (about 1´), or

just smaller than a 1 1/2´ ping pong ball!

CPT codes in the 60,000 series are divided by the

anatomical location of either

Anterior segment

Posterior segmentOcular adenexa





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The Eye





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The Eye

Resources:

http://www.cms.hhs.gov/MLNProducts/65_ ophthalmology.asp

http://www.cms.hhs.gov/MLNProducts/Downloads/internet _ only _ manuals.pdf

Internet only manuals, coding

http://www.visionchannel.net/diabeticretinopathy/Great website for information

http://www.bertscope.com/Literature/Lit _ Requests/info _ poster.html

Free eye posters and online stuff

http://www.optima-hyper.com/eyetests/fitness.htmOptima¶s Eye Fitness Tests

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W 2 1010 Analyzing the Eye WEB