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1、第二章眼科学基础武汉科技大学临床学院眼科姚军平眼科学基础眼科学是研究视觉器官（包括眼球、眼附属器、视路和视觉中枢）及其疾病发生、发展、诊断和防治的临床学科。眼科学基础包括：眼的解剖、生理、生化、遗传、胚胎、药理和流行病学等内容第第 一节一节眼的组织解剖视觉器官(眼)：包括 眼球：接受外界信息。 视路：向视皮质传递信息。 眼附属器：保护和运动眼球。 眼球近似球形 正常成人眼球 前后径24mm （出生时约16mm） 垂直径23mm 水平径23.5mm 眼球平视时 突出眶外缘1214mm 两眼间差不超过2mm 眼球包括眼球壁和眼内容物一、眼球eyeball（一）眼球壁分三层：外层为纤维膜：角膜（1/
2、6）巩膜（5/6）中层为葡萄膜：虹膜睫状体脉络膜内层为视网膜：视网膜色素上皮细胞层视网膜神经感觉层小结EyeballEyecoatFibroustunic CorneaScleraUveaIrisCiliarybodyChoroidRetinaContentofeyeAqueoushumorLensVitreous1.外层（纤维层）由前1/6透明角膜和后5/6白色巩膜组成，起到保护眼内组织和维持眼球形状的作用（1)角膜（cornea）：位于眼球前极中央，略向前凸的横椭圆形组织。横径约11.5-12mm，垂直径约10.5-11mm，中央厚约0.5-0.55mm，周边厚约1mm。组织学分为5层：上
3、皮细胞层：56层细胞再生能力强,损伤修复后不留痕迹前弹力层（Bowmans膜）无结构透明膜，损伤不能再生基质层:规则排列的胶原组成占角膜厚90%后弹力层（Descemets膜）透明均质膜，损伤后迅速再生内皮细胞层：单层六角形有角膜房水屏障功能受损后不能再生The cornea It is an anterior transparent part of the globe, elliptic in shape and slightly protrudes ahead. the horizontal diameter is 11.5-12mm,vertical one is 10.5-11mm,
4、refractive power is equal to that of +43D lens. There is nobloodvessel in cornea, its nourishment is supplied by peripheral blood and nerve branch of limbus and aqueous humor. Its surface can absorb oxygen from atmosphere. The cornea is richinnerve, with sharp sensation. The cornea has fivelayers: 1
5、.Epithelium; 2.Bowmans layer; 3.Stromal layer; 4.Descemets layer; 5.Endothelium. （2）巩膜（sclera） 乳白色、质韧、不透明有少量血管神经通过表面被眼球筋膜覆盖 在后部与视神经交接处分两层外2/3移行于神经鞘膜内1/3呈网眼状，称巩膜筛板视神经由此穿出眼球 眼外肌处最薄（0.3mm）视神经处最厚（1.0mm）The scleravThe sclera is a fibrous collagenous structure, tough in nature, opaque, milk white. It incl
6、udes: episclera, scleral stroma, lamina fuscia. vThe corneosclera limbus is a transitional zone of the cornea and the sclera, surgical incision always was taken here. （3）角巩膜缘（limbus）角膜与巩膜的移行区:前界位于连接前弹力层止端和后弹力层止端的平面;后界定于经过房角内的巩膜突或虹膜根部并垂直于眼表的平面。小梁Schlemm氏管房水引流（4）前房角-房水排出通道位于周边角膜和虹膜根部连接处。前外侧壁为角巩膜缘，从角膜后
7、弹力层止端（Schwalbe线）至巩膜突；后内侧壁为睫状体的前端和虹膜根部。正常前房角依次可见：Schwalbe氏线；小梁网；巩膜突；睫状带；虹膜根部。2.中层(葡萄膜)又称血管膜、色素膜，富含血管和色素由虹膜、睫状体、脉络膜组成。与巩膜之间存在潜在腔隙，称为睫状体脉络膜上腔，但在巩膜突、涡静脉开口处、视神经处与巩膜粘连紧密（1）虹膜（iris）虹膜为晶体前一园盘状膜，中央2.54mm的圆孔为瞳孔虹膜由基质层和色素上皮层组成。基质层内色素细胞的色素含量多少决定虹膜颜色瞳孔括约肌受副交感神经支配瞳孔开大肌受交感神经支配The iris It situates in the most anteri
8、or part of the uvea, in front of the lens, connected with the ciliary body in periphery. There is a round hole (2.5-4mm)in the center called pupil. There is annular sphincter pupillary muscle (innervated by parasympathetic nerve) and dilator pupillary muscle (innervated by sympathetic nerve) to regu
9、late the size of the pupil. .（2）睫状体（ciliarybody）位于虹膜根部与脉络膜之间的宽约6-7mm的环状组织。前1/3：睫状冠，内表面有70-80个睫状突后2/3：睫状体平坦部扁平部与脉络膜连接处称锯齿缘，是睫状体后界巩膜突是睫状体基底部附着处 睫状体由睫状肌和睫状体上皮细胞组成 睫状肌为平滑肌，受副交感神经支配 睫状上皮细胞层由外层的色素上皮和内层的无色素上皮两层细胞组成（3）脉络膜（Choroid）u起于锯齿缘，止于视盘，介于巩膜与视网膜之间，u有丰富的血管和色素细胞借玻璃膜（Bruchsmembrane）与视网膜色素上皮相连。u血管、神经从脉络膜上腔
10、通过。l l透明膜，视觉形成神经信息传递的第一站透明膜，视觉形成神经信息传递的第一站l l外为脉络膜，内为玻璃体，前至锯齿缘、后至视盘外为脉络膜，内为玻璃体，前至锯齿缘、后至视盘l l两个重要的解剖区域：两个重要的解剖区域：黄斑区黄斑区及及视盘视盘（optic discoptic disc）3内层：视网膜（retina）黄斑区（maculalutea）：视网膜后极部无血管的凹陷区，直径约13mm，其中央为一小凹，即中心凹（forvea）。是视网膜上视觉最敏锐的部位视盘（opticdisc）：黄斑鼻侧3mm处，直径为1.5mm，是视网膜上视觉纤维汇集向视中枢传递穿出眼球的部位。中央有小凹陷区称视
11、杯或杯凹（opticcup)视盘上有视网膜中央动静脉通过，分支分布视网膜上。视网膜分化为视网膜色素上皮层和视网膜神经感觉层。视网膜神经感觉层由外向内分别为：1)视锥、视杆细胞层（光感受器细胞层）2）外界膜3）外核层4）外丛状层5）内核层6）内丛状层7）神经节细胞层8）神经纤维层9）内界膜The retinavThe retina is a thin, semitransparent, multilayered sheet of neural tissue that lines the inner aspect of the posterior two-thirds of the wall of
12、 the globe. It extends almost as far anteriorly as the ciliary body, ending at that point in a ragged edge, the ora serrata.vSpecial structures are as following: Macular In the center of the posterior retina is the macular, with the sharpest vision sensation. In the center of the macular is the fove
13、a. The macular area is very thin and without blood vessel in the centre. There are mainly cones here, with single line connection on verve transmission, so during the lesion in macular area, vision diminishes severely.Optic papilla A pink area (about 1.5mm in diameter) located at nasal side about 3m
14、m to the macula is the optic papilla, called the optic disc too, is a site where the visual fibers on the retina come together to go out of the globe to vision centre. On the optic papilla there are vascular branches of artery and vein, a small depression on it is called optic cup. The optic papilla
15、 is the beginning of the transmission tract composed of nerve fiber collection, without photosensory sell, so it manifests as an intrinsic blind area in visual field called physiologic scotoma. （二）眼球内容物由房水、晶状体和玻璃体组成.房水aqueous：眼内透明液体，充满前后房，处于动态循环.晶状体lens：形如双凸透镜借晶体悬韧带与睫状体联系固定.玻璃体vitreous：为透明胶质体，充满玻璃体腔
16、。占眼球容积4/5Circulation route of aqueous humor Aqueous humor is produced by the ciliary body. Entering the posterior chamber, it passes through the pupil into the anterior chamber and then peripheral toward the anterior chamber angel, then through trabecular meshwork, Schlemms canal, collective tubes and aqueous veins, Finally it flows into the anterior ciliary veins in episclera and blood circulation. 二、眼附属器(一)眼眶（orbit）由额骨、蝶骨、筛骨、腭骨、泪骨、上颌骨和颧骨7块骨构成，为四边锥形.眶上裂：III、IV、VI脑神经V脑神经的眼支，眼上静脉，脑膜中动脉眶支部分交感神经纤维此
