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Anatomy of the Eye

Anatomy of the Eye Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I,

Eyes and Vision

 Eyesight provides the brain with more input than all other senses combined.  Each optic nerve contains one million nerve fibers.  It is estimated that more than half of the information in the conscious mind enters through the eyes.  The eyes are the most complex of the four special sense organs.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 1 Anatomy of the Eye

Sequence of Vision

 Rays of light enter the eye through the clear, domed front of the eyeball, the cornea, where they are partly bent (refracted).  The rays then pass through the transparent lens, which changes shape to fine-focus the image, a mechanism known as accommodation.  The light continues through the fluid, or vitreous humor, within the eyeball and shines an upside-down image onto the retina lining.  The retina contains over 120 million cone cells and about 7 million rod signals.

Sequence of Vision

 Rods are scattered through the retina and respond to low levels of light, but do not differentiate colors.  Cones are concentrated in the fovea, need brighter conditions to function, and distinguish colors and fine details.  Nerve fibers from the rods and cones connect via intermediate retinal cells to the fibers that form the optic nerve.  Through this, the image is transmitted to the visual cortex in the brain, where it is turned upright.

Path of Light

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Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 2 Anatomy of the Eye

Anatomy of the Eye The Human Eye is divided into three layers:  Fibrous tunic (scleretic coat) This is the external layer of the eye.  Two parts: Sclera (white of the eye) and Anterior Cornea  Sclera includes:  Episcleral layers  Schlemm’s canal  Trabecular meshwork  Cornea contains:  The limbus  The following layers: Epithelial - Bowman’s – Stroma – Descemet’s – Endothelium

Anatomy of the Eye

 Vascular tunic (uvea or choroid coat) This is the middle layer that is pigmented with melanin and provides the eye with it’s blood supply.  Choroid  Capillary lamina of choroids  Bruch’s membrane  Sattler’s layer  Ciliary body  Ciliary processes  Ciliary muscle  Iris  Stroma  Pupil  Iris dilator muscle  Iris sphincter muscle

Anatomy of the Eye

 Retina: This is the inner layer of the eye composed primarily of nervous tissue. Its primary function is image formation. It contains:  Cells  Photoreceptor cells – rods, cones, horizontal  Bipolar cells  Retinal ganglion cells  Layers  Rods and cones  Retinal pigment epithelium  Macula  Foveola  Fovea

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 3 Anatomy of the Eye

Other Parts of the Eye  Anterior segment:  Anterior chamber  Aqueous humor  Posterior chamber  Lens  Posterior segment  Vitreous body (humor)  Other  Globe  Eyelids  Lacrimal system  Orbit  Optic nerve and visual pathways

Anatomy and Function

 Conjunctiva:

 Clear, moist mucous membrane  Assists in lubricating the eye  Produces mucus and tears along with the lacrimal system  Helps prevent foreign objects from penetrating into deeper structures of the eye.

Anatomy and Function

 Sclera:

 White part of the eye.  Opaque, protective, outer layer.  Maintains the shape of the globe.  Offers resistance to internal and external forces.  Continuous with the dura mater and the cornea.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 4 Anatomy of the Eye

Anatomy and Function

 Cornea: Transparent fibrous coat the covers the front of the eye, including the iris, pupil and anterior chamber.  Works with lens to refract light. After light enters the interior the light rays are bent so they can be brought to a fixed focus.  Accounts for around two-thirds of the eye’s optical power.

Choroid – Vascular Tunic

Choroid

 Is a highly vascular structure composed of capillaries and small arteries and veins that include connective tissue.  It lies between the sclera and retina.  It provides oxygen and other nutrients to the outer layers of the retina and together with the ciliary body and the iris, it forms the uveal tract.  The choroid contains melanin which helps limit uncontrolled reflection within the eye that could result in the perception of mixed-up images.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 5 Anatomy of the Eye

Ciliary Body

 Controls accommodation (the process by which the eye changes optical power to maintain a clear image as the distance changes).  Regulates flow of the aqueous humor into Schlemm’s canal.  Coated by the epithelium, which produces the aqueous humor.

Iris

 Is the colored part of the eye.  Responsible for controlling the size and diameter of the pupil and the amount of light reaching the retina.  Divides the area between the lens and the cornea into an anterior and posterior chamber.  This is the primary location where intraocular pressure is regulated.  Failure to control intraocular pressure can lead to disease, such a glaucoma.

Retina

 The retina is a light-sensitive tissue lining that covers approximately 65% of the back inner surface of the eye.  Rod and cone photosensitive cells, convert light energy into signals that are carried to the brain by the optic nerve.  The fovea or fovea centralis (a small dimple) is the center of the eye’s sharpest vision and has the most color perception.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 6 Anatomy of the Eye

Rods and Cones

 There are two distinct visual systems in the eye:  Photopic vision is more sensitive to light, not color sensitive and is made up of rod cells.  Scotopic vision is less sensitive to light, color sensitive and is made up of cone cells.  The cylindrical shaped rod cells are located on the outer edges of the retina.  Mainly used in peripheral vision, and because they require less light to function are also responsible for night vision.

Rods and Cones  There are three different types of cone cells, each of which absorb light from a different portions of the light spectrum.  Cones that absorb long-wavelength light (reds)  Cones that absorb middle-wavelength light (greens)  Cones that absorb short-wavelength light (blues)  Cone cells are a specialized type of nerve cell that are responsible for color perception and visual acuity.  The macula located in the central area of the retina contains the cone cells.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 7 Anatomy of the Eye

Other Parts of the Eye

 Anterior Chamber:  Is a space in the eye filled with aqueous humor, and lies between the iris and the cornea’s endothelium.  Aqueous Humor:  Flows through the pupil into the anterior chamber through a narrow cleft between the front of the lens and the back of the iris.  Its main function is to provide optical power to the cornea.  Also maintains intraocular pressure, shapes the globe.

Other Parts of the Eye

 Posterior Chamber:  Is the space behind the iris and in front of the lens.  Holds aqueous humor for later transport to the anterior chamber.  Lens:  Is just in front of the iris.  When the lens is relaxed, it’s flattened (increase in diameter – more light comes in)  When the lens is contracted (decrease in diameter – less light comes in)  This is called curvature of the lens and it enables the eye to adjust its focus between near and far objects.

Other Parts of the Eye

 Lacrimal system:  Contains structures for tear production and drainage.  Lacrimal gland secretes tears and with its ecretory ducts, moves the fluid to the surface of the eye providing both normal amounts on the surface of the eye and extra amounts for tears.  Vitreous body:  Is the transparent, colorless, gel that fills the space between the lens and the retina.  It holds the eye taut.  This gel does not get replenished.  Keeps the retina in place by pressing against the choroids and adhering to the retina.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 8 Anatomy of the Eye

Optic Nerve

 The optic nerve is also known as the cranial nerve (CN) II.  It transmits visual information from the retina to the brain.  Is considered part of the CNS  Three layers:  Dura  Arachnoid  Pia mater

Diseases and Disorders

 Retinal detachment:  Retina is pulled or lifted away from its normal position.  Cataracts:  A partial or complete clouding on or in the lens which may obscure vision  Myopia – nearsightedness  Hypermetropia – farsightedness  Glaucoma:  A group of diseases characterized by damage to the optic nerve

Diseases and Disorders  Conjunctivitis:  An infection of the conjunctiva  Blepharitis:  An inflammation of the eyelash follicles along the edge of the eyelid  Corneal ulcers:  An open sore on the cornea  Dacryoadenitis:  An inflammation of the tear-producing lacrimal gland.

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 9 Anatomy of the Eye

Diseases and Disorders

 Endophthalmitis:  A severe swelling and inflammatory condition within the intraocular cavities  Affects the aqueous or vitreous humor  Keratitis:  An inflammation of the cornea in which intense pain and some impaired vision is experienced  Cytomegalovirus Retinitis:  Caused by the herpes-group of viruses  Symptoms of blind spots, blurred vision and floaters

Diseases and Disorders

 Neoplasms – Benign or Malignant  Blurred vision  Diplopia – double vision  Nystagmus – abnormal eye movement  Scotomas – blind spots  Blindness  Amblyopia – lazy eye  Coloboma – part of the eye does not form

Diseases and Disorders

 Retinopathy – abnormal blood vessel development  Strabismus – eyes are not parallel and not aligned with one another  Injuries  Burns  Postoperative complications

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 10 Anatomy of the Eye

ICD-10-CM

 Chapter 7. Diseases of the Eye & Adenexa (H00- H59)  H00 – H05 – Disorders of eyelid, lacrimal system and orbit.  H10 – H11 – Disorders of conjunctiva.  H15 – H22 – Disorders of sclera, cornea, iris and ciliary body.  H25 – H28 – Disorders of lens.  H30 – H36 – Disorders of choroid and retina.  H40 – H42 – Glaucoma.

ICD-10-CM  H43 – H44 – Disorders of vitreous body and globe.  H46 – H47 – Disorders of optic nerve and visual pathways. o H49 – H52 – Disorders of ocular muscles, binocular movement, accommodation and refraction. o H53 – H54 – Visual disturbances and blindness. o H55 – H57 – Other disorders of eye and adnexa. o H59 – Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified.

ICD-10-CM  Additional codes in the following sections of I-10-CM:  Q – Congenital malformations of eye, ear, face and neck  G – Diseases of myoneural junction and muscle  E – Diabetes with ophthalmic complications  T – Poisoning by, adverse effect of and under dosing of glucocorticoids and synthetic analogues  A – Chlamydial conjunctivitis  B - Viral conjunctivitis  C – Neoplasms, malignant  D – Neoplasms, benign  S – Injury - Fracture

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 11 Anatomy of the Eye

Resources

 Advanced Anatomy and Physiology – Contexto  ICD-10-CM 2019  The Human Body Book – DK  Atlas of Human Anatomy - Netter

Eye Muscle

Eye Ball

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 12 Anatomy of the Eye

Eye Contents

Retina

Optic Nerve

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 13 Anatomy of the Eye

Rods & Cones

Lens & Pupil

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 14 Anatomy of the Eye

Pupil & Cornea

Lens – Cornea - Pupil

Coding Fiesta 2019 Sharon J. Oliver, CPC, CDEO, CRC, CPMA, CPC/CRC-I October 26, 2019 15