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Fundamental of
Opthalmology
Faraza Javed
PhD Pharmacology
Diagnostic Tests in Opthalmology
What is ophthalmology?
 Opthalmos=eye
 Logos=word, thought, discourse
The science of eyes is opthalmology
The branch of medicine concerned with
the eyes
 Anatomy
 Function
 Disease
Fundamentals of
Opthalmology
The visual system
 A coordinated pair of eyes
 The appropriate protective
mechanisms
 The necessary neural apparatus to...
 To produce a clear
image of the external
world and transmit
this to visual cortex of
brain
Structure of Eyeball
 Fibrous coat
 Cornea, sclera
 Vascular coat (uveal
tissue)
 Iris, ciliary body, choroid
 Nervou...
Sclera
 Collagen
 Variable thickness
 1mm around optic nerve
head,
 0.3mm posterior to
muscle insertions
 Tough, opaq...
Cornea - anatomy
 500-700 µm thick
 Transparent, avascular
 Forms approximately the
anterior 1/6 of the outer
coat of t...
Iris and pupil (Vascular Coat)
 Attached to ciliary
body
 Forms pupil at center
Pupil movements
 Mydriasis (Dilation):
 Dilator pupillae muscles
 Low-intensity light,
excitement, fear
 Sympathetic
...
Ciliary body
 Connects the iris and the
choroid
 Functions:
 Aqueous humor
production
 Suspension of lens,
accommodati...
Aqueous Humour production
 Active secretion by the
epithelium of the ciliary
processes of the ciliary
body
 Function:
 ...
Lens
 Transparent, biconvex
structure
 Radially arranged zonule
fibers that insert into the
lens around its equator
conn...
Choroid
 Highly vascularised
structure between the
sclera and the retina
 Vessel layer, capillary
layer
 provides O2 + ...
Vitreous body
 Clear gel-like structure
that fills the posterior eye
 98% water+ 2% collagen,
hyaluronic acid, soluble
p...
Retina (Neural Layer)
 Converts light into
nerve impulses
 Multilayered
 2 functional layers:
 Neurosensory retina
 R...
1. Retinal pigment epithelium (RPE)
 Single layer
 Microvilli at the apex where
the photoreceptors attach
 Functions:
...
2. Neurosensory retina
 3 main groups of neuronal cells:
photoreceptors, bipolar cells, ganglion cells
 Photoreceptor ce...
Optic disc
 The location where
ganglion cell axons exit the
eye to form the optic nerve
 Yellowish orange color
 1.5mm ...
Retinal blood supply
 Retinal arteries supply O2
+ nutrients to the inner
layers of the retina
 Outer layers (RPE-outer
...
Optic nerve
 Contains over 1 million
fibres
 Nerve fibres are
myelinated only after
leaving the eye
 Surrounded by
cere...
There are many diseases, disorders, and age-
related changes that may affect the eyes and
surrounding structures. The shar...
Such conditions cause damage to the eye's optic
nerve and gets worse over time. It's often linked
to a buildup of pressure...
Opthamological Method
Tonometery
Tonometry measures the
pressure within your eye.
During tonometry, eye drops
are used to numb the eye.
Then a d...
The range for normal pressure is 12-22 mm
Hg. Most glaucoma cases are diagnosed
with pressure exceeding 20mm Hg.
However, ...
Opthalmoscopy
This diagnostic procedure helps the doctor
examine your optic nerve for glaucoma damage.
Eye drops are used ...
The doctor will then use a small device with a
light on the end to light and magnify the
optic nerve. If intraocular press...
Perimetry
Perimetry is a visual field test that
produces a map of your complete
field of vision. This test will help a
doc...
 After glaucoma has been diagnosed, visual field
tests are usually done one to two times a year to
check for any changes ...
Gonioscopy
This diagnostic exam helps determine whether
the angle where the iris meets the cornea is open
and wide or narr...
This contact lens has a mirror that shows the
doctor if the angle between the iris and
cornea is closed and blocked (a pos...
Pachymetry
Pachymetry is a simple, painless test to measure
the thickness of your cornea. A probe called a
pachymeter is g...
With this measurement,
doctor can better
understand IOP reading
and develop a treatment
plan. The procedure
takes only abo...
Electroretinography
Electroretinography allows to examine the
function of the light-sensing cells
(photoreceptors) in the ...
The eyes are then propped open. The room
is darkened, and the person stares at a
flashing light. The electrical activity
g...
Thanks
Fundamentals of Opthalmology (Anatomy and diagnostic testing)
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Fundamentals of Opthalmology (Anatomy and diagnostic testing)

  1. 1. Fundamental of Opthalmology Faraza Javed PhD Pharmacology Diagnostic Tests in Opthalmology
  2. 2. What is ophthalmology?  Opthalmos=eye  Logos=word, thought, discourse The science of eyes is opthalmology
  3. 3. The branch of medicine concerned with the eyes  Anatomy  Function  Disease
  4. 4. Fundamentals of Opthalmology
  5. 5. The visual system  A coordinated pair of eyes  The appropriate protective mechanisms  The necessary neural apparatus to interpret visual information
  6. 6.  To produce a clear image of the external world and transmit this to visual cortex of brain
  7. 7. Structure of Eyeball  Fibrous coat  Cornea, sclera  Vascular coat (uveal tissue)  Iris, ciliary body, choroid  Nervous coat  Retina
  8. 8. Sclera  Collagen  Variable thickness  1mm around optic nerve head,  0.3mm posterior to muscle insertions  Tough, opaque, mainly avascular  Outer wall of the eyeball -protects intraocular contents, preserve shape  Attachments for the extraocular muscles
  9. 9. Cornea - anatomy  500-700 µm thick  Transparent, avascular  Forms approximately the anterior 1/6 of the outer coat of the eye and is continuous posteriorly with the sclera  5 layers:  Epithelium  Bowman’s membrane  Stroma  Descemet’s membrane  Endothelium
  10. 10. Iris and pupil (Vascular Coat)  Attached to ciliary body  Forms pupil at center
  11. 11. Pupil movements  Mydriasis (Dilation):  Dilator pupillae muscles  Low-intensity light, excitement, fear  Sympathetic  Miosis (Constriction):  Sphincter pupillae muscle  Bright light, accommodation  Parasympathetic
  12. 12. Ciliary body  Connects the iris and the choroid  Functions:  Aqueous humor production  Suspension of lens, accommodation
  13. 13. Aqueous Humour production  Active secretion by the epithelium of the ciliary processes of the ciliary body  Function:  Carries O2, nutrients to lens, cornea and waste products away  Maintain shape of eye by intraocular pressure  Flushes away blood, macrophages, inflammatory cells
  14. 14. Lens  Transparent, biconvex structure  Radially arranged zonule fibers that insert into the lens around its equator connect the lens to the ciliary body  Can change diopteric power but amplitude of accommodation reduces with age
  15. 15. Choroid  Highly vascularised structure between the sclera and the retina  Vessel layer, capillary layer  provides O2 + nutrition to the outer retinal layer,  Temperature homeostasis  Conduct blood vessels  Absorb excess light
  16. 16. Vitreous body  Clear gel-like structure that fills the posterior eye  98% water+ 2% collagen, hyaluronic acid, soluble proteins  Transmission of light onto the retina, cushion to the eyeball during trauma, nutritive and supportive role in retinal metabolism
  17. 17. Retina (Neural Layer)  Converts light into nerve impulses  Multilayered  2 functional layers:  Neurosensory retina  Retinal pigment epithelium (RPE)
  18. 18. 1. Retinal pigment epithelium (RPE)  Single layer  Microvilli at the apex where the photoreceptors attach  Functions:  Melanin pigments which absorb light (antireflection)  Participate in turnover of photoreceptors  Recycle vitamin A to form photosensitive pigments
  19. 19. 2. Neurosensory retina  3 main groups of neuronal cells: photoreceptors, bipolar cells, ganglion cells  Photoreceptor cells (rods + cones) undergo photochemical changes (phototransduction)  Bipolar cells relay nerve impulse to ganglion cells  Ganglion cell exit at optic disc to become optic nerve
  20. 20. Optic disc  The location where ganglion cell axons exit the eye to form the optic nerve  Yellowish orange color  1.5mm diameter (may vary), vertically oval  Central retinal vessels enter and leave the eye here
  21. 21. Retinal blood supply  Retinal arteries supply O2 + nutrients to the inner layers of the retina  Outer layers (RPE-outer nuclear) supplied by choroidal capillaries  SuperiorSuperior and inferior branches, which split into nasal, temporal branches.  Capillaries with nonfenestrated endothelium, prevent large molecules and toxins to permeate; this forms the inner blood retinal barrier
  22. 22. Optic nerve  Contains over 1 million fibres  Nerve fibres are myelinated only after leaving the eye  Surrounded by cerebrospinal fluid in the anterior extension of the subarachnoid space  Protected by the same meningeal layers of the brain
  23. 23. There are many diseases, disorders, and age- related changes that may affect the eyes and surrounding structures. The sharpness of vision is reduced despite use of the best glasses. The amount of light that reaches the back of the retina is reduced, and this wear and tear results in the development of cataract, macular degeneration or glucoma.
  24. 24. Such conditions cause damage to the eye's optic nerve and gets worse over time. It's often linked to a buildup of pressure inside the eye. The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to your brain. If the damage continues, it can lead to retinal cell degeneration and permanent vision loss.
  25. 25. Opthamological Method
  26. 26. Tonometery Tonometry measures the pressure within your eye. During tonometry, eye drops are used to numb the eye. Then a doctor or technician uses a device called a tonometer to measure the inner pressure of the eye. A small amount of pressure is applied to the eye by a tiny device or by a warm puff of air.
  27. 27. The range for normal pressure is 12-22 mm Hg. Most glaucoma cases are diagnosed with pressure exceeding 20mm Hg. However, some people can have glaucoma at pressures between 12 -22mm Hg. Eye pressure is unique to each person.
  28. 28. Opthalmoscopy This diagnostic procedure helps the doctor examine your optic nerve for glaucoma damage. Eye drops are used to dilate the pupil so that the doctor can see through your eye to examine the shape and color of the optic nerve.
  29. 29. The doctor will then use a small device with a light on the end to light and magnify the optic nerve. If intraocular pressure is not within the normal range or if the optic nerve looks unusual, doctor may ask to have one or two more glaucoma exams: perimetry and gonioscopy.
  30. 30. Perimetry Perimetry is a visual field test that produces a map of your complete field of vision. This test will help a doctor determine whether your vision has been affected by glaucoma. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a "map" of your vision.
  31. 31.  After glaucoma has been diagnosed, visual field tests are usually done one to two times a year to check for any changes in your vision.
  32. 32. Gonioscopy This diagnostic exam helps determine whether the angle where the iris meets the cornea is open and wide or narrow and closed. During the exam, eye drops are used to numb the eye. A hand-held contact lens is gently placed on the eye.
  33. 33. This contact lens has a mirror that shows the doctor if the angle between the iris and cornea is closed and blocked (a possible sign of angle-closure or acute glaucoma) or wide and open (a possible sign of open-angle, chronic glaucoma).
  34. 34. Pachymetry Pachymetry is a simple, painless test to measure the thickness of your cornea. A probe called a pachymeter is gently placed on the front of the eye (the cornea) to measure its thickness. Pachymetry can help your diagnosis, because corneal thickness has the potential to influence eye pressure readings.
  35. 35. With this measurement, doctor can better understand IOP reading and develop a treatment plan. The procedure takes only about a minute to measure both eyes.
  36. 36. Electroretinography Electroretinography allows to examine the function of the light-sensing cells (photoreceptors) in the retina by measuring the response of the retina to flashes of light. Eye drops numb the eye and dilate the pupil. A recording electrode in the form of a contact lens is then placed on the cornea, and another electrode is placed on the skin of the face nearby.
  37. 37. The eyes are then propped open. The room is darkened, and the person stares at a flashing light. The electrical activity generated by the retina in response to the flashes of light is recorded by the electrodes.Electroretinography is particularly useful for evaluating diseases, such as retinitis pigmentosa, in which the photoreceptors are affected.
  38. 38. Thanks
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Fundamentals of Opthalmology (Anatomy of eye ball and diagnostic tests to evaluate the pathophysiological conditions in eye diseases.

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