眼科学基础知识讲座.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二层,第三层,第四层,第五层,*,*,*,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 development and present state are helpful to eatabilish foundations of clinic,teaching and science research.,6/17/2026,1,第一章 眼科学基础,Chapter one,Basic ophthalmology,6/17/2026,2,第一节 眼旳组织解剖,anatomy of eyeball,眼球,The globe(eyeball),anterior and posterior distance of normal eyeball is 16mm in born.,At age 3 23mm.,At adult 24mm.,6/17/2026,3,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 external part,the anterior part of the globe is protected by the eyelids.,6/17/2026,4,The globe is composed of the eyecoats,the contents.,6/17/2026,5,The eyecoat is mainly divided into three layers.,Outer layer,Cornea,Sclera,Middle layer,Iris,Ciliary body,Choroid,Inner layer,Retina,6/17/2026,6,外层,The 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.,6/17/2026,7,（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,周围部,The periphery thickness 1mm,6/17/2026,8,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 of+43 diopter lens,角膜,Cornea,6/17/2026,9,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,6/17/2026,10,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,6/17/2026,11,EpitheliumBasement layerBowmans membraneStromaDescemets membraneendothelium,regenerate after injery,6/17/2026,12,(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:,6/17/2026,13,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,6/17/2026,14,角巩膜缘,the cornea scleral limbus,:,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,6/17/2026,15,前房角,Anterior chamber angle:,Include:,Schwalbe line,trabecular reticulum,Schlenm cannel,Sclera spur,Ciliary body,Iris root,涉及,:,Schwalbe,线,小梁网,Schlenm,管,巩膜突,睫状带,虹膜根部,6/17/2026,16,中层,The middle coat,Including three parts:Iris,Ciliary body,Choroid,Rich in pigment and blood vessels,6/17/2026,17,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 round hole in the centre called,Pupil 直径2.5-4mm,6/17/2026,18,虹膜 Iris,6/17/2026,19,睫状体,Ciliary body,Connect iris root and choroid,A distence of about 6mm，corona,：2,mm,，,Pars plana,：4,mm,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,4,6/17/2026,20,睫状体,Ciliary body,扁平部,睫状突,锯齿缘,睫状冠pars plicata,6/17/2026,21,脉络膜,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,6/17/2026,22,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 is 0.1mm thick at the ora serrata and 0.23mm thick at the posterior pole.,6/17/2026,23,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.,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,6/17/2026,24,6/17/2026,25,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,6/17/2026,26,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,6/17/2026,27,1,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,6/17/2026,28,6 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,6/17/2026,29,（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 2.53.0mm.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 pupil.,6/17/2026,30,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,6/17/2026,31,2、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,背面曲率：,6mm,屈光度：,19D,6/17/2026,32,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 lens more spherical,As the lens ages its,accommodative power,is gradually reduced.,6/17/2026,33,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 vessels,or nerves in lens,Functions:1、Focusing 2、accommodation,Changes with age,Larger&harder,Less elastic,Cataract,6/17/2026,34,3、玻璃体,Vitreous body,Consists mainly of water,2/3 of the eyes volume and weight,Viscousity,Important for metabolism of intraocular tissues,Attached to retina,The vitreous has two functions:the refraction and maintainence the transparent and form of the eye.,6/17/2026,35,Vitreous body,Aging changes：Thinner&more liquid,“floaters”,6/17/2026,36,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,6/17/2026,37,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,6/17/2026,38,视路,optic pathway,I,t 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 Intracanalicular 4-10mm,(4)颅内段 Intracranial 10mm,6/17/2026,39,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.,6/17/2026,40,Optic nerveOptic chiasmOptic tractLateral geniculate bodyOptic radiationOccipital cortex,6/17/2026,41,视路 Visual pathway,6/17/2026,42,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,convergence,and constrictionof the pupil.,6/17/2026,43,6/17/2026,44,二、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 injuriedthe external wall of the orbit is quite hard,the other three are with thin bone.,6/17/2026,45,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:,6/17/2026,46,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 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.,6/17/2026,47,3.眶下裂,Inferior orbital fissure,It transmits the 2nd branchof the 5,th,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,6/17/2026,48,（二）眼睑,Eye lids,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 open their mouths at hair folliculosis(毛囊),6/17/2026,49,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 结膜层,The conjunctival layer,Closely attached to the posterior surface of the fibrous layer,6/17/2026,50,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,6/17/2026,51,Eye lids,S,ensory of the eyelid:,they are innervated by the 1st and 2,nd,branch of the trigeminal nerve.,F,unction: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.,6/17/2026,52,(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 connected with tenons capsule,easy to be pushed,elevated.,3穹窿结膜,Fornical conjunctiva,1、goblet cell 2、krause and wolfring glang,6/17/202653,睑结膜,Palpebral conjunctiva,球结膜,Bulbar conjunctiva,穹窿结膜,Fornical conjunctiva,Bulbar conjunctiva,Palpebral conjunctiva,Fornical conjunctiva,6/17/2026,54,(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 lengththe secretion is 0.9-2.2mm each eye.,6/17/2026,55,1泪腺,Lacrimal gland,2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 duct,6/17/2026,56,(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 muscles,6/17/2026,57,4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,6/17/2026,58,四、眼球旳血液循环和神经分布,Blood circulation and innervation of 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,6/17/2026,59,1.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,6/17/2026,60,视网膜中央血管系统,The central retinal vascular system,6/17/2026,61,2.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,6/17/2026,62,(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,6/17/2026,63,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,6/17/2026,64,1.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,6/17/2026,65,visual organ,visual organ,Eyeball,apparatus：eyelid，conjunctiva，lacrimal，ocular，orbitalis,apparatus muscles，,Wall,content：aqueous humor，lens，vitreous body,outer：cornea，sclera,media：iris，ciliary，choroid,inner：retina,visual retina,pathway,Optic,nerve,Optic,chiasm,Optic,tract,Lateral,geniculate body,optic,radiation,occipital lobe,optical center,6/17/2026,66,6/17/2026,67,