1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Language, Second Edition Susan Turley CHAPTER Medical Language Second Edition Ophthalmology 15

2. Ophthalmology The medical specialty that studies the anatomy and physiology of the eye and uses diagnostic tests, medical and surgical procedures, and drugs to treat eye diseases.

3. Figure 15-1 Eye

4. Anatomy and Physiology The eyes belong to a body system that consists of two identical main organs and many associated structures. Each eye or optic globe is located within the orbit, a hollowed out bony socket in the anterior cranium. The walls of the orbit are made up of several different cranial and facial bones.

5. Anatomy and Physiology (cont’d) The bony orbit surrounds all but the anterior surface of the eye. In the posterior wall of the orbit, the optic nerve, arteries, and veins come through openings in the bone to reach the eye. The bony orbit holds the eye and contains a layer of fat that cushions and protects the eye.

6. Anatomy of the Eye (cont’d) Eyelid and Lacrimal Gland – Eyelids protect the delicate tissues of the eye. – Eyelids continually refresh a layer of tears to keep the surface of the eye moist. – Prevent foreign substances from entering the eye.

7. Figure 15-2 Lacrimal glands

8. Anatomy of the Eye (cont’d) Eyelid and Lacrimal Gland (cont’d) – Sebaceous glands at the eyelids’ edges secrete oil to act as a barrier to keep tears in the eye. – Eyelashes form a protective barrier to catch foreign substances before they come in contact with the eye.

9. Anatomy of the Eye (cont’d) Eyelid and Lacrimal Gland (cont’d) – The lacrimal gland is located by the superior- lateral aspect of each eye. – The lacrimal gland continuously produces tears that travel through the lacrimal ducts to moisten the eye.

10. Anatomy of the Eye (cont’d) Eyelid and Lacrimal Gland (cont’d) – Tears contain an antibacterial enzyme to prevent bacterial infections. – At the medial aspects of the upper and lower eyelids, two tiny openings drain excess tears from the eye’s surface.

11. Anatomy of the Eye (cont’d) Conjunctiva – The conjunctiva is a delicate, transparent mucous membrane that covers the insides of the eyelids and continues across the anterior surface of the eye. – The conjunctiva produces watery, clear mucus that allows the eyelids to slide easily across the surface of the eye with each blink.

12. Figure 15-3 Anterior surface of the eye

13. Figure 15-4 Internal structures at the front of the eye

14. Figure 15-5 Tissue layers at the back of the eye

15. Anatomy of the Eye (cont’d) Sclera – A tough, fibrous connective tissue that forms a continuous outer layer around the eye; known as the white of the eye. – Protects the internal structures of the eye and helps maintain the shape of the eye – Is the site of attachment for all of the muscles that move the eye

16. Anatomy of the Eye (cont’d) Sclera (cont’d) – Across the anterior part of the eye, the sclera changes into a transparent layer known as the cornea.

17. Anatomy of the Eye (cont’d) Cornea – Allows light to enter the eye – Bends (refracts) the rays of light – Contains no blood vessels, not even capillaries – Has nerves and is the most sensitive area on the anterior surface of the eye

18. Anatomy of the Eye (cont’d) Iris and Pupil – A circular structure whose color is genetically determined. – At the center of the iris is the pupil, a round opening that allows light rays to enter the eye. – In bright light, muscles in the iris contract to constrict (decrease the diameter of) the pupil; this process is known as miosis.

19. Anatomy of the Eye (cont’d) Iris and Pupil (cont’d) – In dim light, muscles in the iris relax to dilate (increase the diameter of) the pupil; this process is known as mydriasis.

20. Anatomy of the Eye (cont’d) Choroid – A spongy membrane of blood vessels that is part of the internal structure of the eye. – The middle layer between the sclera and the retina. – Blood vessels of the choroid supply blood to the entire eye.

21. Anatomy of the Eye (cont’d) Ciliary Body – An extension of the choroid that attaches to ligaments that hold the lens in place behind the iris – Contains muscles that contract and relax to change the shape of the lens to focus light rays coming through the pupil – Produces aqueous humor

22. Anatomy of the Eye (cont’d) Lens – A clear, flexible disk located behind the pupil that is made of protein molecules arranged in a crystalline structure that is transparent – Becomes thicker and more rounded for near vision or thinner and flatter for far vision – Is enclosed in the lens capsule, a clear membrane

23. Anatomy of the Eye (cont’d) Anterior and Posterior Chambers – The anterior chamber is a small space between the cornea and the iris. – The posterior chamber is a very narrow space posterior to the iris. – Aqueous humor is a clear, watery fluid that is produced continuously by the ciliary body.

24. Anatomy of the Eye (cont’d) Anterior and Posterior Chambers (cont’d) – Aqueous humor carries nutrients and oxygen to the cornea and lens. – The rate of production of aqueous humor normally equals the rate of drainage.

25. Figure 15-6 Aqueous humor

26. Anatomy of the Eye (cont’d) Posterior Cavity – The largest space in the eye – Lies between the lens and the back of the eye – Is filled with vitreous humor, a clear, gel-like substance that helps maintain the shape of the eye

27. Figure 15-7 Internal structures at the back of the eye

28. Anatomy of the Eye (cont’d) Retina – A thin layer of tissue that lines the walls of the posterior cavity – The choroid layer lies beneath the retina and provides blood to the retina. – Fundus is a general word for the retina, whose curved sides and posterior wall form part of the sphere-shaped structure of the eye.

29. Anatomy of the Eye (cont’d) Retina (cont’d) – The optic disk is where the optic nerve enters the eye; known as the blind spot. – The macula is a dark yellow-orange area lateral to the optic disk. – The fovea, a small depression in the center of the macula, is the area of greatest visual acuity.

30. Figure 15-8 The retinae of both eyes

31. Anatomy of the Eye (cont’d) Extraocular Muscles – Control the movements of the eye – Attached to the sclera by tendons – Under voluntary control through nerve impulses

32. Figure 15-9 Extraocular muscles

33. Physiology of Vision Light rays from an object pass through the cornea, which bends the rays to begin to focus them. The light rays then enter the pupil and pass through the lens. Muscles and ligaments in the ciliary body contract or relax to change the shape of the lens and focus the light rays.

34. Physiology of Vision (cont’d) Light rays from objects directly in the line of vision fall on the macula, and these objects produce the clearest, sharpest image. Other parts of the retina pick up light rays from objects at the edges of the visual field. The retina contains special light-sensitive cells known as rods and cones.

35. Physiology of Vision (cont’d) Rods are sensitive to all levels of light but not to color. Rods function in daytime and nighttime vision. It only takes one photon (light particle) to activate a rod, so rods can detect objects in very low light, but they only produce a somewhat grainy black-and-white image of that object.

36. Cones are only sensitive to color. There are three types of cones: those that respond to red, green, or blue light. The cones are concentrated in the macula. Physiology of Vision (cont’d)

37. It takes many photons to activate a cone, which is why it is difficult to see colors in dim light. Cones produce a sharp color image that is superimposed on the black-and-white image created by the rods. Physiology of Vision (cont’d)

38. Figure 15-10 Light rays coming from an object to the retina

39. Rods and cones everywhere in the retina respond to the light rays to create an image. The image is then converted to nerve impulses that are transmitted to the optic nerve. Physiology of Vision (cont’d)

40. The optic nerve from each eye travels to the optic chiasm, a crossing point where parts of one optic nerve cross over to join the other optic nerve. Three-dimensional, stereoscopic vision with a perception of depth and distance is created. Physiology of Vision (cont’d)

41. These combined nerves enter the thalamus, which interprets the sensory information and quickly sends it to the midbrain and the visual cortex in the right and left occipital lobes of the brain. The visual cortex merges the image from each eye to create a single, three-dimensional image.

42. Figure 15-11 Optic nerve, optic chiasm, thalamus, and visual cortex

43. Diseases and Conditions Eyelid – Blepharitis – Blepharoptosis – Ectropion – Hordeolum

44. Figure 15-12 An ectropion Science Photo Library / Photo Researchers, Inc.

45. Diseases and Conditions (cont’d) Lacrimal Gland – Dacryocystitis – Xerophthalmia

46. Diseases and Conditions (cont’d) Conjunctiva, Sclera, and Cornea – Conjunctivitis – Corneal abrasion

47. Figure 15-13 Conjunctivitis Barbara Galati/Phototake NYC

48. Diseases and Conditions (cont’d) Conjunctiva, Sclera, and Cornea (cont’d) – Exophthalmos – Scleral icterus

49. Figure 15-14 Scleral icterus James Stevenson/Photo Researchers, Inc.

50. Diseases and Conditions (cont’d) Iris, Pupil, and Anterior Chamber – Anisocoria – Glaucoma – Hyphema – Photophobia – Uveitis

51. Diseases and Conditions (cont’d) Lens – Aphakia – Cataract – Presbyopia

52. Figure 15-15 Cataract NMSB/Custom Medical Stock Photo, Inc.

53. Diseases and Conditions (cont’d) Posterior Cavity and Retina – Color blindness – Diabetic retinopathy

54. Figure 15-16 Diabetic retinopathy Western Ophthalmic Hospital/Photo Researchers, Inc.

55. Diseases and Conditions (cont’d) Posterior Cavity and Retina – Floaters and flashers – Macular degeneration – Night blindness

56. Diseases and Conditions (cont’d) Posterior Cavity and Retina (cont’d) – Papilledema – Retinal detachment

57. Figure 15-17 Retinal detachment

58. Diseases and Conditions (cont’d) Posterior Cavity and Retina (cont’d) – Retinitis pigmentosa (RP) – Retinoblastoma – Retinopathy of prematurity

59. Diseases and Conditions (cont’d) Extraocular Muscles – Nystagmus – Strabismus

60. Figure 15-18 Esotropia.

61. Diseases and Conditions (cont’d) Refractive Disorders of the Eyes – Astigmatism – Hyperopia – Myopia

62. Figure 15-19 Hyperopia

63. Figure 15-20 Myopia

64. Diseases and Conditions (cont’d) Conditions of the Visual Cortex in the Brain – Amblyopia – Blindness

65. Diseases and Conditions (cont’d) Conditions of the Visual Cortex in the Brain (cont’d) – Diplopia – Scotoma

66. Laboratory and Diagnostic Procedures Diagnostic Procedures – Fluorescein angiography Radiologic Tests – Ultrasonography

67. Medical and Surgical Procedures Medical Procedures – Accommodation – Color blindness testing – Convergence

68. Figure 15-21 Ishihara color plate for testing color blindness

69. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Dilated funduscopy – Eye patching – Fluorescein staining

70. Figure 15-22 Ophthalmoscope REGGIE PARKER/Getty Images, Inc. - Taxi

71. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Gaze testing – Gonioscopy – Peripheral vision – Phorometry

72. Figure 15-23 Phorometer Custom Medical Stock Photo, Inc.

73. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Pupillary response – Slit-lamp examination

74. Figure 15-24 Pupillary response Custom Medical Stock Photo, Inc.

75. Figure 15-25 Slit-lamp examination Marka/Custom Medical Stock Photo, Inc.

76. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Tonometry – Visual acuity testing

77. Figure 15-26 Snellen chart National Library of Medicine

78. Medical and Surgical Procedures (cont’d) Surgical Procedures – Blepharoplasty – Capsulotomy – Cataract extraction – Corneal transplantation

79. Figure 15-27 Phacoemulsification Geoff Tompkinson / Photo Researchers, Inc.

80. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Enucleation – Hyperopia surgery – Laser photocoagulation

81. Figure 15-28 Laser photocoagulation Courtesy of National Eye Institute

82. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Myopia surgery – Retinopexy – Strabismus surgery – Trabeculoplasty

83. Figure 15-29 Keratomileusis Chris Barry / Phototake NYC

84. Drug Categories These categories of drugs are used to treat eye Diseases and Conditions: Note: All drugs used topically in the eye are specially formulated from a solution that is physiologically similar to the fluids of the eye so as not to damage the delicate tissues of the eye. – Antibiotic drugs – Antiviral drugs – Corticosteroid drugs

85. Drug Categories (cont’d) These categories of drugs are used to treat eye Diseases and Conditions: Note: All drugs used topically in the eye are specially formulated from a solution that is physiologically similar to the fluids of the eye so as not to damage the delicate tissues of the eye. – Drugs for glaucoma – Mydriatic drugs

86. Abbreviations