SPECIAL SENSES

Functional anatomy

There are two eyeballs, each being suspended by extraocular muscles and fascial sheaths in a
quadrilateral pyramid-shaped bony cavity called orbit . Each eye is protected anteriorly by two shutters
called the eyelids . The anterior part of the sclera and the posterior surface of the eyelids are lined by a
thin membrane called conjunctiva . For smooth functioning, the cornea and conjunctiva should be kept
moist by tears, which are produced by the lacrimal gland and drained by the lacrimal passages, which
together form the lacrimal apparatus . The eyelids, the eyebrows, the conjunctiva and the lacrimal
apparatus are collectively known as the appendages of the eye . A brief account of anatomy of the
eyeball and its related structures is given next.

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The eyeball

Each eyeball ( Fig. 11.1-1 ) is a cystic structure kept distended by the pressure inside it. Though generally
referred to as a globe, the eyeball is not a sphere but an oblate spheroid.

Figure 11.1-1

Gross anatomy of eyeball.

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Coats of the eyeball

The eyeball comprises three coats – outer (fibrous coat), middle (vascular coat) and inner (nervous
coat).

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The outer fibrous coat

The fibrous coat ( Fig. 11.1-1 ) is a dense strong wall which protects the intraocular contents. Anterior
one-sixth of this fibrous coat is transparent and is called cornea. The posterior five-sixth opaque part is
called sclera. Junction of the cornea and sclera is called limbus.

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Cornea.

The cornea is a transparent, avascular, watch-glass-like structure with a smooth shining surface. The
average diameter of the cornea is 11–12 mm. Its thickness in the central part is 0.52 mm and in the
peripheral part is 0.67 mm.

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Sclera.

The sclera is a strong, opaque, white fibrous layer. It is a relatively avascular structure approximately 1
mm in thickness. It is pierced by nerves and vessels entering the eyeball.

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The middle vascular coat

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Iris.

The iris is a coloured, circular diaphragm with a central aperture of 3–4 mm size known as pupil. The
pupil regulates the light reaching the retina. It constricts and dilates by the contraction of sphincter
pupillae and dilator pupillae muscles of the iris, respectively. The sphincter pupillae is supplied by the
parasympathetic nerves, whereas the dilator pupillae is supplied by the sympathetic nerves.

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Ciliary body.

The ciliary body is the middle part of the uveal tract. In cut section, it is triangular in shape with base
forwards. Anteriorly, the iris is attached to about the middle of the base of the ciliary body. Posteriorly,
the ciliary body becomes continuous with the choroid.

The ciliary body contains a nonstriated muscle called the ciliary muscle which is supplied by
parasympathetic fibres and takes part in the process of accommodation of the eye.

There are approximately 70–80 finger-like projections from the ciliary body. These are called ciliary
processes and are the site of aqueous humour production – a watery fluid which maintains IOP of the
eyeball.

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Choroid.

The choroid is a dark brown highly vascular layer situated in between the sclera and the retina. It
supplies nutrition to the outer layers of the retina.

Note. The inflammations of the choroid invariably involve the underlying retina.

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The inner nervous coat (retina)

The retina, the innermost tunic of the eyeball, is a thin, delicate, transparent membrane. It is the most
highly developed tissue of the eye. It is concerned with the visual functions (details on page 949]).

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Interior of the eyeball

The interior of the eyeball consists of anterior and posterior chambers containing the aqueous humour,
the lens and the vitreous.

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Anterior and posterior chambers

The anterior chamber is the space bounded anteriorly by the back of the cornea and posteriorly by the
anterior surface of the iris. The posterior chamber is the space between the front of the crystalline lens
and the back of the iris. Through the pupil, anterior and posterior chambers communicate with each
other. Aqueous humour is a watery fluid present in the anterior and posterior chambers of the eyeball.

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Maintenance of clear refractive media of the eye

The main prerequisite for visual function is the maintenance of clear refractive media of the eye. The
major factor responsible for transparency of the ocular media is their avascularity. The structures
forming refractive media of the eye from anterior to posterior are the following:

 •

Tear film

 •

Cornea

 •

Aqueous humour (see page 970)

 •
Crystalline lens

 •

Vitreous humour

Physiology of cornea

The cornea forms the main refracting medium of the eye. It is a transparent watch-glass-like structure,
the anterior surface of which is bathed with tears and the endothelial surface is bathed in the aqueous
humour.

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Corneal transparency

The main physiological function of the cornea is to act as a major refracting medium, so that a clear
retinal image is formed. Maintenance of corneal transparency of high degree is a prerequisite to
perform this function.

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Factors responsible for corneal transparency are the following:

 •

Avascularity of the cornea

 •

Absence of pigment in the cornea

 •

A peculiar regular arrangement of the stromal lamellae

 •

Relative dehydration of the stroma

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Physiology of crystalline lens

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Structure of lens

The lens is a transparent, biconvex, crystalline structure. Its diameter is 9–10 mm and thickness varies
with age from 3.5 mm (at birth) to 5 mm (at extreme of age). It consists of the following ( Fig. 11.1-3 ):

Figure 11.1-3

Pathways of glucose metabolism.

Glucose is very essential for the normal working of the lens. In the lens, 80% of glucose is metabolized
anaerobically by the glycolytic pathway, 15% by pentose hexose monophosphate shunt and a small
proportion via the oxidative Krebs or citric acid cycle.

Lesions of the visual pathways at the level of the following: 1, optic nerve; 2, proximal part of optic
nerve; 3, central chiasma; 4, lateral chiasma (both sides); 5, optic tract; 6, geniculate body; 7, part of
optic radiations in the temporal lobe; 8, part of optic radiations in the parietal lobe; 9, optic radiations;
10, visual cortex sparing the macula; 11, visual cortex, only macula.

1. Lesions of the optic nerve. These are characterized by a marked loss of vision or complete blindness
on the affected side associated with abolition of the direct light reflex on the ipsilateral side and
consensual light reflex on the contralateral side. Near (accommodation) reflex is present.

2. Lesions through proximal part of the optic nerve. Salient features of such lesions are ipsilateral
blindness, contralateral hemianopia and abolition of direct light reflex on the affected side and
consensual on the contralateral side. Near reflex is intact.

3. Sagittal (central) lesions of the chiasma. These are characterized by bitemporal hemianopia and
bitemporal hemianopic paralysis of pupillary reflexes. Common causes of central chiasmal lesion are
suprasellar aneurysms and tumours of the pituitary gland.

4. Lateral chiasmal lesions. Salient features of such lesions are binasal hemianopia associated with
binasal hemianopic paralysis of the pupillary reflexes. Common causes of such lesions are distension of
the 3rd ventricle causing pressure on each side of the chiasma.

5. Lesions of optic tract. These are characterized by homonymous hemianopia associated with
contralateral hemianopic pupillary reaction (Wernicke’s reaction).

6. Lesions of lateral geniculate body. These produce homonymous hemianopia with sparing of pupillary
reflexes.

7. Lesions of optic radiations. Their features vary depending on the site of lesion. Involvement of total
optic radiations produces complete homonymous hemianopia (sometimes sparing the macula). Inferior
quadrantic hemianopia ( pie on the floor ) occurs in lesions of the parietal lobe (containing superior
fibres of optic radiations). Superior quadrantic hemianopia ( pie in the sky ) may occur following lesions
of the temporal lobe (containing inferior fibres of optic radiations).

Note. Pupillary reactions are normal as the fibres of the light reflex leave the optic tracts to synapse in
the superior colliculi. Common lesions of the optic radiations include vascular occlusions.

8. Lesions of the visual cortex. Congruous homonymous hemianopia (usually sparing the macula) is a
feature of occlusion of the posterior cerebral artery supplying the anterior part of the occipital cortex.
Congruous homonymous macular defect occurs in lesions of the tip of the occipital cortex following
head injury or gunshot injuries. Pupillary light reflexes are normal and optic atrophy does not occur
following visual cortex lesions.

9. Lesions of visual areas 18 and 19. The visual sensibility remains intact but there is disturbance in
higher visual functions (visual agnosia).