眼科学基础.ppt

2019/12/10,1,Introduction,Ophthalmologyisaspecialmedicalscience,abranchofclinicalmedicine,whichdealswithresearchfordevelopment,treatmentandpreventionofthedisordersofvisualorgans.Oculardiseasehavecloserelationtosystemicones.LearningOphthalmologyandunderstandingitsdevelopmentandpresentstatearehelpfultoeatabilishfoundationsofclinic,teachingandscienceresearch.,2019/12/10,2,第一章眼科学基础ChapteroneBasicophthalmology,2019/12/10,3,第一节眼的组织解剖anatomyofeyeball眼球Theglobe(eyeball)anteriorandposteriordistanceofnormaleyeballis16mminborn.Atage323mm.Atadult24mm.,2019/12/10,4,Theveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.Theanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.Thedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.,2019/12/10,5,Theglobeiscomposedoftheeyecoats,thecontents.,2019/12/10,6,Theeyecoatismainlydividedintothreelayers.,OuterlayerCorneaScleraMiddlelayerIrisCiliarybodyChoroidInnerlayerRetina,2019/12/10,7,外层Theoutercoat,Theoutercoatconsistsofthecorneaandthesclera.Theanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.Thetransitionalsreaofbothisthelimbus.Thefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.,2019/12/10,8,（1）角膜Cornea,横径Thehorizontaldiameteris11.5-12mm垂直径Theverticaldiameteris10.5-11mm中央部Thecentralthickness0.6mm周边部Theperipherythickness1mm,2019/12/10,9,前表面曲率半径Theradiusofcorneacurvatureinfront7.8mm后表面曲率半径Theradiusofcorneacurvatureinback6.8mmItsrefractivepowerisequaltothatof+43diopterlens,角膜Cornea,2019/12/10,10,Thecentralthickness0.6mm,Theradiusofcorneacurvatureinfront7.8mm,Theradiusofcorneacurvatureinback6.8mm,Theperipherythickness1mm,2019/12/10,11,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Endothelium,2019/12/10,12,EpitheliumBasementlayerBowmansmembraneStromaDescemetsmembraneendotheliumregenerateafterinjery,2019/12/10,13,(2)巩膜Sclera,表层巩膜Theepisclera巩膜实质层Thescleralstroma棕黑板层Thelaminafascia,组织学分层thescleraincludes:,2019/12/10,14,Sclera,Thickness:0.3to1.0mm,attheinsertionoftherectusmusles,itisabout0.3mm,elsewhereabout1mm.AnteriorpartcoveredbybulbarconjunctivaConnectedto6extraocularmusclesThinnerandtranslucentinchildren,2019/12/10,15,角巩膜缘thecorneasclerallimbus:isatransitionalzoneofthecorneaandthescleral,wherethecorneainsertsintothescleraitsanteriorborderisBowmanslayerItsposteriormarginisDescemetsmembraneItswidthis1mmSurgicallandmarkofimportantstructures,2019/12/10,16,前房角Anteriorchamberangle:,Include:SchwalbelinetrabecularreticulumSchlenmcannelScleraspurCiliarybodyIrisroot,包括:Schwalbe线小梁网Schlenm管巩膜突睫状带虹膜根部,2019/12/10,17,中层Themiddlecoat,Includingthreeparts:IrisCiliarybodyChoroidRichinpigmentandbloodvessels,2019/12/10,18,虹膜Iris,Itsituatesinthemostanteriorpartofthemiddlecoat,infrontofthelens,connectedwiththecilliarybodyinperphery.Theirisincludslayers:AnteriorsurfacelayerStromalayerPigmentepithelialthrereisaroundholeinthecentrecalledPupil直径2.5-4mm,2019/12/10,19,虹膜Iris,2019/12/10,20,睫状体Ciliarybody,ConnectirisrootandchoroidAdistenceofabout6mm，corona：2mm，Parsplana：4mmTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruchsmembrane4、Epitheliumlayer5、Theinternallimitingmembrane,1睫状肌,4,2019/12/10,21,睫状体Ciliarybody,扁平部,睫状突,锯齿缘,睫状冠parsplicata,2019/12/10,22,脉络膜Choroid,Itissituatedbeweenthescleraandtheretina,anteriortooraserrata,goingbehindtothesurroundingoftheopticnerve.Fullofthepigmentactsasadarkroomandashadeoflight.Including：1、大血管层Largevascularlayer2、中血管层Middlevascularlayer3、毛细血管层Capillarylayer,2019/12/10,23,内层theInnercoat,istheretina,whichcoversthehrinneraspectoftheposteriortwo-thridsofthewalloftheglobe.Theoutsideoftheretinaisthechoroid,theinsideisthevitreous.Theopticneverfixestheretinatothewalloftheglobe.Theretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.,2019/12/10,24,内层theInnercoat,The黄斑Maculaareaisaspecialregionoftheretinawiththesharpestvisualsensation.itsdiameterisabout1-3mmasmallfoveolaisinitscentrecalled黄斑中心凹Foveacentralis,withthedirectophthalmoscopetheFoveacentralisproduceaclearlyfoveareflaction.Apinkarealocatedatnasalsideabout3mmtothemaculaisthe视盘Opticdisc.thevisualfibersontheretinacometogethertogooutoftheglobetovisualcentre.therearearteryandvein.Asmalldepressiononitscentreiscalled视杯Opticcup,2019/12/10,25,2019/12/10,26,视网膜Ratina,dividedinto10layersfromoutsidetoinside.outside:Retinalpigmentepithelium,RPE视网膜色素上皮层,2019/12/10,27,内层inside,视锥、视杆细胞层（光感受器细胞层）Coneandrodlayer外界膜Externallimitingmembrane外核层Outernuclearlayer外丛状层Outerplaxiform内核层Innernuclearlayer内丛状层Innerplexiformlayer神经节细胞层Ganglioncelllayer神经纤维层Nervefiberlayer内界膜Limitingmembrane,2019/12/10,28,1RPERetinalpigmentepithelium2Coneandrodlayer3Externallimitingmembrane4Outernuclearlayer5Outerplaxiform1.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,2019/12/10,29,6Innernuclearlayer7Innerplexiformlayer8Ganglioncelllayer9Nervefiberlayer10Limitingmembrane6.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,2019/12/10,30,（二）眼球内容Contentsoftheeye,1.房水Aqueoushumor前房Anteriorchamber：itisboundedanteriorlybythecornea,posterioritybytheirisandthelens.thedeepthinthecentreis2.5-3.0mm.thevolumeinhumaneyeisabout0.2ml.后房Posteriorchamber:itisboundedanteriorlybytheiris,posterioritybylensanteriorcapsuleanditszonule.thevolumeinhumaneyeisabout0.06ml.Posteriorchamberflowsintotheanteriorchamberthroughthepupil.,2019/12/10,31,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,2019/12/10,32,2、晶状体Lens,Transparent，doubleconvexmirrorBesuspendedBetweenpupil-irisandvitreousbody,connectwithciliarybodyAbout4mmthickand9mmindiameterTheradiusoflenscurvatureinfront：10mmTheradiusoflenscurvatureinback：6mmDiopter：19D透明，双凸透镜位于瞳孔-虹膜和玻璃体之间前面曲率：10mm后面曲率：6mm屈光度：19D,2019/12/10,33,Lens,Thesolefunctionofthelensistofocuslightraysupontheretina.DistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizedNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalAsthelensagesitsaccommodativepowerisgraduallyreduced.,2019/12/10,34,lens,Compositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)Therearenopainfibers,bloodvessels,ornervesinlensFunctions:1、Focusing2、accommodationChangeswithageLarger&harderLesselasticCataract,2019/12/10,35,3、玻璃体Vitreousbody,Consistsmainlyofwater2/3oftheeyesvolumeandweightViscousityImportantformetabolismofintraoculartissuesAttachedtoretinaThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.,2019/12/10,36,Vitreousbody,Agingchanges：Thinner&moreliquid“floaters”,2019/12/10,37,视路及瞳孔反射OpticpathwayandpupillaryreflexThevisualmessageobtainedfromtheretinaistransmittedtobrainviatheopticnever,2019/12/10,38,视路opticpathway,（一）视神经Opticnerve(1)眼内段Intraocular(2)眶内段Intraorbital(3)管内段Intracanalicular(4)颅内段Intracranial（二）视交叉Opticchiasm（三）视束Optictract（四）外侧膝状体Lateralgeniculatebody（五）视放射Opticradiation（六）视皮质Visualcortex,2019/12/10,39,视路opticpathway,Itisaportionofcentralnervoussystem,composedoffiberssendoutbyretinaganglimcells.theopticneveristhesegmentofnervefromthedisctotheanteriorangleofthechiasm,about42-47mmlong.(1)眼内段Intraocular1mm(2)眶内段Intraorbital25-30mm(3)管内段Intracanalicular4-10mm(4)颅内段Intracranial10mm,2019/12/10,40,视路Visualpathway,光感受器retinalphotoreceptor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.,2019/12/10,41,OpticnerveOpticchiasmOptictractLateralgeniculatebodyOpticradiationOccipitalcortex,2019/12/10,42,视路Visualpathway,2019/12/10,43,瞳孔反射路Pathwayofpupillaryreflex,光反射Lightreflex直接光反射directreflex间接光反射indirectreflex近反射Nearreflexwhentheeyeslookatanearobject,3reactionsoccur:accmmodation,convergence,andconstrictionofthepupil.,2019/12/10,44,2019/12/10,45,二、眼眶及附属器Orbitandaccessoryapparatus,(一)眼眶OrbitThedepthofadultsisabout4-5cm,theexternalrimisalittlebehindwithmuchexposureoftheglobewhichiseasytobeinjuried.theexternalwalloftheorbitisquitehard,theotherthreearewiththinbone.,2019/12/10,46,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,Theorbitiscomposedof6bones:,2019/12/10,47,眼眶Orbit,1.视神经孔和管Opticforamenandcanal4-9mminlength,4-6mminwidth.theopticnerveandtheophthalmicarterythroughpasstothecranialcavity.2.眶上裂SuperiororbitalfissureTherearethe3rd,4th,6thcranialnervesandthefirstbranchoftrigeminalnerve,theopthalmicnerve,thesuperiorophthalmicveinaswellasthesympatheticnervepassingthroughthefissure.,2019/12/10,48,3.眶下裂InferiororbitalfissureIttransmitsthe2ndbranchofthe5thcranialnerve,inferiorophthalmicneverandarteryandinferiorophthalmicvein.4.眶上切迹和（眶下孔）ThesupraorbitalnotchandinfraorbitalforamenHerearenerveandbloodvesselwiththesamenamepassingthroughthem,眼眶Orbit,2019/12/10,49,（二）眼睑Eyelids,Theeyelidaredividedintoupperandlowerone,situatedintheanteriormouthoftheorbit,coverontheanteriorsurfaceoftheglobe,theupperoneislimitedbytheeyebrow,thelowereyelidisconnectedwithfacialskin.Palpebralfissure(睑裂)betweentwoeyelids8mmZeisglandandMollglandopentheirmouthsathairfolliculosis(毛囊),2019/12/10,50,Eyelids,1皮肤层TheskinItisoneofthemostflexibleandthinnestskininthebody.2皮下组织层SubcutaneousItiscomposedoflooseconnectivetissueandalittlefat.3肌层Muscularlayer4睑板层LayerofthefibrouslayerThereareverticallgland-Meibomgland5结膜层TheconjunctivallayerCloselyattachedtotheposteriorsurfaceofthefibrouslayer,2019/12/10,51,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,2019/12/10,52,Eyelids,Sensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.Function:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.,2019/12/10,53,(三)结膜Conjunctiva,1睑结膜Palpebralconjunctivaitcloselyadheretothefibrouslayer,cantbepushe,smoothandtransparentverticalsmallbloodvesselsmaybeseeninit.2球结膜Bulbarconjunctivaitcoversonthesclerasituatedinanteriorpartoftheglobe,looselyconnectedwithtenonscapsule,easytobepushed,elevated.3穹窿结膜Fornicalconjunctiva1、gobletcell2、krauseandwolfringglang,2019/12/10,54,睑结膜Palpebralconjunctiva球结膜Bulbarconjunctiva穹窿结膜Fornicalconjunctiva,2019/12/10,55,(四)泪器Lacrimalapparatus,1泪腺LacrimalglandThereareabout10-20excretoryductsopeningtheirmouthsintheexternalandsuperiorfornicalconjunctive.2泪道Lacrimalpassages(1)泪小点LacrimalpunctaThereareeachoneintheupperandlowereyelids,opentheirmouthsintothelacrimallake.(2)泪小管LacrimalcanaliculusLinkupthepunctaandthelacrimalsac.(3)泪囊Lacrimalsac12mminlength,4-7mminwidth.(4)鼻泪管Nasolacrimalduct18mmlength,thesecretionis0.9-2.2mmeacheye.,2019/12/10,56,1泪腺Lacrimalgland2泪道Lacrimalpassages(1)泪小点Lacrimalpuncta(2)泪小管Lacrimalcanaliculus(3)泪囊Lacrimalsac(4)鼻泪管Nasolacrimalduct,2019/12/10,57,(五)眼外肌Extraocularmuscles,4条直肌Rectus上直肌su