MEKELLE UNIVERSITY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF OPHTHALMOLOGY

seminar on uveal tract

prepared by : Shewit T.(year one resident)

moderator : [Link] yibrah(assistant professor of ophthalmology)

 OUTLINES

• Iris • Choroid
 Embryology
Embryology
 Gross anatomy
Gross anatomy
 Micro anatomy
Micro anatomy
• Ciliary body
 Brief embryology Choroidal blood flow
 Gross and micro anatomy
INTRODUCTION

• Layers of the eye globe

Outer fibrous layer
Middle vascular layer
Inner neural layer
ANATOMY OF THE EYE
 UVEA

• Uvea is a Latin word which

means grape-its pigmentation
and structure attribute to its
grape color.
 UVEA

• Uvea is the main vascular

pigmented layer of the eye.
• Uvea is firmly attached to the
sclera at only three sites
Scleral spur
Exit points of the vortex veins
Optic nerve
UVEA

• It consists of three parts-

1. Iris
2. Ciliary body
3. choroid
 PHYSIOLOGY OF UVEA

• source of blood flow to the • Modulate refractive function of

ocular structures. the eye

• aqueous humor production • Controlling the temperature of

and maintenance of the eye.
 Environmental conditions
intraocular pressure.  Metabolic process
 Irradiation
• process of accommodation.  Light energy
• The uveal tract is supplied by three sets of arteries
short posterior ciliary artery-supplies the choroid in a segmental
manner
Long posterior ciliary artery-these are two in number and run in
suprachoroidal space to reach the ciliary muscle, without any branch.
Anterior ciliary artery
 VENOUS DRAINAGE

1. Anterior ciliary veins

2. Smaller veins from sclera
3. Vortex veins
4-6 in number
Pierce the sclera obliquely about 6mm behind the equator of the globe.
Drain blood from : whole of the choroid ,receive small veins from
optic nerve head and sometime from retina
• After passing the oblique
scleral channel the superior
vortex veins join the superior
ophthalmic vein and the
inferior vortex veins join the
inferior ophthalmic veins.
NERVE SUPPLY OF UVEA

Long posterior ciliary nerve Short posterior ciliary nerve

-from nasociliary nerve (V1 -from oculomotor nerve by way of

division of CN V) ciliary ganglion
-have sensory supply to the iris & -have sympathetic fibers for the
ciliary body blood vessels
-have sympathetic supply to iris -have parasympathetic fiber for iris
dilator constrictor & ciliary muscle
IRIS
EMBRYOLOGY OF IRIS

• 6 wks –precursors of iris • Stroma-neural crest cells

• Inner portion of the anterior optic • Iris musculature- neuroectoderm
cup-PPE the iris • 24 wks-major arterial circle
• Outer portion of the anterior optic • 32nd – minor arterial circle
cup-anterior iris epithelium
• Sphincter muscle develops earlier
• 10 wks-pigmentation than dilator muscle.
GROSS ANATOMY

• The most anterior extension of the uvea.

• It is a circular disc with centrally situated round aperture ,the
pupil.
• Lies in contiguity with the anterior surface of the lens dividing the
anterior chamber from posterior chamber.
• Its mobility allows the pupil to change size.
GROSS ANATOMY

• 12 mm in diameter & 0.5 mm in

thickness.
• Thick at 1.5mm from pupillary
margin thin near the root -site for
traumatic iridodialysis and
iridoplegia
• Two surfaces-anterior & posterior
ANTERIOR SURFACE

Pupillary and ciliary zone

Crypts
Contraction furrows
Radial strikes
Collarette
Pigment frill
POSTERIOR SURFACE

• structural folds of Schwalbe

• Contraction folds of Schwalbe
• Contraction furrows
MICROSCOPIC ANATOMY

• Iris is composed of 5 layers

-anterior border layer
-iris stroma
-muscle layer
-anterior pigment epithelium
-posterior pigment epithelium
ANTERIOR BORDER LAYER

• It is modification of iris stroma which become irregular & more dense.

• Thick near margin where it is attached to pigmented epithelium.
• Contains dense network of collagen, fibroblast & melanocytes
• Cells are sparse in crypts but abundant in contraction furrows and
trabecula.
• Color of the iris
 IRIS STROMA

• Composed of pigmented cells, non pigmented cells ,collagen fibers and

matrix containing hyaluronic acid.
• Determines the color of the iris
Densely pigmented-brown color
Lightly pigmented-blue color
• Loose stoma allows the aqueous humor flow freely.
MUSCULATURE

• Sphincter muscle:
 Found with in 1mm of the pupil border
 Supplied by both parasympathetic via CN three and sympathetic nerves
 Derived from neuroectoderm
 Found deep to iris stroma and anterior to posterior pigmented epithelium of the iris

• Dilator muscle:
 Develops from APE and derived from neuroectoderm
 Dual innervation and found in the mid iris
ANTERIOR EPITHELIAL LAYER-MYOEPITHELIUM

Muscular portion
• Long , thin ,ribbon like & radially arranged muscular processes terminating in
epithelial portion.
Epithelial portion
• Found posteriorly and attaches apex to apex with the posterior pigment
epithelium.
• Contains the nucleus ,pigment granules ,mitochondria & ER.
 POSTERIOR PIGMENTED EPITHELIUM

• Densely pigmented and appears velvety smooth and uninform

• Continuous with the non pigmented epithelium of the ciliary body and
neurosensory part of the retina.
• It has basal and apical surface
• Curves around the pupillary margin and extends for a short distance onto
the anterior border layer of the iris stroma as the pigment ruff.
• rubeosis iridis-ectropion
 VESSELS AND NERVES OF THE IRIS

• Blood vessels form the bulk of the stroma.

• Most follow a radial course.
• Large diameter of capillaries.
• Non fenestrated endothelium surrounded by a basement membrane.
• Intima has no internal elastic lamina.
• Served by myelinated and non myelinated nerve fibers.
• Major arterial circle-at the anterior end of the ciliary muscle
nasal and temporal long posterior ciliary arteries plus anterior
ciliary arteries.
• Minor arterial circle-collarete
CILIARY BODY
EMBRYOLOGY OF THE CILIARY BODY

• Formed by combination of mesoderm and neuroctoderm

• 12 wks –outer pigmented epithelial layer start to form meridional ridges,
precursors of ciliary process.
• 14 wks tip of the optic cup contact lens to differentiate in to ciliary body
and iris.
• 15 wks primitive ciliary muscle fibers are noticeable in the mesenchyme
 CILIARY BODY

• Triangular in cross section, bridges the anterior and posterior segment of

the eye.
• Function:
 Aqueous humor production
 Lens accommodation
 Aqueous humor outflow
 It plays a role in the production and turn over of vitreous humor
 GROSS ANATOMY

• Ring shaped structure anteriorly and terminates at ora serrata

and appears flat posteriorly.
• Has triangular shape when viewed in sagittal section
• Apex-ora serrata, base-lies at the scleral spur and anterior
chamber anteriorly.
• Triangular in sagittal section
• 6 to 6.5 mm
• Widest inferotemporal and
narrowest superonasally
• From limbus to orra seratta-7
temporally and 6mm nasally
MICROSCOPIC ANATOMY

• Has two section:

1. Pars plicata
Wider and richly vascularized portion
Consists of app 70 to 80 radial folds, called ciliary process
Majority of the zonular fibers attach to it
CILIARY PROCESS

• Its 2mm in length, 0.5 in width,

and 1mm in height.
• It’s a vascularized connective
tissue core lined with two layers of
epithelium.

• Exact number usually not known.

PARS PLANA

• It’s the 4 mm relatively avascular posterior part.

• Inner part sharply demarcated with retina, orra serrata

• The outer part of pars plana have no sharp demarcation

where supraciliary space blend directly with suprachoroid.
• Safe for posterior segment surgical approach
It avoids hemorrhage and retinal damage
 CILIARY SULCUS

• valley created by the iris & pars plicata.

• Mean diameter is 11.2mm ± 0.3mm.
• Site for IOL placement
• If narrowed sulcus…misdirect haptics to the iris or ciliary
body…..result in vascular occlusion or erosion.
MICROSCOPIC LAYERS

Supraciliary
Ciliary muscle
Stroma
Epithelial layers
 SUPRACILIARY LAYER

Outer most layer of the ciliary body

Consists of collagen and external longitudinal layers of the ciliary
muscle.
Allows the ciliary body to slide against the sclera without detaching
Allows accumulation of fluids and continuous with suprachoroid
lamina
CILIARY MUSCLE

• Composed of three layers of smooth, nonstriated, muscular tissue

• Primarily innervated by parasympathetic nervous system
• Have a great role in lens accommodation
• With aging-increased amount of connective tissue between the
muscles bundle and loss elastic recoil after contraction.
• Longitudinal muscle fibers:
Origin-scleral spur, insertion-suprachoroidal lamina
It helps aqueous humor to flow
Forms bulk of the tissue
• Circular muscle fibers:
Occupy the internal part of the ciliary body
Nearest to the lens and parallel to the limbus
• Oblique middle layer-
• Contraction undergo shortening and
cause
-anterior traction of orra serrata
-inward and posterior pull of scleral
spur
-anterior & inward movement of ciliary
process
STROMA

• Lies between the muscle and the epithelial layers

• Forms the core of the ciliary body
• Highly vascularized loose connective tissue
• It is continuous with iris stroma and choroidal stoma anteriorly and
posteriorly respectively
• It thins in pars plana
EPITHELIAL LAYERS

• Outer layer
Cuboidal, and the cells are joined by desmosomes and gap junctions
Basement membrane is continuous anteriorly and posteriorly with,,,,
• Inner layer:
Non pigmented and composed of cuboidal cells in the pars plicata and
columnar cells in the pars plana
Lateral wall-interdigitation
Apices-desmosomes, gap junctions, and zonula occludens CS
• Apices-desmosomes, gap
junctions, and zonula occludens
• Basement membrane lies towards
the posterior chamber
VASCULATURE

• Runs mainly in the inner part of the stroma

• Ciliary muscle is supplied by a delicate network of capillaries
• Ciliary process is the most vascular region of the eye
Major and minor process
Postcapillary veins
NERVES

• Parasympathetic innervation-short ciliary nerves

• Sympathetic innervation- long ciliary nerves
• Sensory nerves – nasociliary branch of the ophthalmic division of the
trigeminal nerve.
CHOROID

• Largest part of uvea w/c extend from ora serata to optic nerve.
FUNCTION
- nourishes the peripheral retina.
- regulates temperature of the eye.
- channel for the major neurovascular structures.
-determines the color of the fundus.
GROSS ANATOMY

• Vascular area of the eye

• Thickest in the macula and firmly attached to the margin of the optic nerve
and to the sclera behind the equator.
• Inner surface is smooth and outer surface is rough
EMBRYOLOGY

• Choroid formed from neural crest cells & mesoderm.

• Pigment in RPE appear first…..b/n 5th -7th wk
• Capillaries……2nd month
• Veins……….. 3rd month
• Arteries……..4th month
• Melanocytes formed by neural crest cells.
• 7th week-the first layer of Bruch's membrane-RPE basement membrane
• 9th week-basement membrane of the choriocapillaris
• 24-27 week – melanin first appears in the peripapillary melanocytes
MICROSCOPIC ANATOMY

• 0.2mm thick posteriorly & 0.1mm thick anteriorly.

• has three layers-closely interrelated
1,suprachoroid
2,choroidal stroma and vascular layers
3,bruch’s membrane
SUPRACHOROIDAL LAMINA-LAMINA FUSCA

• It is thin membrane of condensed collagen fibers, melanocytes and

fibroblasts, measures 10-34 um
• It is continuous anteriorly with supraciliary lamina of the ciliary body
• Suprachoroidal space:
Contains L and S posterior ciliary arteries and nerves
Measures 30 micrometer and abundant in nerve fibers and ganglions
CHOROIDAL STROMA

• It consists of loose collagenous tissue with some elastic and reticular fibers
• It consists plenty of pigment cells , fibrocytes, macrophages, mast cells, plasma cells
and lymphocytes
• Its main bulk is formed:
Outer layer of large vessels-haller’s layer- diminish as we go towards the
choriocapillaris and mainly contains veins.
Inner layer of medium vessels-sattler’s layer-are arterioles and connect with
choriocapillaris
• Melanocytes with in the stroma impart the brown color that characterizes
the choroid , dense in the outer choroid and diminishes in middle layer.
• The amount of pigmentation of the choroid determines the color of the
fundus
• Collagen fibers are arranged in circular manner around the vessel to
provide adventitia
VASCULATURE

 choriocapillaris
Specialized capillary bed 3-4x wider than the ordinary capillaries-allow
multiple red blood cells pass- are fenestrated and lined by true basement
membrane.
• Densest and thickest in the macular area and is the sole blood supply of the
fovea zone of the retina
• Unique to the choroid and does not continue to the ciliary body
VASCULATURE

• Choriocapillaris are perfused via:

Short posterior ciliary arteries
Perforate the sclera directly near the optic nerve
Long posterior ciliary arteries
Penetrate the sclera peripherally
Anterior ciliary arteries
BRUCH'S MEMBRANE

• Thin acellular well delineated layer between RPE and choriocapillaris

• Measured 2-4 micro meter at the pole 1-2 micro meter at the
periphery
• Extends from the optic nerve to the orra serrate
• It is formed by both the RPE and choriocapillaris
• It increases in thickness as age increases
• It provides support and attachment site for the RPE
• It provides nutrition and metabolites to the outer third of the retina
• It provides medium for metabolic exchange between the
choriocapillaris and the RPE
Bruch’s membrane has five layers
[Link] basement membrane of
choriocapillaris
[Link] outer collagenous zone
[Link] elastic tissue layer
4. The inner collagenous zone

5. The basement membrane RPE

CHOROIDAL BLOOD FLOW

• Takes 85 percent of the blood circulating through the eye.

• Choroidal blood flow is higher than that in most other body tissues
• Blood flow estimates 800-2000 ml/min/100g
• Choroidal venous blood oxygen content 95 percent of that found in the
choroidal arterial blood.
CHOROIDAL BLOOD FLOW

• Blood flow relies on both intrinsic and extrinsic pathways

 Intrinsic-locally secreted mediators-contreveriasl
 Extrinsic-autonomic nervous system and hormones

• PV=IOP except IOP less than 12mm Hg

• Ocular perfusion pressure = 2/3 of MAP(DP PLUS 1/3SP MINUS IOP)
• Exact function of high blood flow not known but the proposed functions
are
-produce high gradient of oxygen to diffuse to the retina
-low gradient of waste products to be removed from the retina.
-also dissipate heat generated in the visual process
-as protective reserve in cases of vascular obstruction
REFERENCES

• BCSC 12th EDITION

• DUAN’S 2012
THANK YOU!!!!!!!!!

A LAMP OF A CREATURE”