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IntroductionOphthalmologyisaspecialmedicalscience,abranchofclinicalmedicine,whichdealswithresearchfordevelopment,treatmentandpreventionofthedisordersofvisualorgans.Oculardiseasehavecloserelationtosystemicones.LearningOphthalmologyandunderstandingitsdevelopmentandpresentstatearehelpfultoeatabilishfoundationsofclinic,teachingandscienceresearch.10/9/20211 第一章眼科学基础ChapteroneBasicophthalmology10/9/20212 第一节眼的组织解剖anatomyofeyeball眼球Theglobe(eyeball)anteriorandposteriordistanceofnormaleyeballis16mminborn.Atage323mm.Atadult24mm.10/9/20213 Theveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.Theanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.Thedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.10/9/20214 Theglobeiscomposedoftheeyecoats,thecontents.10/9/20215 Theeyecoatismainlydividedintothreelayers.OuterlayerCorneaScleraMiddlelayerIrisCiliarybodyChoroidInnerlayerRetina10/9/20216 外层TheoutercoatTheoutercoatconsistsofthecorneaandthesclera.Theanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.Thetransitionalsreaofbothisthelimbus.Thefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.10/9/20217 （1）角膜Cornea横径Thehorizontaldiameteris11.5-12mm垂直径Theverticaldiameteris10.5-11mm中央部Thecentralthickness0.6mm周边部Theperipherythickness1mm10/9/20218 前表面曲率半径Theradiusofcorneacurvatureinfront7.8mm后表面曲率半径Theradiusofcorneacurvatureinback6.8mmItsrefractivepowerisequaltothatof+43diopterlens角膜Cornea10/9/20219 Thecentralthickness0.6mmTheradiusofcorneacurvatureinfront7.8mmTheradiusofcorneacurvatureinback6.8mmTheperipherythickness1mm10/9/202110 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Endothelium10/9/202111 Epithelium Basementlayer Bowman’smembrane Stroma Descemet’smembrane endotheliumregenerateafterinjery10/9/202112 (2)巩膜Sclera①表层巩膜Theepisclera②巩膜实质层Thescleralstroma③棕黑板层Thelaminafascia组织学分层thescleraincludes:10/9/202113 ScleraThickness:0.3to1.0mm,attheinsertionoftherectusmusles,itisabout0.3mm,elsewhereabout1mm.AnteriorpartcoveredbybulbarconjunctivaConnectedto6extraocularmusclesThinnerandtranslucentinchildren10/9/202114 角巩膜缘thecorneasclerallimbus:isatransitionalzoneofthecorneaandthescleral,wherethecorneainsertsintothescleraitsanteriorborderisBowman’slayerItsposteriormarginisDescemet’smembraneItswidthis1mmSurgicallandmarkofimportantstructures10/9/202115 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10/9/202116 中层ThemiddlecoatIncludingthreeparts:IrisCiliarybodyChoroidRichinpigmentandbloodvessels10/9/202117 虹膜IrisItsituatesinthemostanteriorpartofthemiddlecoat,infrontofthelens,connectedwiththecilliarybodyinperphery.Theirisincludslayers:AnteriorsurfacelayerStromalayerPigmentepithelialthrereisaroundholeinthecentrecalledPupil直径2.5-4mm10/9/202118 虹膜Iris10/9/202119 睫状体CiliarybodyConnectirisrootandchoroidAdistenceofabout6mm，corona：2mm，Parsplana：4mmTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruch‘smembrane4、Epitheliumlayer5、Theinternallimitingmembrane1睫状肌410/9/202120 睫状体Ciliarybody扁平部睫状突锯齿缘睫状冠parsplicata10/9/202121 脉络膜ChoroidItissituatedbeweenthescleraandtheretina,anteriortooraserrata,goingbehindtothesurroundingoftheopticnerve.Fullofthepigmentactsasadarkroomandashadeoflight.Including：1、大血管层Largevascularlayer2、中血管层Middlevascularlayer3、毛细血管层Capillarylayer10/9/202122 内层theInnercoatistheretina,whichcoversthehrinneraspectoftheposteriortwo-thridsofthewalloftheglobe.Theoutsideoftheretinaisthechoroid,theinsideisthevitreous.Theopticneverfixestheretinatothewalloftheglobe.Theretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.10/9/202123 内层theInnercoatThe黄斑Maculaareaisaspecialregionoftheretinawiththesharpestvisualsensation.itsdiameterisabout1-3mmasmallfoveolaisinitscentrecalled黄斑中心凹Foveacentralis,withthedirectophthalmoscopetheFoveacentralisproduceaclearlyfoveareflaction.Apinkarealocatedatnasalsideabout3mmtothemaculaisthe视盘Opticdisc.thevisualfibersontheretinacometogethertogooutoftheglobetovisualcentre.therearearteryandvein.Asmalldepressiononitscentreiscalled视杯Opticcup10/9/202124 10/9/202125 视网膜Ratinadividedinto10layersfromoutsidetoinside.outside:Retinalpigmentepithelium,RPE视网膜色素上皮层10/9/202126 内层inside① 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Limitingmembrane10/9/202127 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10/9/202128 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10/9/202129 （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.10/9/202130 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10/9/202131 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：19D10/9/202132 LensThesolefunctionofthelensistofocuslightraysupontheretina.DistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizedNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalAsthelensagesitsaccommodativepowerisgraduallyreduced.10/9/202133 lensCompositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)Therearenopainfibers,bloodvessels,ornervesinlensFunctions:1、Focusing2、accommodationChangeswithageLarger&harderLesselasticCataract10/9/202134 3、玻璃体VitreousbodyConsistsmainlyofwater2/3oftheeye’svolumeandweightViscousityImportantformetabolismofintraoculartissuesAttachedtoretinaThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.10/9/202135 VitreousbodyAgingchanges：Thinner&moreliquid“floaters”10/9/202136 视路及瞳孔反射OpticpathwayandpupillaryreflexThevisualmessageobtainedfromtheretinaistransmittedtobrainviatheopticnever10/9/202137 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Visualcortex10/9/202138 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Intracranial10mm10/9/202139 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.10/9/202140 Opticnerve Opticchiasm Optictract Lateralgeniculatebody Opticradiation Occipitalcortex10/9/202141 视路Visualpathway10/9/202142 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.10/9/202143 10/9/202144 二、眼眶及附属器Orbitandaccessoryapparatus(一)眼眶OrbitThedepthofadult’sisabout4-5cm,theexternalrimisalittlebehindwithmuchexposureoftheglobewhichiseasytobeinjuried.theexternalwalloftheorbitisquitehard,theotherthreearewiththinbone.10/9/202145 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:10/9/202146 眼眶Orbit1.视神经孔和管Opticforamenandcanal4-9mminlength,4-6mminwidth.theopticnerveandtheophthalmicarterythroughpasstothecranialcavity.2.眶上裂SuperiororbitalfissureTherearethe3rd,4th,6thcranialnervesandthefirstbranchoftrigeminalnerve,theopthalmicnerve,thesuperiorophthalmicveinaswellasthesympatheticnervepassingthroughthefissure.10/9/202147 3.眶下裂InferiororbitalfissureIttransmitsthe2ndbranchofthe5thcranialnerve,inferiorophthalmicneverandarteryandinferiorophthalmicvein.4.眶上切迹和（眶下孔）ThesupraorbitalnotchandinfraorbitalforamenHerearenerveandbloodvesselwiththesamenamepassingthroughthem眼眶Orbit10/9/202148 （二）眼睑EyelidsTheeyelidaredividedintoupperandlowerone,situatedintheanteriormouthoftheorbit,coverontheanteriorsurfaceoftheglobe,theupperoneislimitedbytheeyebrow,thelowereyelidisconnectedwithfacialskin.Palpebralfissure(睑裂)betweentwoeyelids8mmZeisglandandMollglandopentheirmouthsathairfolliculosis(毛囊)10/9/202149 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TheconjunctivallayerCloselyattachedtotheposteriorsurfaceofthefibrouslayer10/9/202150 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10/9/202151 EyelidsSensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.Function:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.10/9/202152 (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Fornicalconjunctiva1、gobletcell2、krauseandwolfringglang10/9/202153 睑结膜Palpebralconjunctiva球结膜Bulbarconjunctiva穹窿结膜FornicalconjunctivaBulbarconjunctivaPalpebralconjunctivaFornicalconjunctiva10/9/202154 (四)泪器Lacrimalapparatus1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.10/9/202155 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Nasolacrimalduct10/9/202156 (五)眼外肌Extraocularmuscles4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Inferiorobliquemuscles10/9/202157 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10/9/202158 四、眼球的血液循环和神经分布Bloodcirculationandinnervationoftheglobe（一）血液循环Bloodcirculation动脉Artery1、视网膜中央血管系统thecentralretinalvascularsystem2、睫状血管系统theciliaryvascularsystem10/9/202159 1.视网膜中央血管系统Thecentralretinalvascularsystem视网膜中央动脉Centralretinalartery,CRA10/9/202160 视网膜中央血管系统Thecentralretinalvascularsystem10/9/202161 2.睫状血管系统theciliaryvascularsystem(1)睫状后短动脉Shortposteriorciliaryartery(2)睫状后长动脉Longposteriorciliaryartery(3)睫状前动脉Anteriorciliaryartery10/9/202162 (1)睫状后短动脉Shortposteriorciliaryartery(2)睫状后长动脉Longposteriorciliaryartery(3)睫状前动脉Anteriorciliaryartery睫状后长动脉睫状后短动脉睫状前动脉10/9/202163 静脉Vein1.视网膜中央静脉CentralretinalveinCRV2.涡静脉Vortexvein3.睫状前静脉Anteriorciliaryvein10/9/202164 1.视网膜中央静脉CentralretinalveinCRV2.涡静脉Vortexvein3.睫状前静脉Anteriorciliaryvein视网膜中央静脉涡静脉睫状前静脉10/9/202165 visualorganvisualorganEyeballapparatus：eyelid，conjunctiva，lacrimal，ocular，orbitalisapparatusmuscles，Wallcontent：aqueoushumor，lens，vitreousbodyouter：cornea，scleramedia：iris，ciliary，choroidinner：retinavisualretinapathwayOpticnerveOpticchiasmOptictractLateralgeniculatebodyopticradiationoccipitallobeopticalcenter10/9/202166 10/9/202167
