The Eye: Basic Sciences in Practice

660 Pages·2015·86.46 MB·English

by  John V Forrester

The Eye
Basic Sciences in Practice
To Anne, Lindsey, Christine and Lucy
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4th Edition
The Eye

Basic Sciences in Practice
John V. Forrester, MB ChB Paul G. McMenamin,
MD FRCS(Ed) FRCP(Glasg) BSc MSc(MedSci)
(Hon) FRCOphth(Hon) DSc (Med) PhD
FMedSci FRSE FARVO Director of Centre for Human Anatomy
Education, Department of Anatomy and
Professor of Ophthalmology and Head of
Developmental Biology, Monash University,
Department of Ophthalmology, University
Melbourne, Victoria, Australia
of Aberdeen, Aberdeen, UK; Section of
Immunology and Infection, University of
Fiona Roberts, BSc MB
Aberdeen, UK; Ocular Immunology
Program, The University of Western ChB MD FRCPath
Australia, Australia; Centre for Experimental
Consultant Ophthalmic Pathologist and
Immunology, Lions Eye Institute, Western
Honorary Senior Lecturer in Pathology
Australia, Australia
University Department of Pathology
Southern General Hospital
Glasgow, UK
Andrew D. Dick, BSc MB
BS MD FRCP FRCS Eric Pearlman BSc PhD
FRCOphth FMedSci FARVO Director, Institute of Immunology
Professor, Departments of Ophthalmology
Professor of Ophthalmology and Head of
and Physiology, University of California,
Academic Unit of Ophthalmology
Irvine
University of Bristol
Professor and Director of Research in the
Bristol, UK
Department of Ophthalmology and Visual
Sciences, Case Western Reserve University,
Cleveland, Ohio
EDINBURGH  LONDON  NEW YORK  OXFORD  PHILADELPHIA 
ST LOUIS  SYDNEY  TORONTO  2016
iii
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First edition 1996
Second edition 2002
Third edition 2008
Fourth edition 2016
ISBN 978-0-7020-5554-6
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NOTICES
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the publisher nor the authors, contributors, or editors, assume any
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otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
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Printed in China
Contents
Preface,  vii
Acknowledgements,  viii
1  Anatomy of the eye and orbit,  1
2  Embryology and early development of the eye and adnexa,  103
3  Genetics,  130
4  Biochemistry and cell biology,  157
5  Physiology of vision and the visual system,  269
6  General and ocular pharmacology,  338
7  Immunology,  370
8  Microbial infections of the eye,  462
9  Pathology,  486
Index,  539
eBook Content
For the fourth edition of The Eye, additional content is 
provided in the eBook (https://expertconsult.inkling.com/) 
and accessed at the point where the icon   appears. 
The authors have prepared video clips to help explain  
and expand on aspects of the basic science and these  
can be accessed where the video icon   appears. 
All suggestions for further reading are in the eBook.
v
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Preface
The fourth edition of The Eye is upon us and, in the and ophthalmic science who are embarking on a
intervening years since the third edition, much has career in the basic science of the eye. We expect
happened in the life sciences which have a direct readers will take from the text those aspects of knowl-
bearing on the basic science of the eye. For instance, edge and information which are directly relevant to
the massive strides being taken by the new genetics them and hope that they will also dip into areas which
and functional genomics based on the Human Genome might not seem so immediately important to them but
Project, the new understanding of how the microbi- remain part of the whole. As indicated in the preface
ome affects all aspects of immunology, the remarkable to the third edition, the purpose is to produce a “basic
new imaging technology which is applied to anatomy science of the eye” handbook which is readily
and neurophysiology, the exciting new molecular, and accessible.
other, diagnostic methodologies being used in micro- The book retains its familiar overall organisation in
biology and pathology, have collectively brought a terms of subject matter. Excitingly, however, in this
wealth of new knowledge to students and practition- internet dawn, The Eye is also being produced as an
ers in the fields of ophthalmology and visual science. online text, with links to additional information as
For these reasons alone, we have felt that there is well as video clips prepared by the authors which are
strong need to update the text and allow our continu- aimed to help explain and expand on aspects of the
ing and new readership to view these developments basic science. We hope that our new, as well as our
as they inform the various scientific disciplines in how previous, students and readers enjoy the new product.
they affect the eye and its workings.
And so, The Eye Fourth Edition has been extensively
John V. Forrester
revised with much new text as well as many new
figures. The aim of the book, as always, has been to Andrew D. Dick
provide a concise text which provides as much infor-
Paul G. McMenamin
mation in the simplest and most readable format
which can be used by a diverse readership. This Fiona Roberts
includes optometrists and ophthalmologists in train-
Eric Pearlman
ing, and in practice, as well as new recruits to visual
vii
Acknowledgements
We would like to thank Professor William R. Lee, who extraocular muscles) and Professor Brian Hall (embry-
co-authored the first two editions of The Eye, for his ology of the head and neck).
guidance and support and generous provision of mate-
rial for the current edition. We are also grateful to the John V. Forrester
anonymous reviewers who commented on the draft
Andrew D. Dick
text.
Paul McMenamin would like to thank the following Paul G. McMenamin
for discussions relating to the revisions for the third
Fiona Roberts
edition: Professor Alan Harvey (the anatomy of the
visual pathways), Dr Joseph Demer (anatomy of Eric Pearlman
viii
1  Anatomy of the eye and orbit
Chapter 1 
Anatomy of the eye and orbit
The skull is composed of a large number of separate
• Anatomical terms of reference
bones that are united by sutures (fibrous immovable
• Osteology of the skull and orbits
joints). The cranium consists of eight bones (only two
• Structure of the eye
are paired), the facial skeleton consists of 14 bones, of
• Orbital contents which only two are single (Fig. 1-2A,B). The skull
• Cranial nerves associated with the eye and orbit contains a number of cavities that reflect its multiple
• Ocular appendages (adnexa) functions:
• Anatomy of the visual pathway • cranial cavity – houses, supports and protects the
brain
• nasal cavity – concerned with respiration and
Anatomical terms of reference
olfaction
The internationally accepted terminology for • orbits – contain the eyes and adnexa
description of the relations and position of struc- • oral cavity – start of gastrointestinal tract, respon-
tures in the body requires reference to a series of sible for mastication and initial food processing;
imaginary planes (Fig. 1-1). Thus, relative positions houses taste receptors.
of anatomical structures are referred to in terms of: Many of the cranial bones contain air-filled spaces, the
medial (nearer the median or mid-sagittal plane) paranasal sinuses (Fig. 1-3). Most of the anatomical
and lateral (away from this plane); anterior and features of the whole skull relevant to the study of the
posterior refer to the front and back surfaces of the eye and orbits are indicated in Figure 1-2A and B
body; superior (cranial or rostral) or inferior (caudal) (norma frontalis and norma lateralis). (See video 1-1).
refer to position in the vertical; superficial and deep
specify distance from the surface of the body. A
combination of terms can be used to describe the OSTEOLOGY OF THE ORBIT
relative position of structures that do not fit exactly The orbital cavities, situated between the cranium and
any of the other terms, e.g. ventrolateral, postero- facial skeleton, are separated from each other by the
medial, etc. nasal cavity and the ethmoidal and sphenoidal air
sinuses (Fig. 1-3A–C). Each bony orbit accommodates
Osteology of the skull and orbits and protects the eye and adnexa, and serves to trans-
mit the nerves and vessels that supply the face around
GENERAL ARRANGEMENT AND the orbit. Parts of the following bones contribute to
FEATURES OF THE SKULL the walls of the orbit: maxilla, frontal, sphenoid, zygo-
The skull is divided into two parts: an upper part matic, palatine, ethmoid and lacrimal (Figs 1-4 and
shaped like a bowl, which contains the brain, 1-5A,B). Each orbit is roughly the shape of a quadri-
known as the cranium or neurocranium; and a lower lateral pyramid whose base is the orbital margin and
part, the facial skeleton or viscerocranium. The whose apex narrows at the optic canal. Each orbit has
cranium can be further subdivided into the cranial a floor, roof, medial wall and lateral wall (Fig. 1-4).
vault and cranial base. (See video 1-2).
1