Anterior chamber of the eye structure and functions. What are eye cameras. Pathologies of the anterior and posterior eye chambers and methods for their diagnosis

Inside the chambers of the eye is intraocular fluid, which circulates unhindered if the function and anatomy of these chambers is not impaired. The eyeball has two chambers: anterior and posterior. A more significant function is played by the front camera. It is bounded in front, behind - by the iris. The rear camera is limited at the back, and at the front.

Normally, the volume of intraocular fluid is a constant value. This is due to the unhindered circulation of moisture through the chambers of the eye.

The structure of the chambers of the eye

The anterior chamber has a depth of about 3.5 mm. In the peripheral areas, there is a gradual narrowing of the space of the anterior chamber. Measurement of the size of the anterior chamber is an important diagnostic feature for some diseases. For example, an increase in the size of the anterior chamber occurs after the removal of the lens by. The decrease in this size is typical for .

In the structure of the posterior chamber there is a greater number of thin connective tissue strands. They are called ligaments of zon and are woven into the lens capsule. At the other end, the zinn ligaments are connected to the ciliary body. These ligaments are needed to regulate the curvature of the lens, and they provide a mechanism that allows you to see objects clearly.

The size of the angle of the anterior chamber of the eyeball is important, since intraocular moisture flows out of the chambers through it. If a front angle block occurs, then the so-called closed angle develops. The angle of the anterior chamber is formed in the place where the membrane passes into the cornea.

The intraocular fluid drainage system includes the following structures:

Collector tubules;
Trabecular diaphragm;
Venous sinus of the sclera.

The physiological role of the chambers of the eye

The main function of the chambers of the eye is the production of aqueous humor. The ciliary body secretes intraocular fluid, in which a large number of vessels pass. This body is located in the posterior chamber of the eye, which can be called secreting. Whereas the anterior chamber of the eye is responsible for the normal outflow of fluid from the cavities of the eye.

In addition, eyeball cameras have other functions:

Light transmission (permeability to light waves);
Normal relationship between the various structures of the eye;
Light refraction, due to which rays are focused on a plane.

Video about the structure of the eye chambers

Symptoms of damage to the chambers of the eye

In the presence of these pathologies, the patient may develop the following symptoms of the disease:

Pain sensations;
blurred vision;
Decreased overall visual acuity;
Change in the color characteristics of the iris;
, which is often associated with a purulent inflammatory process in the chambers of the eye.

Diagnostic methods for lesions of the eye chambers

If you suspect a lesion of the anterior or posterior chambers of the eye, it is necessary to perform a set of studies:

slit lamp study.
(microscopy of the anterior chamber of the eye), which allows you to differentiate glaucoma.
Optical coherent tomography.
provides measurement of the depth of the anterior chamber.
The study of fluid secretion and its outflow.
Automated tonometry measures the pressure inside the eye.

It should be said again that the formations of the eye located in the anterior and posterior chambers play an important role in the circulation of intraocular moisture. They also contribute to the formation of a clear image on the retina. With the development of diseases that affect the chambers of the eye, the visual analyzer as a whole suffers, and, consequently, the function of vision.

Diseases of the chambers of the eye

Various diseases can lead to disruption of the structures located inside the anterior and posterior chambers of the eye.

These include:

Congenital absence of the anterior chamber angle.
The presence of embryonic tissue in the corner of the eye.
Violation of the outflow of moisture through the angle of the anterior chamber when it is blocked by pigment, the root of the iris.
Incorrect attachment of the iris in the anterior region.
Damage to the lens during trauma, weakness of the ligaments of Zinn, which leads to a change in the size of the anterior chamber. Its depth becomes uneven in different areas.
Reducing the size of the anterior chamber, which is possible with synechia or occlusion of the pupil.
Purulent inflammation (hypopion).
Hemorrhage in the cavity of the chambers ().
The formation of adhesions, consisting of connective tissue (sinechia).
Glaucoma associated with an imbalance between moisture synthesis and its outflow.
Recession of the angle of the anterior chamber (its splitting).

It is a space bounded by the posterior surface of the cornea, the anterior surface of the iris and the central part of the anterior lens capsule. The place where the cornea passes into the sclera, and the iris into the ciliary body, is called the angle of the anterior chamber.

In its outer wall there is a drainage (for aqueous humor) system of the eye, consisting of a trabecular meshwork, a scleral venous sinus (Schlemm's canal) and collector tubules (graduates).

The anterior chamber freely communicates with the posterior chamber through the pupil. In this place, it has the greatest depth (2.75-3.5 mm), which then gradually decreases towards the periphery. True, sometimes the depth of the anterior chamber increases, for example, after the removal of the lens, or decreases, in the case of detachment of the choroid.

The intraocular fluid that fills the space of the chambers of the eye is similar in composition to blood plasma. It contains nutrients that are essential for the normal functioning of the intraocular tissues and metabolic products, which are then excreted into the bloodstream. The processes of the ciliary body are occupied by the production of aqueous humor, this occurs by filtering blood from the capillaries. Formed in the posterior chamber, the moisture flows into the anterior chamber, then flowing through the angle of the anterior chamber due to the lower pressure of the venous vessels, into which it is ultimately absorbed.

The main function of the chambers of the eye is to maintain the relationship of intraocular tissues and participate in the conduction of light to the retina, as well as in the refraction of light rays together with the cornea. Light rays are refracted due to the similar optical properties of the intraocular fluid and the cornea, which together act as a lens that collects light rays, as a result of which a clear image of objects appears on the retina.

The structure of the angle of the anterior chamber

The anterior chamber angle is the zone of the anterior chamber, corresponding to the zone of transition of the cornea to the sclera, and the iris to the ciliary body. The most important part of this area is the drainage system, which provides a controlled outflow of intraocular fluid into the bloodstream.

The drainage system of the eyeball involves the trabecular diaphragm, scleral venous sinus, and collector tubules. The trabecular diaphragm is a dense network with a porous-layered structure, the pore size of which gradually decreases outward, which helps in regulating the outflow of intraocular moisture.

At the trabecular diaphragm, one can distinguish

uveal
corneoscleral, as well as
juxtacanalicular plate.

Having overcome the trabecular meshwork, the intraocular fluid enters the slit-like narrow space of the Schlemm's canal, located at the limbus in the thickness of the sclera of the circumference of the eyeball.

There is also an additional outflow tract, outside the trabecular meshwork, called uveoscleral. Up to 15% of the total volume of outflowing moisture passes through it, while the fluid from the angle of the anterior chamber enters the ciliary body, passes along the muscle fibers, then penetrating into the suprachoroidal space. And only from here it flows through the veins of graduates, immediately through the sclera, or through the Schlemm canal.

The tubules of the scleral sinus are responsible for the removal of aqueous humor into the venous vessels in three main directions: into the deep intrascleral venous plexus, as well as the superficial scleral venous plexus, into the episcleral veins, into the network of veins of the ciliary body.

Pathology of the anterior chamber of the eye

Congenital pathologies:

No angle in the anterior chamber.
Blockade of the angle in the anterior chamber by the remnants of embryonic tissues.
Anterior attachment of the iris.

Acquired pathologies:

Blockade of the angle of the anterior chamber by the root of the iris, pigment, or other.
Small anterior chamber, bombardment of the iris - occurs when the pupil is fused or circular pupillary synechia.
Uneven depth in the anterior chamber - observed with a post-traumatic change in the position of the lens or weakness of the zinn ligaments.
Precipitates on the corneal endothelium.
Goniosynechia - adhesions in the corner of the anterior chamber of the iris and trabecular diaphragm.
Recession of the anterior chamber angle - splitting, rupture of the anterior zone of the ciliary body along the line that separates the radial and longitudinal fibers of the ciliary muscle.

Diagnostic methods of diseases of the eye chambers

Visualization in transmitted light.
Biomicroscopy (examination under a microscope).
Gonioscopy (study of the angle of the anterior chamber using a microscope and a contact lens).
Ultrasound diagnostics, including ultrasonic biomicroscopy.
Optical coherence tomography for the anterior segment of the eye.
Pachymetry (assessment of the depth of the anterior chamber).
Tonometry (determination of intraocular pressure).
Detailed assessment of the production, as well as the outflow of intraocular fluid.

The chambers of the eye are closed cavities inside the eyeball, connected by the pupil and filled with intraocular fluid. In humans, two chamber cavities are distinguished: anterior and posterior. Consider their structure and functions, and also list the pathologies that can affect these parts of the organs of vision.

The anterior chamber of the eye is located just behind its cornea. Therefore, from the outside, it is limited by the endothelium of the cornea, consisting of a single layer of flat cells.

On the sides, there is a restriction by the angle of the anterior chamber of the eye. And the reverse surface of the cavity is the anterior surface of the iris and the body of the lens.

The depth of the anterior chamber is variable. It has a maximum value near the pupil and is 3.5 mm. With the distance from the center of the pupil to the periphery (lateral surface) of the cavity, the depth evenly decreases. But when the crystal capsule is removed or the retina is detached, the depth can change significantly: in the first case, it will increase, in the second, it will decrease.

Immediately below the anterior is the posterior chamber of the eye. In shape, it is a ring, since the central part of the cavity is occupied by the lens. Therefore, on the inner side of the ring, the chamber cavity is limited by its equator. The outer part borders on the inner surface of the ciliary body. In front is the posterior leaf of the iris, and behind the chamber cavity is the outer part of the vitreous body - a gel-like liquid, resembling glass in optical properties.

Inside the posterior chamber of the eye are many very thin threads called ligaments of zinn. They are essential for controlling the lens capsule and the ciliary body. It is thanks to them that it is possible to contract the ciliary muscle, as well as the ligaments, with the help of which the shape of the lens changes. This feature of the structure of the visual organ gives a person the opportunity to see equally well both at a small and at a great distance.

Both chambers of the eye are filled with intraocular fluid. It is similar in composition to blood plasma. The liquid contains nutrients and transfers them to the eye tissues from the inside, ensuring the functioning of the visual organ. Additionally, it accepts metabolic products from them, which it subsequently redirects to the general bloodstream. The volume of the chamber cavities of the eye is in the range of 1.23-1.32 ml. And all of it is filled with this liquid.

It is important that a strict balance is observed between the production (formation) of new and the outflow of spent intraocular moisture. If it shifts in one direction or another, visual functions are disturbed. If the volume of fluid produced exceeds the volume of moisture that has left the cavity, then intraocular pressure develops, which leads to the development of glaucoma. If more fluid goes into the outflow than it is produced, the pressure inside the chamber cavities drops, which threatens with subatrophy of the visual organ. Any of the imbalances is dangerous for vision and leads, if not to the loss of the visual organ and blindness, then at least to a deterioration in vision.

The production of fluid to fill the eye chambers is carried out in the ciliary processes by filtering the blood flow from the capillary - the smallest vessels. It is released in the posterior chamber space, then enters the anterior one. Subsequently, it flows through the surface of the angle of the anterior chamber. This is facilitated by the pressure difference in the veins, which seem to suck in the spent fluid.

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The anterior chamber angle, or ACA, is the peripheral surface of the anterior chamber where the cornea blends into the sclera and the iris blends into the ciliary body. The most important is the drainage system of the APC, the functions of which include the control of the outflow of spent intraocular moisture into the general bloodstream.

The drainage system of the eye includes:

Venous sinus located in the sclera.
Trabecular diaphragm, including juxtacanalicular, corneoscleral and uveal plates. The diaphragm itself is a dense network with a porous-layered structure. To the outside, the size of the diaphragm becomes smaller, which is useful in controlling the outflow of intraocular fluid.
Collector tubules.

First, intraocular moisture enters the trabecular diaphragm, then into the small lumen of the Schlemm's canal. It is located near the limbus in the sclera of the eyeball.

The outflow of fluid can be carried out in another way - through the uveoscleral pathway. So, up to 15% of its spent volume goes into the blood. In this case, moisture from the anterior chamber of the eye first passes into the ciliary body, after which it moves in the direction of the muscle fibers. Subsequently penetrates into the suprachoroidal space. From this cavity, outflow occurs through the veins-graduates through the Schlemm canal or sclera.

The sinus tubules in the sclera are responsible for removing moisture into the veins in three directions:

In the venous vessels of the ciliary body;
In the episcleral veins;
In the venous plexus inside and on the surface of the sclera.

Pathologies of the anterior and posterior eye chambers and methods for their diagnosis

Any violations associated with the outflow of fluid inside the cavities of the visual organ lead to a weakening or loss of visual functions, it is important to detect possible diseases in a timely manner. For this, the following diagnostic methods are used:

Examination of the eyes in transmitted light;
Biomicroscopy - examination of an organ using a magnifying slit lamp;
Gonioscopy - the study of the angle of the anterior eye chamber using magnifying lenses;
Ultrasound examination (sometimes combined with biomicroscopy);
Optical coherence tomography (OCT for short) of the anterior parts of the visual organ (the method allows you to examine living tissues);
Pachymetry is a diagnostic method that allows you to assess the depth of the anterior eye chamber;
Tonometry - measurement of pressure inside the chambers;
Detailed analysis of the amount of produced and flowing fluid filling the chambers.

Using the diagnostic methods described above, congenital anomalies can be detected:

Absence of an angle in the anterior cavity;
Blockade (closure) of the CPC by particles of embryonic tissues;
Attachment of the iris in front.

There are many more pathologies acquired during life:

Blockade (closure) of the CPC by the root of the iris, pigment or other tissues;
The small size of the anterior chamber, as well as the bombardment of the iris (these deviations are detected when the pupil is overgrown, which is called circular pupillary synechia in medicine);
Unevenly changing depth of the anterior cavity, due to previous injuries, which entailed weakening of the zinn ligaments or displacement of the lens to the side;
Hypopion - filling the anterior cavity with purulent contents;
Precipitate - solid sediment on the endothelial layer of the cornea;
Hyphema - blood entering the cavity of the anterior eye chamber;
Goniosinechia - adhesion (fusion) of tissues in the corners of the anterior chamber of the iris and trabecular meshwork;
ACL recession - splitting or rupture of the anterior part of the ciliary body along the line separating the longitudinal and radial muscle fibers belonging to this body.

To maintain visual ability, it is important to visit an ophthalmologist in a timely manner. He will determine the changes occurring inside the eyeball, and tell you how to prevent them. A preventive examination is required once a year. If your vision deteriorated sharply, pain appeared, you noticed outpouring of blood into the cavity of the organ, visit the doctor unscheduled.

On the sides, there is a restriction by the angle of the anterior chamber of the eye. And the reverse surface of the cavity is the anterior surface of the iris and the body of the lens.

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The drainage system of the eye includes:

Venous sinus located in the sclera.
Trabecular diaphragm, including juxtacanalicular, corneoscleral and uveal plates. The diaphragm itself is a dense network with a porous-layered structure. To the outside, the size of the diaphragm becomes smaller, which is useful in controlling the outflow of intraocular fluid.
Collector tubules.

First, intraocular moisture enters the trabecular diaphragm, then into the small lumen of the Schlemm's canal. It is located near the limbus in the sclera of the eyeball.

The sinus tubules in the sclera are responsible for removing moisture into the veins in three directions:

In the venous vessels of the ciliary body;
In the episcleral veins;
In the venous plexus inside and on the surface of the sclera.

Pathologies of the anterior and posterior eye chambers and methods for their diagnosis

Examination of the eyes in transmitted light;
Biomicroscopy - examination of an organ using a magnifying slit lamp;
Gonioscopy - the study of the angle of the anterior eye chamber using magnifying lenses;
Ultrasound examination (sometimes combined with biomicroscopy);
Optical coherence tomography (OCT for short) of the anterior parts of the visual organ (the method allows you to examine living tissues);
Pachymetry is a diagnostic method that allows you to assess the depth of the anterior eye chamber;
Tonometry - measurement of pressure inside the chambers;
Detailed analysis of the amount of produced and flowing fluid filling the chambers.

Tonometry

Using the diagnostic methods described above, congenital anomalies can be detected:

Absence of an angle in the anterior cavity;
Blockade (closure) of the CPC by particles of embryonic tissues;
Attachment of the iris in front.

There are many more pathologies acquired during life:

Blockade (closure) of the CPC by the root of the iris, pigment or other tissues;
The small size of the anterior chamber, as well as the bombardment of the iris (these deviations are detected when the pupil is overgrown, which is called circular pupillary synechia in medicine);
Unevenly changing depth of the anterior cavity, due to previous injuries, which entailed weakening of the zinn ligaments or displacement of the lens to the side;
Hypopion - filling the anterior cavity with purulent contents;
Precipitate - solid sediment on the endothelial layer of the cornea;
Hyphema - blood entering the cavity of the anterior eye chamber;
Goniosinechia - adhesion (fusion) of tissues in the corners of the anterior chamber of the iris and trabecular meshwork;
ACL recession - splitting or rupture of the anterior part of the ciliary body along the line separating the longitudinal and radial muscle fibers belonging to this body.

Chambers are called closed, interconnected spaces of the eye containing intraocular fluid. The eyeball includes two chambers, anterior and posterior, which are interconnected through the pupil.

The anterior chamber is placed just behind the cornea, delimited posteriorly by the iris. The location of the posterior chamber is directly behind the iris, its posterior border is the vitreous body. Normally, these two chambers have a constant volume, the regulation of which occurs through the formation and outflow of intraocular fluid. The production of intraocular fluid (moisture) occurs through the ciliary processes of the ciliary body, in the posterior chamber, and it flows in bulk through the drainage system that occupies the angle of the anterior chamber, namely the junction of the cornea and sclera - the ciliary body and the iris.

The main function of the chambers of the eye is the organization of normal relationships between the intraocular tissues, and in addition, participation in the conduction of light rays to the retina. In addition, they are involved in conjunction with the cornea in the refraction of incoming light rays. The refraction of the rays is provided by the identical optical properties of the intraocular moisture and the cornea, which act together as a light-gathering lens that forms a clear image on the retina.

The structure of the chambers of the eye

The anterior chamber is limited from the outside by the inner surface of the cornea - its endothelial layer, along the periphery - by the outer wall of the angle of the anterior chamber, from behind, by the anterior surface of the iris and the anterior lens capsule. Its depth is uneven, in the pupil area it is the largest and reaches 3.5 mm, gradually decreasing further towards the periphery. However, in some cases, the depth in the anterior chamber increases (an example is the removal of the lens) or decreases, as in the detachment of the choroid.

Behind the anterior chamber is the posterior chamber, the anterior boundary of which is the posterior leaf of the iris, the outer boundary is the inner side of the ciliary body, the posterior boundary is the anterior segment of the vitreous body, and the inner boundary is the equator of the lens. The internal space of the posterior chamber is pierced by numerous very thin filaments, the so-called zinn ligaments, connecting the lens capsule and the ciliary body. Tension or relaxation of the ciliary muscle, followed by the ligaments, provides a change in the shape of the lens, which gives a person the ability to see well at different distances.

Intraocular moisture, which fills the volume of the eye chambers, has a composition similar to blood plasma, carrying nutrients necessary for the functioning of the internal tissues of the eye, as well as metabolic products that are further excreted into the bloodstream.

Only 1.23-1.32 cm3 of aqueous humor can fit into the chambers of the eye, but a strict balance between its production and outflow is extremely important for the function of the eye. Any violation of this system can lead to an increase in intraocular pressure, as in glaucoma, as well as to its decrease, which happens with subatrophy of the eyeball. At the same time, each of these conditions is very dangerous and threatens with complete blindness and loss of an eye.

The production of intraocular fluid occurs in the ciliary processes by filtering the blood flow of the capillary blood flow. Formed in the posterior chamber, the fluid enters the anterior chamber, and then flows out through the angle of the anterior chamber due to the difference in pressure of the venous vessels, into which moisture is absorbed at the end.

Anterior chamber angle

The angle of the anterior chamber is the area corresponding to the area of transition of the cornea to the sclera and the iris to the ciliary body. The main component of this zone is the drainage system, which provides and controls the outflow of intraocular fluid on its way to the bloodstream.

The drainage system of the eyeball consists of: trabecular diaphragm, scleral venous sinus and collector tubules. The trabecular diaphragm can be represented as a dense network having a layered and porous structure, and its pores gradually decrease outward, making it possible to regulate the outflow of intraocular moisture. In the trabecular diaphragm, it is customary to distinguish the uveal, corneoscleral, and juxtacanalicular plates. After passing through the trabecular meshwork, the fluid flows into a slit-like space called Schlemm's canal, which is localized at the limbus in the thickness of the sclera, along the circumference of the eyeball.

At the same time, there is another, additional outflow tract, the so-called uveoscleral one, which bypasses the trabecular meshwork. Almost 15% of the volume of outflowing moisture passes through it, which comes from the angle in the anterior chamber to the ciliary body along the muscle fibers, falling further into the suprachoroidal space. Then it flows through the veins of the graduates, immediately through the sclera or through the Schlemm canal.

Through the collector tubules of the scleral sinus, aqueous humor is discharged into the venous vessels in three directions: into the deep and superficial scleral venous plexuses, episcleral veins, and the network of veins of the ciliary body.

Video about the structure of the eye chambers

Diagnosis of pathologies of the eye chambers

To identify pathological conditions of the eye chambers, the following diagnostic methods are traditionally prescribed:

Visual examination in transmitted light.
Biomicroscopy - examination with a slit lamp.
Gonioscopy - visual examination of the anterior chamber angle with a slit lamp using a gonioscope.
Ultrasound diagnostics, including ultrasonic biomicroscopy.
Optical coherence tomography of the anterior segment of the eye.
Anterior chamber pachymetry with chamber depth assessment.
Tonography, for detailed identification of the amount of production and outflow of aqueous humor.
Tonometry to determine the indicators of intraocular pressure.

Symptoms of lesions of the eye chambers in various diseases

congenital anomalies

The angle of the anterior chamber is missing.
The iris has an anterior attachment.
The angle of the anterior chamber is blocked by the remnants of embryonic tissues that have not resolved by the time of birth.

Acquired Changes

Anterior chamber angle blocked by iris root, pigment, etc.
Small anterior chamber, bombardment of the iris, which occurs with the infection of the pupil or circular pupillary synechia.
Irregularity in the depth of the anterior chamber, which is due to a change in the position of the lens due to injury or weakness of the zinn ligaments of the eye.
Hypopion - accumulation in the anterior chamber of purulent secretions.
A hyphema is an accumulation of blood in the anterior chamber.
Precipitates on the endothelium of the cornea.
Recession or rupture of the anterior chamber angle due to traumatic splitting in the anterior ciliary muscle.
Goniosinechia - adhesions (fusions) of the iris and trabecular diaphragm in the corner of the anterior chamber.

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The chambers of the eye are filled with intraocular fluid, which freely moves from one chamber to another with the normal structure and functioning of these anatomical structures. There are two chambers in the eyeball - anterior and posterior. However, the front is the most important. Its boundaries in front are the cornea, and behind - the iris. In turn, the posterior chamber is bounded in front by the iris, and behind by the lens.

Important! The volume of chamber formations of the eyeball should normally be unchanged. This is due to the balanced process of intraocular fluid formation and its outflow.

The structure of the chambers of the eye

The maximum depth of the anterior chamber formation is 3.5 mm in the pupil area, gradually narrowing in the peripheral direction. Its measurement is important for the diagnosis of certain pathological processes. Thus, an increase in the thickness of the anterior chamber is observed after phacoemulsification (removal of the lens), and a decrease - with detachment of the choroid. In the posterior chamber formation there are a large number of thin connective tissue strands. These are ligaments of cinnamon that are woven into the lens capsule on one side, and on the other, they are connected to the ciliary body. They are involved in the regulation of the curvature of the lens, which is necessary for a sharp and clear vision. Of great practical importance is the angle of the anterior chamber, since through it the outflow of fluid contained inside the eye is carried out. With its blockade, angle-closure glaucoma develops. The angle of the anterior chamber is localized in the area where the sclera passes into the cornea. Its drainage system includes the following formations:

collector tubules;
venous sinus of the sclera;
trabecular diaphragm.

Functions

The function of the chamber structures of the eye is the formation of aqueous humor. Its secretion is provided by the ciliary body, which has a rich vascularization (a large number of vessels). It is located in the posterior chamber, that is, it is a secretory structure, and the anterior one is responsible for the outflow of this fluid (through the corners).

In addition, the cameras provide:

light conductivity, that is, the unhindered conduction of light to the retina;
ensuring a normal relationship between the various structures of the eyeball;
refraction, which is also carried out with the participation of the cornea, which ensures the normal projection of light beams on the retina.

Diseases with lesions of chamber formations

Pathological processes affecting chamber formations can be both congenital and acquired. Possible diseases of this localization:

missing corner;
the rest of the tissue of the embryonic period in the area of the corner;
incorrect attachment of the iris in front;
violation of the outflow through the anterior angle as a result of its blocking by the pigment or the root of the iris;
a decrease in the size of the anterior chamber formation, which occurs in the case of an overgrown pupil or synechia;
traumatic damage to the lens or weak ligaments that support it, which ultimately leads to different depths of the anterior chamber in its different parts;
purulent inflammation of the chambers (hypopion);
the presence of blood in the chambers (hyphema);
the formation of synechia (connective tissue strands) in the chambers of the eye;
split angle of the anterior chamber (its recession);
glaucoma, which may be the result of increased formation of intraocular fluid or a violation of its outflow.

Symptoms of these diseases

Symptoms that appear when the chambers of the eye are affected:

pain in the eye;
blurred vision, blurred vision;
decrease in its severity;
change in eye color, especially with hemorrhage in the anterior chamber;
clouding of the cornea, especially with purulent lesions of chamber structures, etc.

Diagnostic search for lesions of the eye chambers

Diagnosis for suspected pathological processes includes the following studies:

biomicroscopic examination using a slit lamp;
gonioscopy - microscopic examination of the angle of the anterior chamber, which is especially important for the differential diagnosis of the form of glaucoma;
the use, for diagnostic purposes, of ultrasound;
coherent optical tomography;
pachymetry, which measures the depth of the anterior chamber of the eye;
automated tonometry - measurement of pressure exerted by intraocular fluid;
study of secretion and outflow of fluid from the eye through the corners of the chambers.

In conclusion, it should be noted that the anterior and posterior chamber formations of the eyeball perform important functions that are necessary for the normal functioning of the visual analyzer. On the one hand, they contribute to the formation of a clear image on the retina, and on the other hand, they regulate the balance of intraocular fluid. The development of the pathological process is accompanied by a violation of these functions, which leads to a violation of normal vision.

30-07-2012, 12:55

Description

Anterior chamber of the eye It is customary to call the space bounded by the posterior surface of the cornea, the anterior surface of the iris, and partially the anterior surface of the lens. It has a certain depth and is made with a transparent liquid.

Anterior chamber depth depends on the age of the patient, the refraction of the eye and the state of accommodation. The chamber fluid consists of a solution of crystalloids with a very low protein content. In this regard, chamber moisture is almost invisible even with detailed biomicroscopy.

Research methodology

When examining the anterior chamber, you can use various biomicroscopy angle options. The light gap should be as narrow as possible and as bright as possible. Among the methods of illumination, preference should be given to research in direct focal light.

To judge the depth of the anterior chamber, it is necessary low angle biomicroscopy. The microscope should be located strictly in the midline, its focus is set on the image of the cornea. By moving the focus screw of the microscope forward, a clear image of the iris is obtained in the field of view. Estimating the degree of separation of the cornea from the iris (by the degree of displacement of the microscope focus screw), one can to a certain extent judge the depth of the anterior chamber. A more accurate determination of the depth of the anterior chamber is carried out using special additional installations (micrometric drum).

To study the state of chamber moisture a wider (larger) angle of biomicroscopy should be used, for which the illuminator must be moved to the side. The microscope remains in the middle, zero position. The larger the biomicroscopy angle, the greater the apparent distance between the cornea and the iris. With the position of the illuminator on the temporal side, the internal sections of the anterior chamber and. on the contrary, when moving the illuminator to the bow side - its outer sections.

The anterior chamber of the eye is normal

The anterior chamber appears as a dark, optically empty space on biomicroscopy. However, in the study of some age groups in the moisture of the anterior chamber, one can see physiological inclusions. In children, there are wandering blood elements (leukocytes, lymphocytes), in elderly patients - inclusions of degenerative origin (pigment, elements of a detached lens capsule).

Under normal conditions, the moisture in the anterior chamber is in continuous slow motion. This is noticeable when observing the movement of physiological inclusions, and in some cases elements of inflammatory origin, which appear in the chamber moisture during iridocyclitis. Meesmann connects the movement of the chamber fluid with the existing temperature difference between the fluid layers adjacent to the surface of the richly vascularized iris and located near the avascular cornea, which is in contact with the external environment.

temperature difference it is most pronounced in that portion of the chamber moisture, which is located with the eyelids open against the palpebral fissure. According to Meesmann, it reaches 4-7°, and the speed of intraocular fluid movement in this zone is 1 mm and 3 seconds.

The flow of chamber moisture has vertical direction. The heated intraocular fluid entering the anterior chamber through the pupillary opening rises along the anterior surface of the iris upwards. In the upper part of the chamber angle, it changes its direction and slowly descends, moving along the posterior surface of the cornea (Fig. 53).

Rice. 53. Thermal current of intraocular fluid (scheme).

At the same time, the intraocular fluid partially gives off heat through the avascular cornea to the surrounding atmosphere, as a result of which the rate of movement of the fluid slows down. In the lower parts of the anterior chamber, the moisture again changes its direction, rushing to the iris. Contact with the iris provides heating of the next portion of the intraocular fluid, which causes its further rise along the iris upwards, towards the upper angle of the anterior chamber. Changing the position of the patient's head does not affect the nature of the circulation of the chamber fluid.

In experiments with immersion of the cornea in a warm saline solution, the temperature of which approaches the temperature of the internal parts of the animal's eye, it was obtained slowing down and complete cessation of intraocular fluid flow. Something similar can be observed during long-term biomicroscopy of chamber moisture. Bright focal light usually heats some of the fluid moving down along the surface of the cornea, as a result of which its speed slows down, and sometimes the fluid begins to rise up, which can be judged by observing the particles suspended in it.

Chamber moisture flow rate depends not only on the temperature difference. The degree of viscosity of the intraocular fluid plays an undoubted role. So, with an increase in the content and chamber moisture of the protein, its viscosity increases, which leads to a slowdown in the movement of the liquid. According to Meesmann, in the presence of 2% protein in the anterior chamber fluid, its current completely stops. After a decrease in the concentration of protein fractions, the normal movement of the chamber fluid is restored.

Cooling of chamber moisture, flowing along the posterior surface of the cornea, and as a result of this slowing down the speed of its current creates conditions for the deposition on the cornea of cellular elements suspended in moisture and making multiple movements with it along the walls of the anterior chamber. So there are physiological deposits on the posterior surface of the cornea. They are located in its lower sections strictly along a vertical line, reaching the level of the lower pupillary edge. These deposits are observed quite often in children to young men and are called Erlich-Turk drip line. It is assumed that these deposits are nothing more than wandering elements of the blood.

When not following in transmitted light, they look like translucent elements, the number of which varies from 10 to 30 (Fig. 54).

Rice. 54. Erlich-Turk line.

When viewed in direct focal light, the deposits take on the appearance of white dots and appear less transparent.

These physiological deposits on the posterior surface of the cornea should be remembered when conducting differential diagnosis with inflammatory changes in chamber moisture. At the same time, it must be taken into account that physiological deposits have a strictly defined localization, located in the lower parts of the cornea along the midline, and that they are not constant (disappear upon observation). The endothelium of the posterior surface of the cornea in the area of their location is not changed. Deposits of a pathological nature occupy a much larger area of the cornea, located not only along the midline, but also in its circumference, they are much more stable and constant. The corneal endothelium around the abnormal deposits is usually edematous.

In elderly patients, on the posterior surface of the cornea, one can see pigment migrating here from the back of the iris, as well as elements of a detached lens capsule. These deposits are usually characterized by a variety of localization.

Pathological changes in the anterior chamber

Pathological conditions of the anterior chamber expressed in a change in its depth, the appearance in its moisture of pathological inclusions associated with inflammation or trauma, as well as in the presence of elements of incomplete reverse development of the embryonic vessels of the eye (see Biomicroscopy of the iris).

The main method to judge the depth of the anterior chamber is examination in direct focal light. It is of great importance in the absence or slow recovery of the anterior chamber after antiglaucomatous surgery and cataract extraction surgery.

Biomicroscopic examination convinces that the complete absence of the anterior chamber is extremely rare, mainly with old irreversible changes, characterized by dense adhesion of the posterior surface of the cornea to the anterior surface of the iris and lens. At the same time, it is often observed secondary glaucoma. More often, the absence of the anterior chamber is only apparent. Usually, having obtained a good optical section of the cornea, one can make sure that in the pupil area between the cut of the cornea and the lens there is a thin capillary slit of dark color filled with chamber moisture. An increase in the width of this gap, as well as the appearance of thin layers of intraocular fluid above the lacunae and crypts of the iris, usually indicate that the restoration of the anterior chamber has begun.

A correct understanding of the depth of the anterior chamber and the dynamics of its recovery plays a huge role in such a complication of fistulizing antiglaucomatous surgeries as choroid detachment. As is known, with this complication, a small anterior chamber is observed on the side of the choroidal detachment. Timely biomicroscopic examination, analysis of the depth of the anterior chamber help to diagnose (taking into account other existing symptoms) detachment of the choroid. This is of particular importance if the patient has a cloudy lens, which makes ophthalmoscopy impossible. Monitoring the depth of the anterior chamber in dynamics correctly orients the doctor in relation to the fit of the exfoliated choroid, which is of great importance in choosing a treatment method. Long failure of the anterior chamber usually dictates the need to eliminate the detachment of the choroid surgically.

Deep or uneven depth of the anterior chamber with an injury to the eyeball indicates a shift in the lens(subluxation or dislocation).

Anterior chamber examination with iridocyclitis reveals biomicroscopic changes of inflammatory origin. The moisture of the anterior chamber becomes more noticeable, opalescent as a result of the appearance of an increased amount of protein in it. The above occurs Tyndall phenomenon, for the study of which it is recommended to use a very narrow illuminating slit or a round aperture of the diaphragm. Against the background of diffusely turbid chamber moisture, fibrin filaments and cellular inclusions, elements of precipitates, are often visible. The occurrence of the latter is associated with inflammation of the ciliary body, as evidenced by the histological composition of these inclusions (leukocytes, lymphocytes, ciliary epithelial cells, pigment. fibrin).

In a dynamic study with a slit lamp, it can be seen that with an increase in the protein content in the chamber moisture, i.e., as the moisture becomes more distinguishable, the speed of movement of cellular elements and fibrin suspended in it decreases. Especially fluid flow slows down in the lower parts of the chamber, in the place where the fluid changes its direction, rushing from the cornea to the iris. Whirlpools usually occur here and even the flow of chamber moisture stops. This creates conditions for deposition on the posterior surface of the cornea cell precipitation precipitates.

Favorite localization of precipitates in the lower parts of the cornea is associated not only with the thermal current of the intraocular fluid. The weight (heaviness) of the precipitates themselves and the condition of the corneal endothelium undoubtedly play a role in this process.

A variety of localization of precipitates is possible, but more often they are located in the lower third of the cornea in the form of a triangle facing the wide base down. Larger precipitates are usually found at the base of the triangle, while smaller ones are near its apex. In some cases, deposits are arranged in a vertical line, forming a spindle shape. Much less often, there is a disorderly, atypical localization of precipitates (in the center, on the periphery of the cornea, in its paracentral sections), which is usually associated with the nature of the cornea lesion. For example, with focal keratitis and the accompanying iridocyclitis, the precipitates are concentrated according to the site of the lesion of the cornea. In cases of severe iridocyclitis, a disseminated distribution of precipitates is observed over the entire posterior surface of the cornea.

An idea of the localization of precipitates can be obtained by conducting transmitted light research. In this case, precipitates are detected as deposits of a dark color, of various sizes and shapes. There are large, disc-shaped precipitates that have clear boundaries and often protrude into the anterior chamber. These precipitates are also easily detected by conventional research methods. In addition to those indicated, there are small, punctate, dusty or unformed precipitates.

For a more detailed examination of the precipitates and the detection of their true color, it is necessary to study in direct focal light. with a slightly widened illuminating slit. In most cases, the precipitates are characterized by a white-yellow or grayish color, sometimes with a brownish tint. Some authors (Koerre, 1920) consider a certain type and size of precipitates to be pathognomonic for certain forms of iridocyclitis. Without completely sharing this opinion, we can say that the study of the size, shape and color of precipitates, taking into account other clinical symptoms and data from the general examination of the patient, helps to classify iridocyclitis as specific or nonspecific inflammation, and also to assess to a certain extent the duration of the process, i.e. to answer the question whether iridocyclitis is in the phase of a progressive course or the period of its reverse development has begun.

Chronic granulomatous inflammation of the vascular tract (iridocyclitis of tuberculous, syphilitic origin) is usually characterized by the appearance large white-yellow, formed precipitates with clear boundaries, prone to merging (Fig. 55.1).

Pic. 65. Precipitates on the posterior surface of the cornea. 1 - decorated; 2 - unformed; 3 - lens.

Such deposits, due to their typical appearance and color, are called "fatty" or "sebaceous" precipitates. They differ in the duration of existence and after them, clouding of the cornea often remains. According to A. Ya. Samoilov (1930), in tuberculous iridocyclitis, such precipitates are carriers of a specific infection on the corneal tissue, as a result of which parenchymal tuberculous keratitis can develop around the precipitate.

A large group of nonspecific iridocyclitis is characterized by the appearance of very tender, unformed, dusty precipitates(Figure 55.2) of an unstable nature. Sometimes they are also detected in the form of a kind of dustiness of the edematous endothelium of the cornea.

It should be noted that the precipitates acquire their inherent peculiar form only as the clinical manifestations of iridocyclitis develop. During the biomicroscopic study in the first days of the disease, no regularity in the form and location of precipitates can be noted.

With the onset of the regressive phase of iridocyclitis chamber moisture becomes less saturated with protein, and its speed increases. This affects the size and shape of the precipitates. Point deposits quickly disappear without a trace, and formed precipitates are significantly reduced in size, flattened, their boundaries become jagged, uneven. These changes can be associated with the resorption of fibrin and the migration of cellular elements into the surrounding chamber moisture, which form the precipitate. In the study in transmitted light, it is seen that the precipitates become translucent, translucent.

As it dissolves precipitates acquire a brown or brown hue, which is associated with the exposure of one of the elements of the precipitate - a pigment, previously masked by a mass of other cellular elements. In the chronic course of iridocyclitis, precipitates can exist for months, often leaving behind light pigmentation.

In addition to precipitates of inflammatory origin, there are precipitates, the occurrence of which is associated with an injury to the lens - the so-called lens precipitates(Fig. 55.3). They are formed during spontaneous injury of the lens, accompanied by a significant violation of the integrity of its anterior capsule, as well as after extracapsular cataract extraction with incomplete extraction of the lens substance. In some cases, the deposition of lens masses (precipitates) on the posterior surface of the cornea may accompany phacogenetic iridocyclitis. The appearance of these precipitates is associated with the washing out of the turbid lens masses by chamber moisture and their transfer during its conventional movement to the posterior surface of the cornea.

When examining with a slit lamp crystalline precipitates look like large, shapeless gray-white deposits. As they dissolve, they become looser, fluffy, and acquire a bluish color. Lenticular precipitates, as a rule, resolve without tears. Detection of such precipitates should not lead to the diagnosis of infectious iridocyclitis.

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