Protective Mechanisms of the Eye and the Eyelids




(1)
University of Sydney, Sydney, Australia

 




Protective Mechanisms of the Eye



Overview






  • Several mechanisms exist to protect the eye from external injury.


  • Mechanisms of potential damage to the eye include:

    (a)

    Mechanical insult

     

    (b)

    Chemical insult

     

    (c)

    Biological insult

     

    (d)

    Electromagnetic radiation

     


Mechanical Insult




1.

The orbit (Fig. 1.1)

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Fig. 1.1
The orbit




  • The orbital fat and bony walls support and provide protection for the eye and orbital tissues [1].


  • The orbital fat acts as a semi-fluid padding that cushions the eye.


  • The inferior and medial orbital walls are thin. They are readily fractured on blunt trauma, providing some shock absorption and orbital decompression to protect the eye from injury [2, 3].

 

2.

The eyelids



  • The eyelids provide a mechanical barrier between the eye and external environment, rapidly closing on reflexive or voluntary blinking [4].


  • Cilia (modified fine hairs) on the eyelid skin are highly sensitive to airborne particles; when stimulated, they elicit a blink reflex [5].

 

3.

The corneoscleral shell (see Chap. 3, The Cornea and Sclera)



  • The corneoscleral shell provides tensile strength to the globe [6].


  • Dense corneal innervation allows for rapid blink and withdrawal reflexes.


  • Corneal innervation also provides trophic factors that promote epithelial healing [7, 8].

 


Chemical Insult




1.

Eyelid closure



  • Reflex blinking provides rapid closure of the eye in response to splash or foreign body sensation.

 

2.

Bell’s phenomenon



  • A normal Bell’s phenomenon provides involuntary upward rotation of the globe on lid closure, removing the cornea from noxious stimuli [9].

 

3.

Tears



  • Tear flow increases dramatically in response to mechanical or noxious stimuli [10].


  • This causes dilution and washout of the irritant.

 

4.

Corneal epithelial barrier



  • The corneal epithelium is 5–7 layers thick with cells adjoined by desmosomes [11, 12].


  • Tight junctions (zonulae occludens) surround the most superficial corneal epithelial cells providing a low conductance barrier to fluid and solutes [13].

 


Biological Insult




1.

Tear film and conjunctiva (see Chap. 2, The Ocular Surface)



  • The tear film has several bacteriostatic properties [14]:


(i)

Glycocalyx and mucous layer



  • Mucins in the glycocalyx (conjunctival cell membrane-bound mucin) and the mucous layer of the tear film provide a physical barrier to pathogens and can trap microorganisms [15, 16].

 

(ii)

Aqueous layer



  • The aqueous layer has several antibacterial constituents including secretory immunoglobulin A (IgA), lysozyme, and lactoferrin.

 

(iii)

Normal conjunctival flora



  • The normal bacterial flora may inhibit survival of more pathogenic species [16].

 

(iv)

Natural killer cells



  • Present in the conjunctiva, natural killer cells may have a role in restricting the spread of viral infection or tumors.

 

 

2.

Corneal epithelium and Bowman’s layer



  • These act as physical barriers against ocular penetration by microbial pathogens.

 

3.

Descemet’s membrane



  • Descemet’s membrane is resistant to proteolysis in severe corneal infections, maintaining the integrity of the globe [17].

 


Electromagnetic Radiation (EMR) Toxicity






  • The primary function of the eye is to detect and interpret light information from the external world.


  • However, excessive EMR can be damaging to the eye, and several protective mechanisms exist:


1.

Eyelid closure



  • The dazzle reflex: bright light induces reflexive blinking.

 

2.

Pupil constriction



  • Rapid pupil constriction in response to bright light limits excessive radiation exposure to the ocular media internal to the iris [18].

 

3.

Light absorption by ocular tissues (Table 1.1)


Table 1.1
The electromagnetic spectrum: optical radiation [1921, 23]






















































Waveband

Domain

Wavelength (nm)

Absorption by anterior ocular media

Absorption by retinal and choroidal pigments (non-photoreceptor)

Ultraviolet (UV)

UV-C

200–280

Cornea and sclera
 

UV-B

280–315

Cornea and sclera
 

UV-A

315–400

Crystalline lens
 

Visible light
 
400–780
 
Xanthophylls, hemoglobin, and melanin

Infrared (IR)

IR-A

780–1400
 
Haemoglobin and melanin

IR-B

1400–3000

Cornea and sclera
 

IR-C

3000–10,000

Cornea and sclera
 




  • Absorption of nonvisible optic radiation prevents harmful levels of EMR from damaging the eye.


  • The cornea and sclera absorb ultraviolet (UV)-B, UV-C, infrared (IR)-B, and IR-C [1921].


  • The crystalline lens absorbs UV-A.


  • Antioxidants in the lens and macula prevent excessive UV-induced oxidative damage.


  • The yellow macular carotenoid xanthophyll pigments in Henle’s fibre layer absorb short wavelength radiation [22]. They minimize blue light incident to the fovea and reduce chromatic aberration and glare.


  • Hemoglobin and melanin, principally found in the choroid, absorb excessive light and IR radiation. This results in excessive heat generation; the choroidal circulation acts as a heat sink to dissipate thermal energy [23].

 


Eyelids



Overview


The eyelids are important for protection and maintenance of normal ocular health and function [24].

1.

Barrier function



  • Eyelid closure provides a barrier function elicited by voluntary or reflexive blinking [4, 16].

 

2.

Maintenance of globe position



  • The eyelids apply gentle posterior pressure on the globe to counteract forward pressure from orbital tissues behind the globe.

 

3.

Ocular surface integrity (see Chap. 2, The Ocular Surface)



  • Blinking distributes tears across the ocular surface and promotes drainage of tears via the lacrimal pump mechanism [25, 26].

 

4.

Eyelid glands



  • The eyelid contains glands with secretions that add to the tear film.

 


Structure




1.

Dimensions



  • In adults, the normal interpalpebral fissure height is 8–11 mm; the horizontal palpebral fissure length is 27–30 mm.


  • The upper lid margin rests 1.5–2 mm below the limbus; the lower rests on the limbus [27, 28].

 

2.

Anterior lamella (Fig. 1.2)

A347009_1_En_1_Fig2_HTML.gif


Fig. 1.2
Eyelid anatomy

The anterior lamella functions as a single unit, consisting of skin, muscle (orbicularis oculi (OO)), and associated glands [29, 30].

(i)

Skin



  • The eyelid skin is thin, allowing rapid and large movements on eyelid opening and closure.

 

(ii)

Muscle: the orbicularis oculi (Fig. 1.3)

A347009_1_En_1_Fig3_HTML.gif


Fig. 1.3
Divisions of orbicularis oculi


Oct 28, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Protective Mechanisms of the Eye and the Eyelids

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