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Disclosure Ocular Anatomy and Motility Ocular Anatomy Overview the Human Vision System the Human Vision System Lids and Lacrimal

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Disclosure Ocular Anatomy and Motility Ocular Anatomy Overview the Human Vision System the Human Vision System Lids and Lacrimal 10/19/2012 Disclosure Ocular Anatomy and Motility Jenean Carlton BA, ABOC, NCLC 9President, Carlton & Associates, LLC – Carlton and Associates, 6 Course #214 Monterey Symposium LLC provides communications and educational materials for the optical industry 9Contributing Editor for Refractive Eyecare magazine. 6 Jenean Carlton BA, ABOC, NCLC 9Contributing Author Eyecare Business magazine. 9Communications Committee member OWA. 9Has been in the optical industry for 30 years with more than half of this time working in practices. 9Vision Monday’s Most Influential Women Award in Optical 2005 1 Ocular Anatomy Overview The Human Vision System 9 The eye is an amazing organ that works like a camera. 9 Think of the cornea and crystalline lens as the lenses of a camera, the iris as the shutter, and the retina as the photographic film. The Human Vision System Lids and Lacrimal System Vision takes place in the occipital lobe of The tear film has 3 layers: the brain Outer: the lipid layer (meibomian 9The brain can be glands in lids) is the oil layer. thought of as the development Middle: the aqueous layer center because it (lacrimal glands) is mainly water and provides oxygen converts and nutrients. electrical signals from the retina Inner: the mucin layer (goblet cells in conjunctiva) helps the tears into vision. adhere to the cornea. It is the mucus layer. 1 10/19/2012 Dry Eye Syndrome Lid Disorders What causes dry eyes? Ectropion= Out Treatments Entropion= In Ptosis- a drooping of the lid. Lids can have other problems too like turning out, in. Lids Disorders Lid Disorders Blepharitis is a chronic Hordeolum (stye) - inflammation- not an acute inflammation of a infection. sebaceous gland. Treatments are lid scrubs, warm compresses, antibiotics and anti-inflammatories. Image source: http://www.bascomoptometry.com/eyedisorders.html Lid Disorders Conjunctiva and Sclera Disorders Chalazion-Chronic inflammation of a Subconjunctival meibomian gland - hemorrhage - result of a not an infection. broken blood vessel. Results in blockage Spontaneous – benign of the gland. The Traumatic – ruptured first symptoms globe until proven resemble those of otherwise. styles. 2 10/19/2012 Conjunctiva and Sclera Disorders Conjunctiva and Sclera Disorders Conjunctivitis – “pink eye” Pinguecula - elevated growth Pterygium - a membrane that grows of the conjunctiva. across the cornea Viral = clear Allergic = giant Bacterial= discharge, papillary, itch green/yellow contagious discharge, antibiotics Both caused by excessive UV exposure, and dusty, windy environments. Image: http://www.pterygium.us/images/pinguecula.jpg Cornea- 5 Layers Corneal Disorders Outer layer The cornea is the Abrasions- This could be an abrasion from a window of the eye and has five layers. foreign body caught in the upper lid. The cornea has 45 diopters of power Inner and is avascular. layer Corneal Disorders Corneal Disorders 9 Foreign Bodies Corneal Ulcer is an infection developed after a break of the epithelium layer. 9 Symptoms and removal Image 1: opt.pacificu.edu 3 10/19/2012 Corneal Disorders Pupil and Iris Keratoconus- progressive thinning of the central cornea. The iris controls the size of the pupil and light passing through the eye. Image 1: http://www.eyeconx.com/patient/article.asp?itemtype=publicarticle&itemid=CADC1677B4957B1807E1024FBBE0ED36 Image 2: http://commons.wikimedia.org/wiki/Image:Keratoconus_eye.jpg Crystalline Lens Accommodation Retina Near objects 9The retina has photoreceptor cells called rods and cones. Far objects Presbyopia – loss of focusing ability with age Retinal Problems Optic Nerve Problems - Glaucoma Normal fundus Retinal detachment Image*: http://www.houstonretina.com/tear.html 4 10/19/2012 How the Eye Works How the Eye Works 1) Light enters the eye through the ___________. 2) Light travels through the _____ and is focused by the __________ ____. The ____ is the colored muscular ring that surrounds the _____ and functions like a camera shutter. How the Eye Works How the Eye Works 3) Light exits the ___________ ___ and travels through a jelly- like substance in the middle of the eye ________ _____. Images are focused onto the ______. 5) Signals travel from the retina to the brain through the ______ _____. The _________ ____ of the brain then translates light into vision. Vision in humans takes place in the _____- not the eye. Rapid Fire Review Normal Eye and Refraction 3. 2. 4. 5. 1. Through Cornea To 8. focus Light travels from on Retina 7. distant object 6. 5 10/19/2012 Myopia- Nearsighted Eye Spectacle Correction of Myopia A “minus” lens causes light rays to diverge... ...the eye is longer ...to focus further back in the eye, on the retina Hyperopic- Farsighted Eye Hyperopic- Farsighted Eye …or Cornea is too “flat” ...the eye is shorter causing light to be out of focus Astigmatism Astigmatism Astigmatism - In one plane, light focuses on retina …but does not in another plane 6 10/19/2012 Astigmatism Presbyopia Causing light in both planes to focus on the retina Normally, when a close object is viewed... The lens will change shape…Accommodation Presbyopia Presbyopia …to focus light on the retina With Presbyopia, the lens will not sufficiently reshape... Presbyopia ...and glasses may be required for close viewing Ocular Motility: the movement of our eyes to place images on the fovea of each eye. 7 10/19/2012 Ocular Motility Ocular Motility 6 Convergence 6 Binocular Vision 6 Divergence 6 Fixation 6 Extraocular Muscles 6 Eyes that move together in perfect harmony have stereo vision. Image source: http://www.ebicom.net/~rsf1/fun/3d-not.htm Ocular Motility 3 Cranial Nerves control ocular movement 3LRSO6 4 9 CNIII‐ Oculomotor Nerve 9 CN IV‐Trochlear Nerve 9 CN VI‐ Abducens Nerve Image source:http://library.thinkquest.org/11965/html/cyber- http://www.uniteforsight.org/course/im anatomy_ner692.html age/eyemuscle3.jpg Binocular Vision Binocular Vision Binocular Vision- A single image is gained by the Depth Perception blending of retinal 6 Allows us to travel about safely in our world. signals from both eyes. 6 Without it our ability to judge distances or estimate the size of objects is limited. 6 However, everyone ‐ even monocular patients, have some level of depth perception. Image source: http://www.hhmi.org/senses/popups/images/b410_1p.gif 8 10/19/2012 Ocular Motility Ocular Motility problems 6 Monocular patients estimate depth perception_________ 6 Diplopia is double vision or 6 Magnification 2 images. 6 Parallel lines 6 Shadows 6 Monocular or binocular? 6 Strabismus is a misalignment of the eyes. Image source: http://www.honda- tech.com/zerothread?id=1246218&postid=16525201 Strabismus Strabismus Strabismus: Strabismus can be subtle or obvious, intermittent or Failure of the two eyes constant. to simultaneously direct their gaze at the same 6 It can affect one eye only or shift between object due to an the eyes. imbalance in the activity of the EOM’s. 6 Usually presents early in life. 6 If left untreated strabismus can result in the brain suppressing the image from one eye, this is called amblyopia. Image source: http://www.fairview.org/healthlibrary/content/ea_strabism_art.htm Diagnosing Strabismus Strabismus 6 Amblyopia: Cover Test 6 Loss of vision due to muscle imbalance, anisometropia, or cataract. 6 Sometimes referred to as “lazy eye”. 6 Can occur in children up to teenage years. 6 The amblyopic eye is the weaker eye. http://www.ssc.education.ed.ac.uk/courses/Pictures/jskill15.jpg 9 10/19/2012 Diagnosing Strabismus Diagnosing Strabismus 6 Krimsky’s Test Hirschberg Reflex Test 9 The strength of the prism 6 A screening test for the recognition of strabismus is the required to center the corneal Hirschberg Reflex test. Light reflexes _______________ in reflection in the eye with strabismus is equal to the the same place for each eye. amount of _______________. OD: Note that light reflex falls on center of pupil. OS: Light reflex falls on temporal Image source: http://eyelearn.med.utoronto.ca/Lectures04- margin of pupil. 05/Paediatric/03Strabismus.htm Strabismus Treatment Strabismus Treatment 6 Prisms displace images towards the _______ of the prism. Strabismus Treatment: 9 1. Prism 9 2. Patching/Atropine drops 9 3. Vision Training/Orthoptics 9 4. Botox injections 9 5. Surgery Image source:http://science.howstuffworks.com/lens3.htm Strabismus Treatment Strabismus Treatment 6 Botox: Patching the ____________ forces the brain to use 6 a toxin developed from Clostridium the problem eye. botulinium, a common____________________. Patching= occlusion. What about drops? Image source: http://eyelearn.med.utoronto.ca/Lectures04- Image source: 05/Paediatric/03Strabismus.htm http://www.ophthalmic.hyperguides.com/tutorials/pediatric/botulinum/tuto rial.asp 10 10/19/2012 Strabismus Treatment Rapid Fire Review 6 Strabismus surgery is done to straighten the eye. With Resection 9 Eyes that don’t move perfectly together resection_____________________ don’t__________________________________. _______________________. 9 Binocular vision is_______________________. 6 If the muscle is too strong it is made weak Recession 9 What is amblyopia and what causes it? by__________________________ ____________________________ ______. 9 Horizontal movements are made by these 2 muscles________________. Image source: http://www.myeyeworld.com/files/squint.htm Rapid Fire Review Thank You!! 9 Diplopia is_______________________. 6 Please contact me: [email protected] 9 Strabismus is____________________. 9 Occluding the good eye forces________. 9 There are 5 methods of treating strabismus. They are _________________________. 11.
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