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Angle drainage
- 1. University of Bradford - Optometry Ocular Anatomy & Physiology Anterior Angle & Aqueous Drainage
- 2. University of Bradford - Optometry Your Goals for this Topic • Describe the route taken by aqueous humour from production to drainage from the eye. • Describe in detail the anatomical structure and relations of the anterior angle. • Explain the mechanism by which aqueous humour is removed from the eye. • Appreciate some of the clinical findings associated with aqueous drainage.
- 3. University of Bradford - Optometry Recall - the Eye Schematic view of the eye in cross-section
- 4. University of Bradford - Optometry Anterior Angle General Characteristics
- 5. University of Bradford - Optometry Anterior Eye showing aqueous flow
- 6. University of Bradford - Optometry Aqueous Flow determines Intraocular Pressure Data from Oyster, p389
- 7. University of Bradford - Optometry Aqueous Flow determines Intraocular Pressure
- 8. University of Bradford - Optometry Anterior chamber and angle Oyster, p380 The angle between the anterior iris and posterior cornea is the anterior angle. A wide (or open) angle allows aqueous humour to drain freely - intraocular pressure reduces. A narrow (or closed) angle restricts aqueous drainage - intraocular pressure increases.
- 9. University of Bradford - Optometry Clinical Grading of the Anterior Angle Wolff’s Anatomy, p282 Grade 0 : angle (almost) closed Grade 1 : angle susceptible to closure Grade 2 : closure possible Grades 3-4 : angle closure not possible
- 10. University of Bradford - Optometry Clinical Grading of the Anterior Angle Grade 0 : angle (almost) closed Grade 1 : very narrow angle Grade 2 : moderately narrow angle
- 11. University of Bradford - Optometry Anterior Angle Regional Anatomy
- 12. University of Bradford - Optometry Structures of the Limbal Region Wolff’s Anatomy, p280 Superficial Limbus 1. Conjunctival epithelium 2. Conjunctival stroma 3. Tenon’s capsule and episclera Middle Limbus 4. Limbal or Corneoscleral stroma Deep Limbus 5. Fibres of Ciliary Muscle adjacent to the Canal of Schlemm and Trabecular Meshwork
- 13. University of Bradford - Optometry Anterior Angle Structure and Function
- 14. University of Bradford - Optometry Anterior Angle - Detailed Anatomy • Internal scleral sulcus – sulcus, Schwalbe’s ring, scleral spur • Trabecular meshwork – uveal, corneoscleral, trabeculae, iris processes • Canal of Schlemm & collector channels – canal, endothelium, vacuoles, collector channels, aqueous veins
- 15. University of Bradford - Optometry Structure of Anterior Angle Wolff’s Anatomy, p280 C = Cornea CM = Ciliary Muscle I = Iris S = Canal of Schlemm r = recess of angle Sp = Scleral Spur T = Trabecular Meshwork
- 16. University of Bradford - Optometry Structure of Limbus & Anterior Angle Snell and Lemp, p151
- 17. University of Bradford - Optometry Anterior Angle - 3D representation Snell & Lemp, p152 Note features: 1. Ciliary Band 2. Scleral Spur 3. Trab. Meshwork 4. Schwalbe’s line 5. Angle recess
- 18. University of Bradford - Optometry Aqueous Drainage - 3D representation Snell & Lemp, p195 90% of outflow via trabecular meshwork, 10% ciliary body
- 19. University of Bradford - Optometry Schwalbe’s Ring or Line Oyster, p394 ‘The edge of the cornea is defined by the termination of Descemet’s membrane. The transition zone between cornea and trabecular meshwork is Schwalbe’s ring. It can be an important landmark in gonioscopy.’
- 20. University of Bradford - Optometry Anterior Angle - Gonioscopy
- 21. University of Bradford - Optometry Trabecular Meshwork & Canal of Schlemm Oyster, p392 ‘The trabecular meshwork is made of interlaced cords of tissue extending from the apex of the angle to the margin of the cornea.’
- 22. University of Bradford - Optometry Trabecular Meshwork left Wolff’s Anatomy, p286 Uveal (UT) and corneal (CT) trabeculae. Note narrowing of inter-trabecular space (IT) in the corneal region. Right : overlapping trabeculae increase outflow resistance.
- 23. University of Bradford - Optometry Trabecular Meshwork right Oyster, p395 Trabecular cords have a central core of collagen wrapped by a sheath of endothelium. The endothelium can ingest and break down pigment granules and other debris (phagocytosis). left Oyster, p395 Trabecular Meshwork & CoS are separated by loose collagen and fibroblasts (pericanalicular tissue)
- 24. University of Bradford - Optometry Trabecular Meshwork to Canal of Schlemm left Oyster, p397 Canal of Schlemm is lined with endothelium which forms vacuoles that fill with aqueous from the trabecular meshwork. right Wolff’s Anatomy, p297 Schematic view showing inside of Canal (SC) adjacent to trabecular meshwork (TM). Trabecular wall shows endothelial cell vacuoles (v) and nuclei (N). Corneoscleral wall (CW) of the canal formed of collagen and elastic tissue
- 25. University of Bradford - Optometry Aqueous drainage mechanism Wolff’s Anatomy, p297 1. Endothelial cell in non- vacuolated state. 2. Vacuole forms by infolding of basal surface of cell. 3 & 4. Progressive enlargement of vacuole. 5. Opening of vacuole into Canal to form a transient channel for continuous flow of aqueous. Vacuole closes from basal side and cell returns to non- vacuolated state 1.
- 26. University of Bradford - Optometry Canal of Schlemm right Friedrich Schlemm 1795 - 1858 Professor of Anatomy, University of Berlin left Oyster, p396 ‘A large annular vessel encircling the angle of the anterior chamber.’
- 27. University of Bradford - Optometry Canal of Schlemm left Internal view of complete neoprene cast of the Canal of Schlemm and its associated vessels. right Detail showing anastomosis external collector channels to form the deep scleral plexus.
- 28. University of Bradford - Optometry Drainage of Canal of Schlemm Snell & Lemp, p155 Canal of Schlemm and its associated veins and arteries
- 29. University of Bradford - Optometry Drainage of Canal of Schlemm Oyster, p399 Aqueous drains out of the Canal of Schlemm into venous plexi in the limbal stroma. Canal of Schlemm Deep Scleral Plexus Intrascleral Plexus Aqueous Veins Episcleral Veins
- 30. University of Bradford - Optometry Canal of Schlemm & Aqueous Vein left Neoprene cast of CoS showing features indicated in diagram with aqueous vein encircled by a wire loop. right Aqueous vein (V) communicates with CoS via collecting channels a, b, c which also interconnect through vessel f in deep scleral plexus.
- 31. University of Bradford - Optometry Laminated Vein left Photograph of a laminated aqueous vein seen through the bulbar conjunctiva. A large tortuous scleral vessel runs across the top of the picture. The aqueous vein is crossed by superficial conjunctival vessels.