眼科學基礎知識講座第一章眼科學基礎ChapteroneBasicophthalmology6/18/20252第一節(jié)眼旳組織解剖

anatomyofeyeball眼球

Theglobe(eyeball)anteriorandposteriordistanceofnormaleyeballis16mminborn.Atage323mm.Atadult24mm.6/18/20253Theveticaloneisaverage23mm，thehorizontaloneisaverage23.5mminnormaladult.Theanteriorpoleoftheglobe,protrudedabout12-14mmbryondtheprbitalrim.Thedifferenceofthetwoeyesisusuallylessthan2mm.Itiseasytobeinjuried,especiallyinitsexternalpart,theanteriorpartoftheglobeisprotectedbytheeyelids.6/18/20254Theglobeiscomposedoftheeyecoats,thecontents.6/18/20255Theeyecoatismainlydividedintothreelayers.OuterlayerCorneaScleraMiddlelayerIrisCiliarybodyChoroidInnerlayerRetina6/18/20256外層TheoutercoatTheoutercoatconsistsofthecorneaandthesclera.

Theanterioronesixthistransparentcornea,otherfivesixthsiswhitesclera.Thetransitionalsreaofbothisthelimbus.Thefunctionistomaintaintheshapeoftheglobeandtoprotectinteaoculartissue.6/18/20257（1）角膜Cornea

橫徑Thehorizontaldiameteris11.5-12mm垂直徑Theverticaldiameteris10.5-11mm中央部Thecentralthickness0.6mm周圍部Theperipherythickness1mm6/18/20258前表面曲率半徑

Theradiusofcorneacurvatureinfront7.8mm后表面曲率半徑

Theradiusofcorneacurvatureinback6.8mmItsrefractivepowerisequaltothatof+43diopterlens角膜Cornea6/18/20259Thecentralthickness0.6mmTheradiusofcorneacurvatureinfront7.8mmTheradiusofcorneacurvatureinback6.8mmTheperipherythickness1mm6/18/202510組織學分層

fromanteriortoposterior,thecorneahasfivedistinctlayers:①上皮細胞層Epithelium②前彈力層Bowman’smembrane③基質層Stroma④后彈力層Descemet’smembrane⑤內皮細胞層Endothelium

6/18/202511Epithelium

Basementlayer

Bowman’smembrane

Stroma

Descemet’smembrane

endothelium

regenerateafterinjery6/18/202512

(2)鞏膜

Sclera

①表層鞏膜Theepisclera②鞏膜實質層Thescleralstroma③棕黑板層Thelaminafascia組織學分層thescleraincludes:6/18/202513ScleraThickness:0.3to1.0mm,attheinsertionoftherectusmusles,itisabout0.3mm,elsewhereabout1mm.AnteriorpartcoveredbybulbarconjunctivaConnectedto6extraocularmusclesThinnerandtranslucentinchildren6/18/202514角鞏膜緣

thecorneasclerallimbus:isatransitionalzoneofthecorneaandthescleral,wherethecorneainsertsintothescleraitsanteriorborderisBowman’slayerItsposteriormarginisDescemet’smembraneItswidthis1mmSurgicallandmarkofimportantstructures6/18/202515前房角Anteriorchamberangle:Include:SchwalbelinetrabecularreticulumSchlenmcannelScleraspurCiliarybodyIrisroot涉及:Schwalbe線小梁網(wǎng)Schlenm管鞏膜突睫狀帶虹膜根部6/18/202516

中層ThemiddlecoatIncludingthreeparts:IrisCiliarybodyChoroid

Richinpigmentandbloodvessels

6/18/202517虹膜

IrisItsituatesinthemostanteriorpartofthemiddlecoat,infrontofthelens,connectedwiththecilliarybodyinperphery.Theirisincludslayers:AnteriorsurfacelayerStromalayerPigmentepithelial

threreisaroundholeinthecentrecalledPupil直徑2.5-4mm

6/18/202518虹膜Iris6/18/202519睫狀體CiliarybodyConnectirisrootandchoroidAdistenceofabout6mm，corona：2mm，Parsplana：4mmTheciliarybodyisdividedinto5layersfrominnertoouter1、ciliarymusle2、Vascularlayer3、Bruch‘smembrane4、Epitheliumlayer5、Theinternallimitingmembrane

1睫狀肌46/18/202520睫狀體Ciliarybody扁平部睫狀突鋸齒緣睫狀冠parsplicata6/18/202521脈絡膜ChoroidItissituatedbeweenthescleraandtheretina,anteriortooraserrata,goingbehindtothesurroundingoftheopticnerve.Fullofthepigmentactsasadarkroomandashadeoflight.Including：1、大血管層Largevascularlayer2、中血管層Middlevascularlayer3、毛細血管層Capillarylayer6/18/202522

內層theInnercoat

istheretina,whichcoversthehrinneraspectoftheposteriortwo-thridsofthewalloftheglobe.Theoutsideoftheretinaisthechoroid,theinsideisthevitreous.Theopticneverfixestheretinatothewalloftheglobe.Theretinais0.1mmthickattheoraserrataand0.23mmthickattheposteriorpole.6/18/202523

內層theInnercoat

The黃斑Maculaareaisaspecialregionoftheretinawiththesharpestvisualsensation.itsdiameterisabout1-3mmasmallfoveolaisinitscentrecalled黃斑中心凹Foveacentralis,withthedirectophthalmoscopetheFoveacentralisproduceaclearlyfoveareflaction.Apinkarealocatedatnasalsideabout3mmtothemaculaisthe視盤Opticdisc.thevisualfibersontheretinacometogethertogooutoftheglobetovisualcentre.therearearteryandvein.Asmalldepressiononitscentreiscalled視杯Opticcup

6/18/2025246/18/202525視網(wǎng)膜Ratina

dividedinto10layersfromoutsidetoinside.

outside:

Retinalpigmentepithelium,RPE

視網(wǎng)膜色素上皮層6/18/202526內層inside

①

視錐、視桿細胞層（光感受器細胞層）

Coneandrodlayer②

外界膜Externallimitingmembrane③

外核層Outernuclearlayer④

外叢狀層Outerplaxiform⑤

內核層Innernuclearlayer⑥

內叢狀層Innerplexiformlayer⑦

神經(jīng)節(jié)細胞層Ganglioncelllayer⑧

神經(jīng)纖維層Nervefiberlayer⑨

內界膜Limitingmembrane6/18/2025271RPERetinalpigmentepithelium2Coneandrodlayer3Externallimitingmembrane4Outernuclearlayer5Outerplaxiform1.色素上皮2.視錐和視桿細胞3.外界膜4.外核層5.外叢狀層6/18/2025286Innernuclearlayer7Innerplexiformlayer8Ganglioncelllayer9Nervefiberlayer10Limitingmembrane

6.內核層7.內叢狀層8.神經(jīng)節(jié)細胞層9.神經(jīng)纖維層10.內界膜6/18/202529（二）

眼球內容

Contentsoftheeye1.

房水Aqueoushumor前房Anteriorchamber：itisboundedanteriorlybythecornea,posterioritybytheirisandthelens.thedeepthinthecentreis2.5-3.0mm.thevolumeinhumaneyeisabout0.2ml.后房Posteriorchamber:itisboundedanteriorlybytheiris,posterioritybylensanteriorcapsuleanditszonule.thevolumeinhumaneyeisabout0.06ml.Posteriorchamberflowsintotheanteriorchamberthroughthepupil.6/18/202530TheFlowofAqueousHumor

:

ciliary睫狀體posteriorchamber后房pupil瞳孔anteriorchamber前房trabecular小梁網(wǎng)SchlemmcanalSchlemm管collectioncanal集液管

aqueousvein房水靜脈ciliaryveins睫狀前靜脈脈絡膜上腔

6/18/2025312、晶狀體LensTransparent，doubleconvexmirrorBesuspendedBetweenpupil-irisandvitreousbody,connectwithciliarybodyAbout4mmthickand9mmindiameterTheradiusoflenscurvatureinfront：10mmTheradiusoflenscurvatureinback：6mmDiopter：19D透明，雙凸透鏡位于瞳孔-虹膜和玻璃體之間前面曲率：10mm背面曲率：6mm屈光度：19D6/18/202532LensThesolefunctionofthelensistofocuslightraysupontheretina.DistantobjecttheciliarymusclerelaxeszonularfiberstensionlensminimizedNesarobjecttheciliarymusclecontractszonularfibersreleaseingthetensionlensmoresphericalAsthelensagesitsaccommodativepowerisgraduallyreduced.6/18/202533lensCompositionthelensconsistsofabout65%water,obout35%protein(thehightestproteincontentofanytissueofthebody)Therearenopainfibers,bloodvessels,ornervesinlensFunctions:1、Focusing2、accommodationChangeswithageLarger&harderLesselasticCataract6/18/2025343、玻璃體VitreousbodyConsistsmainlyofwater2/3oftheeye’svolumeandweightViscousityImportantformetabolismofintraoculartissuesAttachedtoretinaThevitreoushastwofunctions:therefractionandmaintainencethetransparentandformoftheeye.6/18/202535VitreousbodyAgingchanges：Thinner&moreliquid“floaters”

6/18/202536視路及瞳孔反射

Opticpathwayandpupillaryreflex

Thevisualmessageobtainedfromtheretinaistransmittedtobrainviatheopticnever6/18/202537視路opticpathway

（一）視神經(jīng)Opticnerve(1)眼內段Intraocular(2)眶內段Intraorbital(3)管內段Intracanalicular(4)顱內段Intracranial（二）視交叉Opticchiasm（三）視束Optictract（四）外側膝狀體Lateralgeniculatebody（五）視放射Opticradiation（六）視皮質Visualcortex6/18/202538視路opticpathwayItisaportionofcentralnervoussystem,composedoffiberssendoutbyretinaganglimcells.theopticneveristhesegmentofnervefromthedisctotheanteriorangleofthechiasm,about42-47mmlong.(1)眼內段Intraocular1mm(2)眶內段Intraorbital25-30mm(3)管內段Intracanalicular4-10mm(4)顱內段Intracranial10mm6/18/202539視路Visualpathway

光感受器retinalphotoreceptor→雙級細胞bipolarcell→神經(jīng)節(jié)細胞nervousganglioncells→視乳頭opticdisk→視神經(jīng)opticnerve→視交叉opticchasm→視束optictract→外側膝狀體lateralgeniculatebody→視放射opticradiation→視皮質visualcortex.6/18/202540Opticnerve

Opticchiasm

Optictract

Lateralgeniculatebody

Opticradiation

Occipitalcortex6/18/202541視路Visualpathway6/18/202542瞳孔反射路

Pathwayofpupillaryreflex光反射

Lightreflex

直接光反射directreflex

間接光反射indirectreflex

近反射Nearreflexwhentheeyeslookatanearobject,3reactionsoccur:accmmodation,convergence,andconstrictionofthepupil.6/18/2025436/18/202544二、眼眶及附屬器

Orbitandaccessoryapparatus(一)眼眶OrbitThedepthofadult’sisabout4-5cm,theexternalrimisalittlebehindwithmuchexposureoftheglobewhichiseasytobeinjuried.theexternalwalloftheorbitisquitehard,theotherthreearewiththinbone.6/18/202545眼眶OrbitFrontal額骨Zygomayic顴骨Maxillary上頜骨Ethmoidal篩骨Sphenoid蝶骨Lacrimal淚骨Palatine顎骨

Theorbitiscomposedof6bones:6/18/202546眼眶Orbit1.視神經(jīng)孔和管Opticforamenandcanal4-9mminlength,4-6mminwidth.theopticnerveandtheophthalmicarterythroughpasstothecranialcavity.2.眶上裂SuperiororbitalfissureTherearethe3rd,4th,6thcranialnervesandthefirstbranchoftrigeminalnerve,theopthalmicnerve,thesuperiorophthalmicveinaswellasthesympatheticnervepassingthroughthefissure.6/18/2025473.眶下裂InferiororbitalfissureIttransmitsthe2ndbranchofthe5thcranialnerve,inferiorophthalmicneverandarteryandinferiorophthalmicvein.4.眶上切跡和（眶下孔）ThesupraorbitalnotchandinfraorbitalforamenHerearenerveandbloodvesselwiththesamenamepassingthroughthem眼眶Orbit6/18/202548（二）眼瞼Eyelids

Theeyelidaredividedintoupperandlowerone,situatedintheanteriormouthoftheorbit,coverontheanteriorsurfaceoftheglobe,theupperoneislimitedbytheeyebrow,thelowereyelidisconnectedwithfacialskin.Palpebralfissure(瞼裂)betweentwoeyelids8mmZeisglandandMollglandopentheirmouthsathairfolliculosis(毛囊)6/18/202549Eyelids1皮膚層TheskinItisoneofthemostflexibleandthinnestskininthebody.2皮下組織層SubcutaneousItiscomposedoflooseconnectivetissueandalittlefat.3肌層Muscularlayer4瞼板層LayerofthefibrouslayerThereareverticallgland---Meibom’gland5結膜層TheconjunctivallayerCloselyattachedtotheposteriorsurfaceofthefibrouslayer6/18/202550Zeis腺毛囊Moll腺Muller肌結膜瞼板層meibom眼輪匝肌Meibom開口皮膚提上瞼肌6/18/202551EyelidsSensoryoftheeyelid:theyareinnervatedbythe1stand2ndbranchofthetrigeminalnerve.Function:toprotecttheglobe,duetocnostantblinking,thetearsmaymositthesurfaceoftheglobe,tocleandustandbacteriainconjunctivesac.6/18/202552(三)結膜Conjunctiva1瞼結膜Palpebralconjunctivaitcloselyadheretothefibrouslayer,can’tbepushe,smoothandtransparentverticalsmallbloodvesselsmaybeseeninit.2球結膜Bulbarconjunctivaitcoversonthesclerasituatedinanteriorpartoftheglobe,looselyconnectedwithtenon’scapsule,easytobepushed,elevated.3穹窿結膜Fornicalconjunctiva

1、gobletcell2、krauseandwolfringglang6/18/202553瞼結膜Palpebralconjunctiva球結膜Bulbarconjunctiva穹窿結膜FornicalconjunctivaBulbarconjunctivaPalpebralconjunctivaFornicalconjunctiva6/18/202554(四)淚器Lacrimalapparatus

1淚腺LacrimalglandThereareabout10-20excretoryductsopeningtheirmouthsintheexternalandsuperiorfornicalconjunctive.2淚道Lacrimalpassages(1)淚小點LacrimalpunctaThereareeachoneintheupperandlowereyelids,opentheirmouthsintothelacrimallake.(2)淚小管LacrimalcanaliculusLinkupthepunctaandthelacrimalsac.(3)淚囊Lacrimalsac12mminlength,4-7mminwidth.(4)鼻淚管Nasolacrimalduct18mmlength,thesecretionis0.9-2.2mmeacheye.6/18/2025551淚腺Lacrimalgland2淚道Lacrimalpassages(1)淚小點Lacrimalpuncta(2)淚小管Lacrimalcanaliculus(3)淚囊Lacrimalsac(4)鼻淚管Nasolacrimalduct6/18/202556(五)眼外肌Extraocularmuscles

4條直肌Rectus

上直肌superiorrectimuscles

下直肌inferiorrectimuscles

內直肌medialrectimuscles

外直肌externalrectimuscles2條斜肌Obliquemuscle

上斜肌superiorobliquemuscles

下斜肌Inferiorobliquemuscles6/18/2025574條直肌Rectus上直肌superiorrectimuscles下直肌inferiorrectimuscles內直肌medialrectimuscles外直肌externalrectimuscles2條斜肌Obliquemuscle上斜肌superiorobliquemuscles下斜肌Inferiorobliquemuscles上直肌

上斜肌

外直肌內直肌下直肌