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No. 19 1. Introduction of the Sensory Organs 2. Visual Organ PART Ⅴ The Sensory Organs Sensory organs include the receptors and accessory organs. The receptors receive the stimulation from the external or internal environment of the body, and convert it into nerve impulses. Classification of the receptors: On the bases of the location and the origin of the senses, receptors may be divided into three kinds. 1. The exteroceptors They are located in the skin, the mucous membrane of the nasal and oral cavity, pain, light and sound from the external environment. 2. The proprioceptors They are located in the muscles, tendons, joints and ligatents, and receive stimuli from there they located. 3. The interoceptors or visceroceptors They are located in the wall of viscera, the heart and blood vessels, and pick up information about the internal environment. Chapter 1 The Visual Organ The visual organ (eye) receives stimulation of light and convert it into nerve impulses. The nerve impulse is conducted through the visual pathways to the visual center in the brain, and produces visual sensation and visual reflex. The eye is the sense organ that contains the receptors for vision. Each eye is situated in a bony cavity in the skull called the orbit. The visual organ consists of eyeball and accessory organs of eye. Most portions of the eye are concerned with gathering and focusing light rays from that are sensitive to light rays. Section 1 The Eyeball The eyeball is embedded in the fat inside the orbit, but is separated from it by the fascial sheath of eyeball (capsule of Tenon). Ⅰ. The Shape of Eyeball The eyeball is spherical in shape with a diameter of approximately 2.5 cm. Optic and visual axes: The central points of the anterior and posterior surfaces of the eyeball are known as the anterior and posterior poles, the line joining the two poles is the axis oculi. An imaginary line encircling the eyeball, midway between the anterior and posterior poles, is the equator. Of more importance is the axis optica, it joins the center of the pupil to the fovea centralis of the retina. The optic axis and the visual axis decussate sharply. Ⅱ. The Structure of Eyeball The eyeball comprises the wall of the eyeball and the contents enclosed by it. Ⅰ) The Wall of Eyeball It consists of three tunics, from outside inwards, which are the fibrous tunic, the vascular tunic and the retina. 1. The fibrous tunic It consists of the posterior 5/6 of the fibrous tunic, the sclera, and the anterior 1/6 , the cornea. 1) The cornea Characteristics: It is the anterior one-sixth of the fibrous tunic. It is transparent and more convex part of the external tunic, through which the light enters the eye. The cornea is a non-vascular structure, but numerous sensory nerve terminals supply the cornea, this makes it very sensitive to pain and touch stimulation. Function: It has the supporting, protecting and dioptric functions. 2) The sclera Characteristics It is the posterior 5/6 of the fibrous tunic. It consists of strong fibrous connective tissue, is white in colour and opaque. Posteriorly, the sclera is pierced by the optic nerve fibers and is continuous with dura mater through the fibrous sheath of this nerve. Where the optic nerve fibers pierce the sclera, the latter has the appearance of a cribriform plate and is named the cribribform plate of sclera, where is a weakened point of the sclera. A circular sinus venous sclerae is in the sclera, nearer to the cornea. Function: It plays an important role for maintaining the shape of the eyeball and protecting the contents within it. 2. The vascular tunic Divisions: It is the middle coat, and consists of the iris, ciliary body and choroids. Characteristics This layer contains numerous blood vessels and pigment cells and is brown in colour. Function Its function is to provide the nutrition for the tissue inside the eyeball, and to regulate the amount of light entering the eyeball. 1) The iris ①Characteristics It is the most anterior coloured part of the vascular tunic. In shape the iris is a circular, muscular perforated diaphragm. Near its center is a round aperture, named pupil which controls the amount of light entering the eye. The iris uncompletely separates the anterior chamber from the posterior chamber. The anterior and posterior chambers of the eye communicate through the pupil. Colour: The colour of iris varies from different races, e. g. , it is: light blue in White, brown in Chinese, very dark brown in Black people. ② Structure Iridocorneal angle (angle of anterior chamber): Trabecular reticulum: Smooth muscles: The iris contains two sets of smooth muscles. The circularly arranged muscle fibers form the sphincter pupillae which constricts the pupil. The radially arranged muscle fibers form the dilator pupillae which dilates the pupil. The size of the pupil is altered by the contraction of the sphincter pupillae or the dilator pupilae, so altering the amount of light entering the eye. 2) The ciliary body ① Characteristics in structure It lies at the inner surface of the junction of the cornea and the sclera. It is the anterior extension of the choroid and connects in turn to the iris. This body runs like an annulus and consists of the ciliary ring, the ciliary processes and the ciliary muscles. The ciliary processes are situated in the anterior portion of the cillary body. The lens is attached to the inner side of the ciliary processes by the ciliary zonule (suspensory ligament) . ② Function: The ciliary muscle may contract and relax, regulate the convexity of the lens to change its dioptric effect. The ciliary body secretes the aqueous humor to supply nutrition for the cornea and to maintain the normal intraocular pressure. 3) The choroids It covers the inner surface of the sclera and extends as far forwards as the ora serrata of the retina. The choroids occupies posterior 2/3 of the vascular tunic, and contains rich pigment cells and vessels. Function It supplies the nutrition for outer layer of retina, absorbs the scattered light in the eye. 3 The inner tunic (the retina) It is the neural sensory stratum lining the internal surface of the vascular tunic. 1) Arrangement and structure of retina Two layers: The outer becomes the pigment cell lamina. The inner is nervous layer: From behind forwards it is divided into: The optic part (pars optica) The ciliary part (pars ciliaris) The iridial part (pars iridica) The iridial and the ciliary parts are known as the blind part, because of lacking light sensitive elements of the retina. The optic part of retina lines the internal surface of the choroids, and extends from the optic disc to the ora serrata which is the irregular edge of the optic parts at the posterior border of the ciliary body. Structure of the optic part (pars optica) The optic part is composed of three layers of cells: Outer layer: rod and cone cells. They are photoreceptors. Middle layer: bipolar cells. They convey the nerve impulses from the photoreceptors to the ganglion cells. They are the first order neurons in the visual pathway. Inner layer: ganglion cells: They are the second order neurons in the visual pathway. 2) Morphology Macula lutea and fovea centralis Near the center of the posterior part of the retina, there is an oval yellowish area, named the macula lutea (yellow spot), it shows a central depression termed the fovea centralis, where visual acuity is highest. Optic disc and “blind spot” About 3.5 mm to the nasal side of the macula lutea, the optic nerve pierces the retina and forms the optic disc with a diameter of about 1.5 mm. The circumference of the disc is slightly raised, while the central part presents a slight depression. The center of the disc is pierced by the central artery and vein of retina. The optic disc is insensitive to light, and termed the “blind spot”. On ophthalmoscopic examination, the normal disc is seen to be pink during life. The connection between the inner and the outer lamina may be separated from the outer lamina and results in the retinodialysis. Ⅱ) The Contents of the Eyeball Inclusion: The aqueous humor The lens The vitreous body Function: They are all transparent and avascular, with the cornea altogether form the refractive media. Each plays a part in refracting the light entering the eye. 1. Chambers of eyeball and aqueous humor (1) The chambers of eyeball Definition: They are the spaces between the cornea and the lens, filled with aqueous humor and incompletely divided into the anterior and the posterior chambers by the iris. The anterior and the posterior chambers communicate through the pupil. Iridocorneal angle and space of iridocorneal angle (Fontana’s space) At the peripheral part of the anterior chamber, the cornea and the iris meet to form the iridocorneal angle. The anterolateral wall of the angle is made up by Trabecular reticulum. The spaces between trabeculae are termed the space of iridocorneal angle (Fontana’s space), through which the aqueous humor in the anterior chamber of eyeball may communicate with the sinus venosus sclerae (Schlemm’s canal) (2) The aqueous humor Characteristics: It is colourless, transparent and watery fluid. It fills the chambers of the eye. Production and circulation: It is formed by active transport and diffusion from the capillaries of the ciliary body, from which it passes into the posterior chamber. Then it passes into the anterior chamber through the pupil and escapes from the iridocorneal angle into the sinus venosus sclerae through the space of iridocorneal angle, and finally, is drained into the scleral veins. Functions: In addition to the dioptric role, the aqueous humor also maintains the normal interocular pressure. 3. The lens It lies between the iris and the vitreous body. (1) Characteristics of construction: Characteristics It is a transparent and elastic, biconvex body lacking vessels and nerves, and the convexity of its anterior surface is less than that of its posterior surface. Suspensory ligament (ciliary zonule): A transparent, elastic membrane closely surrounded the lens is known as the lens capsule which is connected by the suspensory ligament (the ciliary zonule) to the ciliary process. The substance of lens consists of two parts: Cortex of lens. Nucleus of lens. (2) Function The shape of the lens is maintained by the tension of the suspensory ligament. During near vision: The ciliary muscle contracts, pulling the ciliary body anterointernally. This relaxes the suspensory ligament, and allows the elasticity of the lens to increase its convexity, thus shortening the focal length and bringing near objects into sharp focus in the retina. During far vision: The condition is reversed. (3) Clinical points Presbyopia: The lens becomes increasingly harder, and decreases its elasticity with age, and results in decrease of dioptric range, thus focusing on near objects becomes progressively more difficult. This condition is known as presbyopia. Senile cataract: The lens may also becomes opaque in the aged, this condition is termed senile cataract. 4. The vitreous body (1) Characteristics: It is a colourless, transparent and jelly-like substance. It fills the space between the lens and the retina (the vitreous chamber). (2) Function: The vitreous body, in addition to the refracting role, plays the supporting role for the retina. (3) Clinical points: Retinodialysis: When the supporting role of the vitreous body is weakened, retinodialysis may occur. Myopia and hyperopia: Myopia may occur, when the diopter of the refracting apparatus is too high, or the axis bulbi is too long; on the contrary, the hyperopia may occur, if the axis is too short, or the diopter is too low. Section 2 The Accessory Organs of Eye The accessory organs of the eye includes the eyebrow, the eyelids, the cojunctiva, the lacrimal apparatus, the extraocular muscles, the adipose body of orbit and the orbital fasciae fasciae. Ⅰ. The Eyelids (or palpebrae) Definition: They are thin, movable folds of skin, and consist of the upper and lower eyelids. They meet at the medial and lateral angles of the eye. palpebral fissure: The gap space between the two eyelids is termed the palpebral fissure. The ciliary glands (of Zeis): They are arranged in rows inside the free margin of each eyelid and open near the attachments of the eyelashes. Inflammation of these glands is known as the sty. Structure: From outside inwards, each eyelid includes: ①Skin ②Subcutaneous areolar tissue ③Muscular layer (Orbicularis oculi, Levator palpebrae superioris, Müller muscle) ④Tarsus ⑤Conjunctiva. Müller muscle: The deep lamella of the levator palpebae superioris contains the nostriated muscle fibers, termed the superior tarsalis (socalled Müller muscle). It is attached to the upper margin of the superior tarsus. The skin or eyelid is extremely thin, and its subcutaneous areolar tissue is loose and delicate, thus obvious edema of the eyelid can occur under some pathological conditions. Tarsus and tarsal glands: The tarsus is formed by dense connective tissue and is a framework of the eyelid. The tarsal glands (of Meibom) are embedded in deep surface of tarsus, and open at the margin of eyelids, their secretion ensures the airtight closure of the eyelids. A swelling of the eyelid because of the retained secretion of these glands is known as the chalazion. Ⅱ. The Conjunctiva It is a thin and transparent mucous membrane which covers the eyeball (bulbar conjunctiva) and is reflected to the posterior surface of both eyelids (palpebral conjunctiva). Thus, it joins the eyeball to the eyelids. Conjunctival fornices and conjunctival sac: The reflected parts of the conjunctiva from the superior and inferior eyelids onto the eyeball is respectively named the superior and inferior conjunctival fornices. The saccular space formed by the conjunctiva is named the conjunctival sac. Ⅲ. The Lacrimal Apparatus It consists of the lacrimal gland and the lacrimal passages. Ⅰ) Lacrimal Gland: It lies in the lacrimal fossa of the orbit. Its excretory ducts (lacrimal ducts) open into the lateral part of superior fornix of the conjunctival sac. Excretory channel of tears: The secretion of lacrimal gland (tears) flows over the anterior surface of the eyeball to the lacrimal punctum and then passes to the lacrimal ductules, the lacrimal sac and the nasolacrimal duct. The tears contains a special enzyme dissolving bacteria, and help to remove the foreign material and moist the front of the eyeball. Ⅱ) The Lacrimal Passages 1. The lacrimal punctum. On the medial end of the margin of each eyelid, there is a small conical elevation termed the lacrimal papilla. A minute opening on the apex of the papilla is known as the lacrimal punctum. 2. The lacrimal ductule (canaliculus). The upper and lower lacrimal ductule ascends or descends at first, and then runs almost at an acute angle to the medial side, with uniting to the lacrimal sac. 3. The lacrimal sac: It is lodged in the fossa of lacrimal sac situated in the anteroinferior part of the medial wall of the orbit. The medial palpebral ligament and palpebral part of the orbicularis oculi lie anterior to its upper part. The contraction of orbicularis oculi may dilate this sac, thus, the tears are sucked into the lacrimal sac via the lacrimal ductules. 4. The nasolacrimal duct It opens into the anterior part of the inferior nasal meatu. Ⅳ. The Extraocular Muscles Which include the levator palpebral superioris, the four rectus and two oblique muscles. Ⅰ) The Four Rectus Muscles They arise from a common tendinous ring which encircles the optic canal. These muscles are inserted into the sclera in front of the equator of the eyeball. The medial rectus turns the anterior pole of the eyeball medially. The lateral rectus turns the anterior pole laterally. The superior rectus turns the eyeball superomedially. The inferior rectus turns the eyeball inferomedially. Ⅱ) The Two Oblique Muscles The superior obliquus (superior oblique m.) Contraction of this muscle turns the anterior pole of the eyeball inferolaterally. The inferior obliquus (inferior oblique m.) Its action is to turn the eyeball superolaterally. Ⅲ) The Levator Palpebrae Superioris It cannot move the eyeball, but rises the upper eyelid upward. Ⅳ. The Connective Tissue in the Orbit The orbital cavity contains a lot of adipose tissues, named the adipose body of orbit. It fills the space among the organs in the orbital cavity, and plays the supporting and protective roles for these organs inside the orbital cavity. The eyeball is embedded in this adipose tissue but is separated from it by a thin membranous sac, named the sheath of eyeball (the capsule of Tenon). This sheath envelops the eyeball from the optic nerve to the sclerocorneal junction. Its inner surface is smooth, and is separated from the outer surface of the sclera by the episcleral space; the space is traversed by delicate bands of connective tissue extended between the fascia and the sclera. The eyeball can freely rotate inside the episcleral space. Section 3 The Blood Vessels and Nerves of Eye Ⅰ. The Arteries Ophthalmic artery. The Central Artery of Retina It is the first and the smallest branch of the ophthalmic artery. It pierces the inferior surface of the optic nerve about 1.0~1.5 cm behind the eyeball, and runs forwards to the optic disc of the retina along the center of the nerve. Branches: In the optic disc, it divides into superior and inferior branches, and these two branches divide again into superior and inferior nasal retinal arteries, superior and inferior temporal retinal arteries, which supply the internal lamina of the retina. The branches of the central artery of retina can be seen through the pupil by the ophthalmoscopy. Ⅱ. The Veins Ⅰ) The ophthalmic veins The superior ophthalmic vein The inferior ophthalmic vein Ⅱ) The central vein of retina Ⅲ. The Nerves Ⅰ) The optic nerve Ⅱ) Other nerves 1. Oculomotor nerve: Controlling levator palpebrae superioris, rectus superior, rectus inferior, rectus medialis, obliquus inferior. 2. Trochlear nerve: Controlling obliquus superior. 3. Abducent nerve: Controlling rectus lateralis. 4. Parasympathetic nerve fibers in oculomotor nerve: Controlling ciliary muscle and sphincter pupilae. 5. Sympathetic nerve: Controlling dilator pupillae. 6. Ophthalmic nerve of trigeminal nerve: Controlling the sense of eyeball. 7. Facial nerve: Controlling the secretion of lacrimal gland.