眼科学基础知识讲座专家讲座

IntroductionOphthalmologyisaspecialmedicalscience,abranchofclinicalmedicine,whichdealswithresearchfordevelopment,treatmentandpreventionofthedisordersofvisualorgans.Oculardiseasehavecloserelationtosystemicones.LearningOphthalmologyandunderstandingitsdevelopmentandpresentstatearehelpfultoeatabilishfoundationsofclinic,teachingandscienceresearch.3/3/20231眼科学基础知识讲座第1页第一章眼科学基础ChapteroneBasicophthalmology3/3/20232眼科学基础知识讲座第2页第一节眼组织解剖

anatomyofeyeball眼球

Theglobe(eyeball)anteriorandposteriordistanceofnormaleyeballis16mminborn.Atage323mm.Atadult24mm.3/3/20233眼科学基础知识讲座第3页Theveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.Theanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.Thedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.3/3/20234眼科学基础知识讲座第4页Theglobeiscomposedoftheeyecoats,thecontents.3/3/20235眼科学基础知识讲座第5页Theeyecoatismainlydividedintothreelayers.OuterlayerCorneaScleraMiddlelayerIrisCiliarybodyChoroidInnerlayerRetina3/3/20236眼科学基础知识讲座第6页外层TheoutercoatTheoutercoatconsistsofthecorneaandthesclera.

Theanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.Thetransitionalsreaofbothisthelimbus.Thefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.3/3/20237眼科学基础知识讲座第7页（1）角膜Cornea

横径Thehorizontaldiameteris11.5-12mm垂直径Theverticaldiameteris10.5-11mm中央部Thecentralthickness0.6mm周围部Theperipherythickness1mm3/3/20238眼科学基础知识讲座第8页前表面曲率半径

Theradiusofcorneacurvatureinfront7.8mm后表面曲率半径

Theradiusofcorneacurvatureinback6.8mmItsrefractivepowerisequaltothatof+43diopterlens角膜Cornea3/3/20239眼科学基础知识讲座第9页Thecentralthickness0.6mmTheradiusofcorneacurvatureinfront7.8mmTheradiusofcorneacurvatureinback6.8mmTheperipherythickness1mm3/3/202310眼科学基础知识讲座第10页组织学分层

fromanteriortoposterior,thecorneahasfivedistinctlayers:①上皮细胞层Epithelium②前弹力层Bowman’smembrane③基质层Stroma④后弹力层Descemet’smembrane⑤内皮细胞层Endothelium

3/3/202311眼科学基础知识讲座第11页Epithelium

Basementlayer

Bowman’smembrane

Stroma

Descemet’smembrane

endothelium

regenerateafterinjery3/3/202312眼科学基础知识讲座第12页

(2)巩膜

Sclera

①表层巩膜Theepisclera②巩膜实质层Thescleralstroma③棕黑板层Thelaminafascia组织学分层thescleraincludes:3/3/202313眼科学基础知识讲座第13页ScleraThickness:0.3to1.0mm,attheinsertionoftherectusmusles,itisabout0.3mm,elsewhereabout1mm.AnteriorpartcoveredbybulbarconjunctivaConnectedto6extraocularmusclesThinnerandtranslucentinchildren3/3/202314眼科学基础知识讲座第14页角巩膜缘

thecorneasclerallimbus:isatransitionalzoneofthecorneaandthescleral,wherethecorneainsertsintothescleraitsanteriorborderisBowman’slayerItsposteriormarginisDescemet’smembraneItswidthis1mmSurgicallandmarkofimportantstructures3/3/202315眼科学基础知识讲座第15页前房角Anteriorchamberangle:Include:SchwalbelinetrabecularreticulumSchlenmcannelScleraspurCiliarybodyIrisroot包含:Schwalbe线小梁网Schlenm管巩膜突睫状带虹膜根部3/3/202316眼科学基础知识讲座第16页

中层ThemiddlecoatIncludingthreeparts:IrisCiliarybodyChoroid

Richinpigmentandbloodvessels

3/3/202317眼科学基础知识讲座第17页虹膜

IrisItsituatesinthemostanteriorpartofthemiddlecoat,infrontofthelens,connectedwiththecilliarybodyinperphery.Theirisincludslayers:AnteriorsurfacelayerStromalayerPigmentepithelial

threreisaroundholeinthecentrecalledPupil直径2.5-4mm

3/3/202318眼科学基础知识讲座第18页虹膜Iris3/3/202319眼科学基础知识讲座第19页睫状体CiliarybodyConnectirisrootandchoroidAdistenceofabout6mm，corona：2mm，Parsplana：4mmTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruch‘smembrane4、Epitheliumlayer5、Theinternallimitingmembrane

1睫状肌43/3/202320眼科学基础知识讲座第20页睫状体Ciliarybody扁平部睫状突锯齿缘睫状冠parsplicata3/3/202321眼科学基础知识讲座第21页脉络膜ChoroidItissituatedbeweenthescleraandtheretina,anteriortooraserrata,goingbehindtothesurroundingoftheopticnerve.Fullofthepigmentactsasadarkroomandashadeoflight.Including：1、大血管层Largevascularlayer2、中血管层Middlevascularlayer3、毛细血管层Capillarylayer3/3/202322眼科学基础知识讲座第22页

内层theInnercoat

istheretina,whichcoversthehrinneraspectoftheposteriortwo-thridsofthewalloftheglobe.Theoutsideoftheretinaisthechoroid,theinsideisthevitreous.Theopticneverfixestheretinatothewalloftheglobe.Theretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.3/3/202323眼科学基础知识讲座第23页

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

3/3/202324眼科学基础知识讲座第24页3/3/202325眼科学基础知识讲座第25页视网膜Ratina

dividedinto10layersfromoutsidetoinside.

outside:

Retinalpigmentepithelium,RPE

视网膜色素上皮层3/3/202326眼科学基础知识讲座第26页内层inside

①

视锥、视杆细胞层（光感受器细胞层）

Coneandrodlayer②

外界膜Externallimitingmembrane③

外核层Outernuclearlayer④

外丛状层Outerplaxiform⑤

内核层Innernuclearlayer⑥

内丛状层Innerplexiformlayer⑦

神经节细胞层Ganglioncelllayer⑧

神经纤维层Nervefiberlayer⑨

内界膜Limitingmembrane3/3/202327眼科学基础知识讲座第27页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3/3/202328眼科学基础知识讲座第28页6Innernuclearlayer7Innerplexiformlayer8Ganglioncelllayer9Nervefiberlayer10Limitingmembrane

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3/3/202329眼科学基础知识讲座第29页（二）

眼球内容

Contentsoftheeye1.

房水Aqueoushumor前房Anteriorchamber：itisboundedanteriorlybythecornea,posterioritybytheirisandthelens.thedeepthinthecentreis2.5-3.0mm.thevolumeinhumaneyeisabout0.2ml.后房Posteriorchamber:itisboundedanteriorlybytheiris,posterioritybylensanteriorcapsuleanditszonule.thevolumeinhumaneyeisabout0.06ml.Posteriorchamberflowsintotheanteriorchamberthroughthepupil.3/3/202330眼科学基础知识讲座第30页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

3/3/202331眼科学基础知识讲座第31页2、晶状体LensTransparent，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：19D3/3/202332眼科学基础知识讲座第32页LensThesolefunctionofthelensistofocuslightraysupontheretina.DistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizedNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalAsthelensagesitsaccommodativepowerisgraduallyreduced.3/3/202333眼科学基础知识讲座第33页lensCompositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)Therearenopainfibers,bloodvessels,ornervesinlensFunctions:1、Focusing2、accommodationChangeswithageLarger&harderLesselasticCataract3/3/202334眼科学基础知识讲座第34页3、玻璃体VitreousbodyConsistsmainlyofwater2/3oftheeye’svolumeandweightViscousityImportantformetabolismofintraoculartissuesAttachedtoretinaThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.3/3/202335眼科学基础知识讲座第35页VitreousbodyAgingchanges：Thinner&moreliquid“floaters”

3/3/202336眼科学基础知识讲座第36页视路及瞳孔反射

Opticpathwayandpupillaryreflex

Thevisualmessageobtainedfromtheretinaistransmittedtobrainviatheopticnever3/3/202337眼科学基础知识讲座第37页视路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Visualcortex3/3/202338眼科学基础知识讲座第38页视路opticpathwayItisaportionofcentralnervoussystem,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Intracranial10mm3/3/202339眼科学基础知识讲座第39页视路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.3/3/202340眼科学基础知识讲座第40页Opticnerve

Opticchiasm

Optictract

Lateralgeniculatebody

Opticradiation

Occipitalcortex3/3/202341眼科学基础知识讲座第41页视路Visualpathway3/3/202342眼科学基础知识讲座第42页瞳孔反射路

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.3/3/202343眼科学基础知识讲座第43页3/3/202344眼科学基础知识讲座第44页二、眼眶及从属器

Orbitandaccessoryapparatus(一)眼眶OrbitThedepthofadult’sisabout4-5cm,theexternalrimisalittlebehindwithmuchexposureoftheglobewhichiseasytobeinjuried.theexternalwalloftheorbitisquitehard,theotherthreearewiththinbone.3/3/202345眼科学基础知识讲座第45页眼眶OrbitFrontal额骨Zygomayic颧骨Maxillary上颌骨Ethmoidal筛骨Sphenoid蝶骨Lacrimal泪骨Palatine颚骨

Theorbitiscomposedof6bones:3/3/202346眼科学基础知识讲座第46页眼眶Orbit1.视神经孔和管Opticforamenandcanal4-9mminlength,4-6mminwidth.theopticnerveandtheophthalmicarterythroughpasstothecranialcavity.2.眶上裂SuperiororbitalfissureTherearethe3rd,4th,6thcranialnervesandthefirstbranchoftrigeminalnerve,theopthalmicnerve,thesuperiorophthalmicveinaswellasthesympatheticnervepassingthroughthefissure.3/3/202347眼科学基础知识讲座第47页3.眶下裂InferiororbitalfissureIttransmitsthe2ndbranchofthe5thcranialnerve,inferiorophthalmicneverandarteryandinferiorophthalmicvein.4.眶上切迹和（眶下孔）ThesupraorbitalnotchandinfraorbitalforamenHerearenerveandbloodvesselwiththesamenamepassingthroughthem眼眶Orbit3/3/202348眼科学基础知识讲座第48页（二）眼睑Eyelids

Theeyelidaredividedintoupperandlowerone,situatedintheanteriormouthoftheorbit,coverontheanteriorsurfaceoftheglobe,theupperoneislimitedbytheeyebrow,thelowereyelidisconnectedwithfacialskin.Palpebralfissure(睑裂)betweentwoeyelids8mmZeisglandandMollglandopentheirmouthsathairfolliculosis(毛囊)3/3/202349眼科学基础知识讲座第49页Eyelids1皮肤层TheskinItisoneofthemostflexibleandthinnestskininthebody.2皮下组织层SubcutaneousItiscomposedoflooseconnectivetissueandalittlefat.3肌层Muscularlayer4睑板层LayerofthefibrouslayerThereareverticallgland---Meibom’gland5结膜层TheconjunctivallayerCloselyattachedtotheposteriorsurfaceofthefibrouslayer3/3/202350眼科学基础知识讲座第50页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3/3/202351眼科学基础知识讲座第51页EyelidsSensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.Function:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.3/3/202352眼科学基础知识讲座第52页(三)结膜Conjunctiva1睑结膜Palpebralconjunctivaitcloselyadheretothefibrouslayer,can’tbepushe,smoothandtransparentverticalsmallbloodvesselsmaybeseeninit.2球结膜Bulbarconjunctivaitcoversonthesclerasituatedinanteriorpartoftheglobe,looselyconnectedwithtenon’scapsule,easytobepushed,elevated.3穹窿结膜Fornicalconjunctiva

1、gobletcell2、krauseandwolfringglang3/3/202353眼科学基础知识讲座第53页睑结膜Palpebralconjunctiva球结膜Bulbarconjunctiva穹窿结膜FornicalconjunctivaBulbarconjunctivaPalpebralconjunctivaFornicalconjunctiva3/3/202354眼科学基础知识讲座第54页(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.3/3/202355眼科学基础知识讲座第55页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Nasolacrimalduct3/3/202356眼科学基础知识讲座第56页(五)眼外肌Extraocularmuscles

4条直肌Rectus

上直肌superiorrectimuscles

下直肌inferiorrectimuscles

内直肌medialrectimuscles

外直肌externalrectimuscles2条斜肌Obliquemuscle

上斜肌superiorobliquemuscles

下斜肌Inferiorobliquemuscles3/3/202357眼科学基础知识讲座第57页4条直肌Rectus上直肌superiorrectimuscles下直肌inferiorrectimuscles内直肌medialrectimuscles外直肌externalrectimuscles2条斜肌Obliquemuscle上斜肌superiorobliquemuscles下斜肌Inferiorobliquemuscles上直肌

上斜肌

外直肌内直肌下直肌下斜肌3