眼科学基础知识讲座专家讲座.pptx

IntroductionnOphthalmologyisaspecialmedicalscience,abranchofclinicalmedicine,whichdealswithresearchfordevelopment,treatmentandpreventionofthedisordersofvisualorgans.nOculardiseasehavecloserelationtosystemicones.nLearningOphthalmologyandunderstandingitsdevelopmentandpresentstatearehelpfultoeatabilishfoundationsofclinic,teachingandscienceresearch.10/22/20241眼科学基础知识讲座第1页第一章第一章 眼科学基础眼科学基础 Chapter one Basic ophthalmology10/22/20242眼科学基础知识讲座第2页 第一节第一节 眼组织解剖眼组织解剖 anatomy of eyeball 眼球眼球 The globe(eyeball)nanterior and posterior distance of normal eyeball is 16mm in born.nAt age 3 23mm.nAt adult 24mm.10/22/20243眼科学基础知识讲座第3页nTheveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.nTheanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.nThedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.10/22/20244眼科学基础知识讲座第4页The globe is composed of the eyecoats,the contents.10/22/20245眼科学基础知识讲座第5页The eyecoat is mainly divided into three layers.nOuterlayernCorneanScleranMiddlelayernIrisnCiliarybodynChoroidnInnerlayernRetina10/22/20246眼科学基础知识讲座第6页 外层外层 The outer coat nTheoutercoatconsistsofthecorneaandthesclera.nTheanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.nThetransitionalsreaofbothisthelimbus.nThefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.10/22/20247眼科学基础知识讲座第7页（1）角膜）角膜 Cornean横径横径The horizontal diameter is 11.5-12mmn垂直径垂直径The vertical diameter is 10.5-11mmn中央部中央部 The central thickness 0.6mmn周围部周围部 The periphery thickness 1mm10/22/20248眼科学基础知识讲座第8页n前表面曲率半径前表面曲率半径 n The radius of cornea curvature in front 7.8mmn后表面曲率半径后表面曲率半径 n The radius of cornea curvature in back 6.8mmnIts refractive power is equal to that of+43 diopter lens角膜角膜 Cornea10/22/20249眼科学基础知识讲座第9页The central thickness 0.6mmThe radius of cornea curvature in front 7.8mmThe radius of cornea curvature in back 6.8mmThe periphery thickness 1mm10/22/202410眼科学基础知识讲座第10页组织学分层组织学分层 fromanteriortoposterior,thecorneahasfivedistinctlayers:上皮细胞层Epithelium前弹力层Bowmansmembrane基质层Stroma后弹力层Descemetsmembrane内皮细胞层Endothelium10/22/202411眼科学基础知识讲座第11页EpitheliumBasement layerBowmans membraneStromaDescemets membraneendothelium regenerate after injery10/22/202412眼科学基础知识讲座第12页(2)巩膜巩膜Scleran表层巩膜Theepiscleran巩膜实质层Thescleralstroman棕黑板层Thelaminafascia组织学分层thescleraincludes:10/22/202413眼科学基础知识讲座第13页ScleranThickness:0.3 to 1.0 mm,at the insertion of the rectus musles,it is about 0.3mm,elsewhere about 1mm.nAnterior part covered by bulbar conjunctivanConnected to 6 extraocular musclesnThinner and translucent in children10/22/202414眼科学基础知识讲座第14页n角 巩 膜 缘 the cornea sclerallimbus:isatransitional zone of thecorneaandthescleral,where the corneainsertsintothescleranitsanteriorborderisBowmanslayernIts posterior margin isDescemetsmembranenItswidthis1mmnSurgicallandmarkofimportantstructures10/22/202415眼科学基础知识讲座第15页前房角Anteriorchamberangle:Include:SchwalbelinetrabecularreticulumSchlenmcannelScleraspurCiliarybodyIrisroot包含包含:Schwalbe 线线小梁网小梁网Schlenm 管管巩膜突巩膜突睫状带睫状带虹膜根部虹膜根部10/22/202416眼科学基础知识讲座第16页 中层 The middle coat Includingthreeparts:IrisCiliarybodyChoroidRichinpigmentandbloodvessels10/22/202417眼科学基础知识讲座第17页虹膜IrisItsituatesinthemostanteriorpartofthemiddlecoat,infront of the lens,connected with thecilliarybodyinperphery.Theirisincludslayers:nAnteriorsurfacelayernStromalayernPigmentepithelialnthrereisaroundholeinthecentrecalledPupil直径2.5-4mm10/22/202418眼科学基础知识讲座第18页虹膜Iris10/22/202419眼科学基础知识讲座第19页睫状体CiliarybodynConnectirisrootandchoroidnAdistenceofabout6mm，corona：2mm，Parsplana：4mmnTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruchsmembrane4、Epitheliumlayer5、Theinternallimitingmembrane1睫状肌410/22/202420眼科学基础知识讲座第20页睫状体Ciliarybody扁平部睫状突锯齿缘睫状冠parsplicata10/22/202421眼科学基础知识讲座第21页脉络膜ChoroidnIt is situated beween the scleraand the retina,anterior to oraserrata,goingbehindtothesurroundingoftheopticnerve.nFullofthepigmentactsasadarkroomandashadeoflight.nIncluding：1、大血管层Largevascularlayer2、中血管层Middlevascularlayer3、毛细血管层Capillarylayer10/22/202422眼科学基础知识讲座第22页内层theInnercoatnis the retina,which covers the hr inneraspectoftheposteriortwo-thridsofthewalloftheglobe.nTheoutsideoftheretinaisthechoroid,theinsideisthevitreous.nTheopticneverfixestheretinatothewalloftheglobe.nTheretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.10/22/202423眼科学基础知识讲座第23页内层theInnercoatnThe黄斑Maculaareaisaspecialregionoftheretina with the sharpest visual sensation.itsdiameterisabout1-3mmnasmallfoveolaisinitscentrecalled黄斑中心凹Fovea centralis,with the direct ophthalmoscopethe Fovea centralis produce a clearly foveareflaction.nApinkarealocatedatnasalsideabout3mmtothemaculaisthe视盘Opticdisc.thevisualfibersontheretinacometogethertogooutoftheglobetovisualcentre.therearearteryandvein.nA small depression on its centre is called 视杯Opticcup10/22/202424眼科学基础知识讲座第24页10/22/202425眼科学基础知识讲座第25页视网膜Ratinadividedinto10layersfromoutsidetoinside.outside:Retinalpigmentepithelium,RPE视网膜色素上皮层10/22/202426眼科学基础知识讲座第26页内层insiden视锥、视杆细胞层（光感受器细胞层）nConeandrodlayern外界膜Externallimitingmembranen外核层Outernuclearlayern外丛状层Outerplaxiformn内核层Innernuclearlayern内丛状层Innerplexiformlayern神经节细胞层Ganglioncelllayern神经纤维层Nervefiberlayern内界膜Limitingmembrane10/22/202427眼科学基础知识讲座第27页1RPE Retinal pigment epithelium2 Cone and rod layer3 External limiting membrane4 Outer nuclear layer5 Outer plaxiform1.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10/22/202428眼科学基础知识讲座第28页6 Inner nuclear layer 7 Inner plexiform layer 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10/22/202429眼科学基础知识讲座第29页（二）眼球内容Contentsoftheeyen1.房水Aqueoushumorn前房Anteriorchamber：itisboundedanteriorlyby the cornea,posteriority by the iris and thelens.the deepth in the centre is 2.5-3.0mm.thevolumeinhumaneyeisabout0.2ml.n后房Posteriorchamber:itisboundedanteriorlybythe iris,posteriority by lens anterior capsule andits zonule.the volume in human eye is about0.06ml.nPosteriorchamberflowsintotheanteriorchamberthroughthepupil.10/22/202430眼科学基础知识讲座第30页TheFlowofAqueousHumor:ciliary睫状体posteriorchamber后房pupil瞳孔anteriorchamber前房trabecular小梁网SchlemmcanalSchlemm管collectioncanal集液管aqueousvein房水静脉ciliaryveins睫状前静脉脉络膜上腔10/22/202431眼科学基础知识讲座第31页2、晶状体LensnTransparent，doubleconvexmirrornBesuspendedBetweenpupil-irisandvitreousbody,connectwithciliarybodynAbout4mmthickand9mmindiameternTheradiusoflenscurvatureinfront：10mmnTheradiusoflenscurvatureinback：6mmnDiopter：19Dn透明，双凸透镜n位于瞳孔-虹膜和玻璃体之间n前面曲率：10mmn后面曲率：6mmn屈光度：19D10/22/202432眼科学基础知识讲座第32页LensnThesolefunctionofthelensistofocuslightraysupontheretina.nDistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizednNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalnAsthelensagesitsaccommodativepowerisgraduallyreduced.10/22/202433眼科学基础知识讲座第33页lensnCompositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)nTherearenopainfibers,bloodvessels,ornervesinlensnFunctions:1、Focusing2、accommodationnChangeswithageuLarger&harderuLesselasticuCataract10/22/202434眼科学基础知识讲座第34页3、玻璃体VitreousbodynConsistsmainlyofwatern2/3oftheeyesvolumeandweightnViscousitynImportantformetabolismofintraoculartissuesnAttachedtoretinanThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.10/22/202435眼科学基础知识讲座第35页VitreousbodynAgingchanges：Thinner&moreliquidn“floaters”10/22/202436眼科学基础知识讲座第36页视路及瞳孔反射Opticpathwayandpupillaryreflex The visual message obtained from the retina is transmitted to brain via the optic never10/22/202437眼科学基础知识讲座第37页视路opticpathwayn（一）视神经Opticnerven(1)眼内段Intraocularn(2)眶内段Intraorbitaln(3)管内段Intracanalicularn(4)颅内段Intracranialn（二）视交叉Opticchiasmn（三）视束Optictractn（四）外侧膝状体Lateralgeniculatebodyn（五）视放射Opticradiationn（六）视皮质Visualcortex10/22/202438眼科学基础知识讲座第38页视路opticpathwaynItisaportionofcentralnervoussystem,composedoffiberssendoutbyretinaganglimcells.theopticneveristhesegmentofnervefromthedisctotheanteriorangleofthechiasm,about42-47mmlong.n(1)眼内段Intraocular1mmn(2)眶内段Intraorbital25-30mmn(3)管内段Intracanalicular4-10mmn(4)颅内段Intracranial10mm10/22/202439眼科学基础知识讲座第39页视路Visualpathwayn光 感 受 器 retinal photoreceptor 双 级 细 胞bipolarcell神经节细胞nervousganglioncells视乳头opticdisk视神经opticnerve视交叉opticchasm视束optictract外侧膝状体lateralgeniculatebody视放射opticradiation视皮质visualcortex.10/22/202440眼科学基础知识讲座第40页Optic nerveOptic chiasmOptic tractLateral geniculate bodyOptic radiationOccipital cortex10/22/202441眼科学基础知识讲座第41页视路Visualpathway10/22/202442眼科学基础知识讲座第42页瞳孔反射路Pathway of pupillary reflexn光反射Light reflexn 直接光反射 direct reflexn 间接光反射 indirect reflexn 近反射 Near reflex when the eyes look at a near object,3 reactions occur:accmmodation,convergence,and constrictionof the pupil.10/22/202443眼科学基础知识讲座第43页10/22/202444眼科学基础知识讲座第44页二、眼眶及从属器Orbit and accessory apparatusn(一)眼眶OrbitnThe 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 other three are with thin bone.10/22/202445眼科学基础知识讲座第45页眼眼眶眶OrbitnFrontal 额骨额骨nZygomayic 颧骨颧骨nMaxillary 上颌骨上颌骨nEthmoidal 筛骨筛骨nSphenoid 蝶骨蝶骨nLacrimal 泪骨泪骨nPalatine 颚骨颚骨 The orbit is composed of 6 bones:10/22/202446眼科学基础知识讲座第46页眼眼眶眶Orbitn1.视神经孔和管 Optic foramen and canaln4-9mm in length,4-6mm in width.the optic nerve and the ophthalmic artery through pass to the cranial cavity.n2.眶上裂 Superior orbital fissurenThere 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.10/22/202447眼科学基础知识讲座第47页n3.眶下裂 Inferior orbital fissurenIt transmits the 2nd branchof the 5th cranial nerve,inferior ophthalmic never and artery and inferior ophthalmic vein.n4.眶上切迹和（眶下孔）nThe supraorbital notch and infraorbital foramen Here are nerve and blood vessel with the same name passing through them眼眶眼眶Orbit10/22/202448眼科学基础知识讲座第48页（二）眼睑Eye lidsnThe 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.nPalpebral fissure(睑裂)between two eyelids 8mmnZeis gland and Moll gland open their mouths at hair folliculosis(毛囊)10/22/202449眼科学基础知识讲座第49页Eye lidsn1 皮肤层 The skinnIt is one of the most flexible and thinnest skin in the body.n2 皮下组织层 SubcutaneousnIt is composed of loose connective tissue and a little fat.n3 肌层 Muscular layern4 睑板层 Layer of the fibrous layernThere are verticall gland-Meibomglandn5 结膜层 The conjunctival layernClosely attached to the posterior surface of the fibrous layer10/22/202450眼科学基础知识讲座第50页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10/22/202451眼科学基础知识讲座第51页Eye lidsnSensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.nFunction:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.10/22/202452眼科学基础知识讲座第52页(三)结膜Conjunctivan1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.n2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.n3穹窿结膜Fornical conjunctiva 1、goblet cell 2、krause and wolfring glang10/22/202453眼科学基础知识讲座第53页n睑结膜nPalpebralconjunctivan球结膜nBulbarconjunctivan穹窿结膜nFornicalconjunctivaBulbarconjunctivaPalpebralconjunctivaFornicalconjunctiva10/22/202454眼科学基础知识讲座第54页(四)泪器Lacrimal apparatus1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,the secretion is 0.9-2.2mm each eye.10/22/202455眼科学基础知识讲座第55页1泪腺 Lacrimal gland2泪道 Lacrimal passages (1)泪小点 Lacrimal puncta (2)泪小管 Lacrimal canaliculus (3)泪囊 Lacrimal sac (4)鼻泪管 Nasolacrimal duct10/22/202456眼科学基础知识讲座第56页(五)眼外肌Extraocularmuscles4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 muscles2条斜肌 Oblique muscle 上斜肌 superior oblique muscles 下斜肌 Inferior oblique muscles10/22/202457眼科学基础知识讲座第57页n4条直肌Rectusn上直肌superiorrectimusclesn下直肌inferiorrectimusclesn内直肌medialrectimusclesn外直肌externalrectimusclesn2条斜肌Obliquemusclen上 斜 肌 superior obliquemusclesn下 斜 肌 Inferior obliquemuscles上直肌上斜肌外直肌内直肌下直肌下斜肌10/22/202458眼科学基础知识讲座第58页四、眼球血液循环和神经分布Blood circulation and innervation of the globen（一）血液循环 Blood circulationn动脉 Arteryn 1、视网膜中央血管系统 n the central retinal vascular system n 2、睫状血管系统n the ciliary vascular system10/22/202459眼科学基础知识讲座第59页n1.视网膜中央血管系统nThe central retinal vascular system视网膜中央动脉Central retinal artery,CRA10/22/202460眼科学基础知识讲座第60页视网膜中央血管系统The central retinal vascular system10/22/202461眼科学基础知识讲座第61页2.睫状血管系统the ciliary vascular systemn(1)睫状后短动脉nShort posterior ciliary arteryn(2)睫状后长动脉nLong posterior ciliary arteryn(3)睫状前动脉nAnterior ciliary artery10/22/202462眼科学基础知识讲座第62页(1)睫状后短动脉Shortposteriorciliaryartery(2)睫状后长动脉Longposteriorciliaryartery(3)睫状前动脉Anteriorciliaryartery睫状后长动脉睫状后短动脉睫状前动脉10/22/202463眼科学基础知识讲座第63页静脉Veinn1.视网膜中央静脉nCentral retinal vein CRVn2.涡静脉Vortex veinn3.睫状前静脉Anterior ciliary vein10/22/202464眼科学基础知识讲座第64页n1.视网膜中央静脉nCentral retinal vein CRVn2.涡静脉Vortex veinn3.睫状前静脉Anterior ciliary vein视网膜中央静脉涡静脉睫状前静脉10/22/202465眼科学基础知识讲座第65页visual organvisual organEyeball apparatus：eyelid，conjunctiva，lacrimal，ocular，orbitalis apparatus muscles，Wallcontent：aqueous humor，lens，vitreous bodyouter：cornea，scleramedia：iris，ciliary，choroidinner：retinavisual retina pathwayOptic nerveOptic chiasmOptic tract Lateral geniculate body optic radiationoccipital lobeoptical center10/22/202466眼科学基础知识讲座第66页10/22/202467眼科学基础知识讲座第67页