眼科學(xué)基礎(chǔ)知識(shí)講座

IntroductionOphthalmologyisaspecialmedicalscience,abranchofclinicalmedicine,whichdealswithresearchfordevelopment,treatmentandpreventionofthedisordersofvisualorgans.Oculardiseasehavecloserelationtosystemicones.LearningOphthalmologyandunderstandingitsdevelopmentandpresentstatearehelpfultoeatabilishfoundationsofclinic,teachingandscienceresearch.10/4/20231第1頁(yè)第一章眼科學(xué)基礎(chǔ)ChapteroneBasicophthalmology10/4/20232第2頁(yè)第一節(jié)眼旳組織解剖

anatomyofeyeball眼球

Theglobe(eyeball)anteriorandposteriordistanceofnormaleyeballis16mminborn.Atage323mm.Atadult24mm.10/4/20233第3頁(yè)Theveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.Theanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.Thedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.10/4/20234第4頁(yè)Theglobeiscomposedoftheeyecoats,thecontents.10/4/20235第5頁(yè)Theeyecoatismainlydividedintothreelayers.OuterlayerCorneaScleraMiddlelayerIrisCiliarybodyChoroidInnerlayerRetina10/4/20236第6頁(yè)外層TheoutercoatTheoutercoatconsistsofthecorneaandthesclera.

Theanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.Thetransitionalsreaofbothisthelimbus.Thefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.10/4/20237第7頁(yè)（1）角膜Cornea

橫徑Thehorizontaldiameteris11.5-12mm垂直徑Theverticaldiameteris10.5-11mm中央部Thecentralthickness0.6mm周邊部Theperipherythickness1mm10/4/20238第8頁(yè)前表面曲率半徑

Theradiusofcorneacurvatureinfront7.8mm后表面曲率半徑

Theradiusofcorneacurvatureinback6.8mmItsrefractivepowerisequaltothatof+43diopterlens角膜Cornea10/4/20239第9頁(yè)Thecentralthickness0.6mmTheradiusofcorneacurvatureinfront7.8mmTheradiusofcorneacurvatureinback6.8mmTheperipherythickness1mm10/4/202310第10頁(yè)組織學(xué)分層

fromanteriortoposterior,thecorneahasfivedistinctlayers:①上皮細(xì)胞層Epithelium②前彈力層Bowman’smembrane③基質(zhì)層Stroma④后彈力層Descemet’smembrane⑤內(nèi)皮細(xì)胞層Endothelium

10/4/202311第11頁(yè)Epithelium

Basementlayer

Bowman’smembrane

Stroma

Descemet’smembrane

endothelium

regenerateafterinjery10/4/202312第12頁(yè)

(2)鞏膜

Sclera

①表層鞏膜Theepisclera②鞏膜實(shí)質(zhì)層Thescleralstroma③棕黑板層Thelaminafascia組織學(xué)分層thescleraincludes:10/4/202313第13頁(yè)ScleraThickness:0.3to1.0mm,attheinsertionoftherectusmusles,itisabout0.3mm,elsewhereabout1mm.AnteriorpartcoveredbybulbarconjunctivaConnectedto6extraocularmusclesThinnerandtranslucentinchildren10/4/202314第14頁(yè)角鞏膜緣

thecorneasclerallimbus:isatransitionalzoneofthecorneaandthescleral,wherethecorneainsertsintothescleraitsanteriorborderisBowman’slayerItsposteriormarginisDescemet’smembraneItswidthis1mmSurgicallandmarkofimportantstructures10/4/202315第15頁(yè)前房角Anteriorchamberangle:Include:SchwalbelinetrabecularreticulumSchlenmcannelScleraspurCiliarybodyIrisroot涉及:Schwalbe線小梁網(wǎng)Schlenm管鞏膜突睫狀帶虹膜根部10/4/202316第16頁(yè)

中層ThemiddlecoatIncludingthreeparts:IrisCiliarybodyChoroid

Richinpigmentandbloodvessels

10/4/202317第17頁(yè)虹膜

IrisItsituatesinthemostanteriorpartofthemiddlecoat,infrontofthelens,connectedwiththecilliarybodyinperphery.Theirisincludslayers:AnteriorsurfacelayerStromalayerPigmentepithelial

threreisaroundholeinthecentrecalledPupil直徑2.5-4mm

10/4/202318第18頁(yè)虹膜Iris10/4/202319第19頁(yè)睫狀體CiliarybodyConnectirisrootandchoroidAdistenceofabout6mm，corona：2mm，Parsplana：4mmTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruch‘smembrane4、Epitheliumlayer5、Theinternallimitingmembrane

1睫狀肌410/4/202320第20頁(yè)睫狀體Ciliarybody扁平部睫狀突鋸齒緣睫狀冠parsplicata10/4/202321第21頁(yè)脈絡(luò)膜ChoroidItissituatedbeweenthescleraandtheretina,anteriortooraserrata,goingbehindtothesurroundingoftheopticnerve.Fullofthepigmentactsasadarkroomandashadeoflight.Including：1、大血管層Largevascularlayer2、中血管層Middlevascularlayer3、毛細(xì)血管層Capillarylayer10/4/202322第22頁(yè)

內(nèi)層theInnercoat

istheretina,whichcoversthehrinneraspectoftheposteriortwo-thridsofthewalloftheglobe.Theoutsideoftheretinaisthechoroid,theinsideisthevitreous.Theopticneverfixestheretinatothewalloftheglobe.Theretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.10/4/202323第23頁(yè)

內(nèi)層theInnercoat

The黃斑M(jìn)aculaareaisaspecialregionoftheretinawiththesharpestvisualsensation.itsdiameterisabout1-3mmasmallfoveolaisinitscentrecalled黃斑中心凹Foveacentralis,withthedirectophthalmoscopetheFoveacentralisproduceaclearlyfoveareflaction.Apinkarealocatedatnasalsideabout3mmtothemaculaisthe視盤(pán)Opticdisc.thevisualfibersontheretinacometogethertogooutoftheglobetovisualcentre.therearearteryandvein.Asmalldepressiononitscentreiscalled視杯Opticcup

10/4/202324第24頁(yè)10/4/202325第25頁(yè)視網(wǎng)膜Ratina

dividedinto10layersfromoutsidetoinside.

outside:

Retinalpigmentepithelium,RPE

視網(wǎng)膜色素上皮層10/4/202326第26頁(yè)內(nèi)層inside

①

視錐、視桿細(xì)胞層（光感受器細(xì)胞層）

Coneandrodlayer②

外界膜Externallimitingmembrane③

外核層Outernuclearlayer④

外叢狀層Outerplaxiform⑤

內(nèi)核層Innernuclearlayer⑥

內(nèi)叢狀層Innerplexiformlayer⑦

神經(jīng)節(jié)細(xì)胞層Ganglioncelllayer⑧

神經(jīng)纖維層Nervefiberlayer⑨

內(nèi)界膜Limitingmembrane10/4/202327第27頁(yè)1RPERetinalpigmentepithelium2Coneandrodlayer3Externallimitingmembrane4Outernuclearlayer5Outerplaxiform1.色素上皮2.視錐和視桿細(xì)胞3.外界膜4.外核層5.外叢狀層10/4/202328第28頁(yè)6Innernuclearlayer7Innerplexiformlayer8Ganglioncelllayer9Nervefiberlayer10Limitingmembrane

6.內(nèi)核層7.內(nèi)叢狀層8.神經(jīng)節(jié)細(xì)胞層9.神經(jīng)纖維層10.內(nèi)界膜10/4/202329第29頁(yè)（二）

眼球內(nèi)容

Contentsoftheeye1.

房水Aqueoushumor前房Anteriorchamber：itisboundedanteriorlybythecornea,posterioritybytheirisandthelens.thedeepthinthecentreis2.5-3.0mm.thevolumeinhumaneyeisabout0.2ml.后房Posteriorchamber:itisboundedanteriorlybytheiris,posterioritybylensanteriorcapsuleanditszonule.thevolumeinhumaneyeisabout0.06ml.Posteriorchamberflowsintotheanteriorchamberthroughthepupil.10/4/202330第30頁(yè)TheFlowofAqueousHumor

:

ciliary睫狀體posteriorchamber后房pupil瞳孔anteriorchamber前房trabecular小梁網(wǎng)SchlemmcanalSchlemm管collectioncanal集液管

aqueousvein房水靜脈ciliaryveins睫狀前靜脈脈絡(luò)膜上腔

10/4/202331第31頁(yè)2、晶狀體LensTransparent，doubleconvexmirrorBesuspendedBetweenpupil-irisandvitreousbody,connectwithciliarybodyAbout4mmthickand9mmindiameterTheradiusoflenscurvatureinfront：10mmTheradiusoflenscurvatureinback：6mmDiopter：19D透明，雙凸透鏡位于瞳孔-虹膜和玻璃體之間前面曲率：10mm背面曲率：6mm屈光度：19D10/4/202332第32頁(yè)LensThesolefunctionofthelensistofocuslightraysupontheretina.DistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizedNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalAsthelensagesitsaccommodativepowerisgraduallyreduced.10/4/202333第33頁(yè)lensCompositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)Therearenopainfibers,bloodvessels,ornervesinlensFunctions:1、Focusing2、accommodationChangeswithageLarger&harderLesselasticCataract10/4/202334第34頁(yè)3、玻璃體VitreousbodyConsistsmainlyofwater2/3oftheeye’svolumeandweightViscousityImportantformetabolismofintraoculartissuesAttachedtoretinaThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.10/4/202335第35頁(yè)VitreousbodyAgingchanges：Thinner&moreliquid“floaters”

10/4/202336第36頁(yè)視路及瞳孔反射

Opticpathwayandpupillaryreflex

Thevisualmessageobtainedfromtheretinaistransmittedtobrainviatheopticnever10/4/202337第37頁(yè)視路opticpathway

（一）視神經(jīng)Opticnerve(1)眼內(nèi)段Intraocular(2)眶內(nèi)段Intraorbital(3)管內(nèi)段Intracanalicular(4)顱內(nèi)段Intracranial（二）視交叉Opticchiasm（三）視束Optictract（四）外側(cè)膝狀體Lateralgeniculatebody（五）視放射Opticradiation（六）視皮質(zhì)Visualcortex10/4/202338第38頁(yè)視路opticpathwayItisaportionofcentralnervoussystem,composedoffiberssendoutbyretinaganglimcells.theopticneveristhesegmentofnervefromthedisctotheanteriorangleofthechiasm,about42-47mmlong.(1)眼內(nèi)段Intraocular1mm(2)眶內(nèi)段Intraorbital25-30mm(3)管內(nèi)段Intracanalicular4-10mm(4)顱內(nèi)段Intracranial10mm10/4/202339第39頁(yè)視路Visualpathway

光感受器retinalphotoreceptor→雙級(jí)細(xì)胞bipolarcell→神經(jīng)節(jié)細(xì)胞nervousganglioncells→視乳頭opticdisk→視神經(jīng)opticnerve→視交叉opticchasm→視束optictract→外側(cè)膝狀體lateralgeniculatebody→視放射opticradiation→視皮質(zhì)visualcortex.10/4/202340第40頁(yè)Opticnerve

Opticchiasm

Optictract

Lateralgeniculatebody

Opticradiation

Occipitalcortex10/4/202341第41頁(yè)視路Visualpathway10/4/202342第42頁(yè)瞳孔反射路

Pathwayofpupillaryreflex光反射

Lightreflex

直接光反射directreflex

間接光反射indirectreflex

近反射Nearreflexwhentheeyeslookatanearobject,3reactionsoccur:accmmodation,convergence,andconstrictionofthepupil.10/4/202343第43頁(yè)10/4/202344第44頁(yè)二、眼眶及附屬器

Orbitandaccessoryapparatus(一)眼眶OrbitThedepthofadult’sisabout4-5cm,theexternalrimisalittlebehindwithmuchexposureoftheglobewhichiseasytobeinjuried.theexternalwalloftheorbitisquitehard,theotherthreearewiththinbone.10/4/202345第45頁(yè)眼眶OrbitFrontal額骨Zygomayic顴骨Maxillary上頜骨Ethmoidal篩骨Sphenoid蝶骨Lacrimal淚骨Palatine顎骨

Theorbitiscomposedof6bones:10/4/202346第46頁(yè)眼眶Orbit1.視神經(jīng)孔和管Opticforamenandcanal4-9mminlength,4-6mminwidth.theopticnerveandtheophthalmicarterythroughpasstothecranialcavity.2.眶上裂SuperiororbitalfissureTherearethe3rd,4th,6thcranialnervesandthefirstbranchoftrigeminalnerve,theopthalmicnerve,thesuperiorophthalmicveinaswellasthesympatheticnervepassingthroughthefissure.10/4/202347第47頁(yè)3.眶下裂InferiororbitalfissureIttransmitsthe2ndbranchofthe5thcranialnerve,inferiorophthalmicneverandarteryandinferiorophthalmicvein.4.眶上切跡和（眶下孔）ThesupraorbitalnotchandinfraorbitalforamenHerearenerveandbloodvesselwiththesamenamepassingthroughthem眼眶Orbit10/4/202348第48頁(yè)（二）眼瞼Eyelids

Theeyelidaredividedintoupperandlowerone,situatedintheanteriormouthoftheorbit,coverontheanteriorsurfaceoftheglobe,theupperoneislimitedbytheeyebrow,thelowereyelidisconnectedwithfacialskin.Palpebralfissure(瞼裂)betweentwoeyelids8mmZeisglandandMollglandopentheirmouthsathairfolliculosis(毛囊)10/4/202349第49頁(yè)Eyelids1皮膚層TheskinItisoneofthemostflexibleandthinnestskininthebody.2皮下組織層SubcutaneousItiscomposedoflooseconnectivetissueandalittlefat.3肌層Muscularlayer4瞼板層LayerofthefibrouslayerThereareverticallgland---Meibom’gland5結(jié)膜層TheconjunctivallayerCloselyattachedtotheposteriorsurfaceofthefibrouslayer10/4/202350第50頁(yè)Zeis腺毛囊Moll腺M(fèi)uller肌結(jié)膜瞼板層meibom眼輪匝肌Meibom開(kāi)口皮膚提上瞼肌10/4/202351第51頁(yè)EyelidsSensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.Function:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.10/4/202352第52頁(yè)(三)結(jié)膜Conjunctiva1瞼結(jié)膜Palpebralconjunctivaitcloselyadheretothefibrouslayer,can’tbepushe,smoothandtransparentverticalsmallbloodvesselsmaybeseeninit.2球結(jié)膜Bulbarconjunctivaitcoversonthesclerasituatedinanteriorpartoftheglobe,looselyconnectedwithtenon’scapsule,easytobepushed,elevated.3穹窿結(jié)膜Fornicalconjunctiva

1、gobletcell2、krauseandwolfringglang10/4/202353第53頁(yè)瞼結(jié)膜Palpebralconjunctiva球結(jié)膜Bulbarconjunctiva穹窿結(jié)膜FornicalconjunctivaBulbarconjunctivaPalpebralconjunctivaFornicalconjunctiva10/4/202354第54頁(yè)(四)淚器Lacrimalapparatus

1淚腺LacrimalglandThereareabout10-20excretoryductsopeningtheirmouthsintheexternalandsuperiorfornicalconjunctive.2淚道Lacrimalpassages(1)淚小點(diǎn)LacrimalpunctaThereareeachoneintheupperandlowereyelids,opentheirmouthsintothelacrimallake.(2)淚小管LacrimalcanaliculusLinkupthepunctaandthelacrimalsac.(3)淚囊Lacrimalsac12mminlength,4-7mminwidth.(4)鼻淚管Nasolacrimalduct18mmlength,thesecretionis0.9-2.2mmeacheye.10/4/202355第55頁(yè)1淚腺Lacrimalgland2淚道Lacrimalpassages(1)淚小點(diǎn)Lacrimalpuncta(2)淚小管Lacrimalcanaliculus(3)淚囊Lacrimalsac(4)鼻淚管Nasolacrimalduct10/4/202356第56頁(yè)(五)眼外肌Extraocularmuscles

4條直肌Rectus

上直肌superiorrectimuscles

下直肌inferiorrectimuscles

內(nèi)直肌medialrectimuscles

外直肌externalrectimuscles2條斜肌Obliquemuscle

上斜肌superiorobliquemuscles

下斜肌Inferiorobliquemuscles10/4/202357第57頁(yè)4條直肌Rectus上直肌superiorrectimuscles下直肌inferiorrectimuscles內(nèi)直肌medialrectimuscles外直肌externalrectimuscles2條斜肌Obliquemuscle上斜肌superiorobliquemuscles下斜肌Inferiorobliquemuscles上