Ocular Anatomy and Physiology, Clinical Microbiology and Investigative Techniques (10 cr)

Objective

Knowledge base
Students are able to

• describe anatomy and physiology of the eye with in detail and describe the developement of the eye in the area of: (1) orbit, (2) extraocular muscles (basics), (3) ocular blood supply, (4) ocular and orbital nerves, (5) eyelid, (6) eyebrow, (7) conjunctiva, (8) lacrimal system, (9) cornea, (10) sclera and episclera, (11) anterior chamber and angle, (12) iris, (13) pupil and posterior chamber, (14) ciliary body, (15) lens and zonules, (16) choroid, (17) vitreous, (18) retina (basics) (19) optic nerve, and (20) visual pathways (basics).

• describe the basic features of microbiology and immunology in the area of (1) virology, (2) bacteriology, (3) mycology, (4) parasitology, (5) antigens and antibodies, (6) complement system, (7) non-specific immunity, (8) specific immunity, (9) hypersensitivity response, and (10) autoimmunity (11) vaccinations

• describe the basic features of the eye examination equipments, methods of examinations techniques, use of them when exam the healthy structure of the eye and recognize the abnormal signs of the eye. (1) slit lamp microscopy, (2) direct ophthalmoscopy, (3) pupil reactions tests, (4) keratometry, (5) topography, (6) non- contact tonometry (air pressure) and rebound tonometry

Clinical/practical
Students are able to (basic)
• assess anterior parts of the eyes with slit lamp using the basic illumination techniques
• assess fundus with direct ophthalmoscopy
• measure keratometry values and topography
• measure intra ocular pressure
• assess pupil reactions
• measure thickness of the cornea without anesthesia
• concerning measurements above; make the records and identify the normal values

Content

Anatomy of the eye:
Orbit
o Location of bones and openings
o Anatomical relationships among orbital structures (extraocular muscles, nerves, blood vessels, fat compartments, fascia)
Extraocular muscles
o Names, origins, insertions
o Innervation, blood supply
Ocular blood supply
o Branches of internal and external carotid arteries related to the orbit, eyelid and upper face
o Branches of the internal and external jugular veins
o Dural sinuses
Ocular and orbital nerves
o Intracranial and extracranial course, branches and functions of cranial nerve I, III, IV, V, VI, VII
o Parasympathetic and sympathetic nerves (coursse, branches, tissue innervated)
Eyelid
o Structures of the layers, muscles and glands
o Blood supply and drainage, lymphatic drainage
o Innervation
Eyebrow (structure and function)
Conjunctiva
o Structures of the layers, cell types and glands
o Blood supply and drainage, lymphatic drainage
o Innervation
o Composition of plica semilunaris and caruncle
o Relationship with adjacent structures
Lacrimal system
o Lacrimal gland (structure, innervation, blood supply)
o Accessory lacrimal glands (location, function)
o Composition and structure of the tear film
o Drainage of tears
o Location of lacrimal fossa and nasolacrimal canal
Cornea
• Normal dimensions
• Temperature
• Composition and ultrastructure of epithelium, Bowmans’s membrane, stroma, Descemet’s membrane and endothelium
• Innervation
• Wound healing and regeneration
Sclera
o Dimensions and colour
o Relationship to adjacent structures
o Composition of layers
o Location and content emissaria
o Structure of lamina cribrosa
Anterior chamber and angle
o Shape and dimensions
o Composition of ultrastructure of the trabecular meshwork, juxtacanalicular tissue, Schlemm’s canal, the scleral spur and Schwalbe’s ring
Iris
o Dimensions, zones and coloration
o Composition and ultrastructure of anterior border, anterior epithelium, stroma and posterior epithelium
o Composition and ultrastructure of sphincter an dilatator muscles
o Blood supply, venous drainage
o Innervation
Pupil and posterior chamber
o Locations and dimensions
Ciliary body
o Dimensions and relationship to adjacent structures
o Locations and components of pars plana and pars plicata
o Ultrastructure of the epithelium and stroma and the ciliary muscle
o Blood supply, venous drainage
o Innervation
Lens and zonules
o Ultrastructure and composition of capsule, epithelium and cortex
o Location of nuclei and sutures
Choroid
o Extent and thickness
o Ultrastructure of choriocapillaris
o Composition of stroma
o Blood supply, venous drainage
o Innervation
o Location and composition of Bruch’s membrane
Vitreous
o Composition, ultrastructure, volume and shape
o Attachments to retina and lens (ultrastructure)
o Locations of patellar fossa, anterior and posterior hyaloids
o Location and origin of hyaloid canal
Retina
o Components and ultrastructure of each layer
o Relationship between retinal pigment epithelium and Bruch’s membrane and photoreceptor outer segments
o Synaptic connections within retina
• Location, names and function of glial cells
o Blood supply, venous drainage
o Location, size and ultrastructure of areea centralis, parafovea, fovea, foveola, macula lutea, ora serrata
Optic nerve
o Composition and blood supply of the prelaminar, laminar and retrolaminar portion
o Location of central retinal artery and vein
o Normal surface and optic disc/cup features
Visual pathway
o Localisation of retinal fibres along visual pathway, optic nerve, chiasm, optic tract, lateral geniculate body, optic radiations, cisual cortex
o Layers of lateral geniculate body
o Layers of visual cortex, areas
o Blood supply
Developement of the ocular and visual pathway:
Orbit, extraocular muscles, eyelid, conjunctiva, lacrimal system, cornea, sclera iris, ciliary body, lens and zonules, choroid, vitreous, retina, optic nerve, and visual pathway
Circulation
o Haemodynamic patterns (resistance, trans mural pressure, flow rate, critical closing pressures)
o Autoregulation
o Autonomic nervous system control
o Unique environment of the eye (high extravascular pressure)
o Uveal blood flow: choroid, ciliary body, iris (unique characteristics of each, functions of each)
o Retinal blood flow (unique characteristiscs, dual supply, functions)
Eyelids
o Blink reflexes and protective functions
o Role in production, distribution and drainage of tears
Tears
o Physical characteristics
o Function of tears
o Source and function of each layer of tears
o Basic and reflex tear secretion
Cornea
o Physical characteristics (water content, protein content, cells, resistance to trauma)
o Permeability characteristics of various layers
o Metabolic characteristics of various layers
o Factors influencing cornreal thickness/hydration and theories of transparency
o Physiological parameters, necessary to maintain corneal integrity
o Physiological charcteristics of corneal nerves
o Ageing changes of the cornea

Intraocular pressure
o Mean values and diurnal variation
o Association to corneal thickness
o Factors controlling aqueouss production and outflow
o Nervous system regulation of IOP
o Systemic factors influencing IOP
Aqueous
o Function of aqueous
o Physical characteristics
o Formation (ultrafiltration, active transport)
o Factors influencing rate of flow
o Composition
o Blood aqueous barriers location, ultrastructure, function)
Lacrimal apparatus
o Regulation of basic and reflex tear secretion
Pupillary pathways
o Sympathetic and parasympathetic pathway to iris
o Functional relationship between pupillary pathways and central nervous system
Lens
o Function and physical characteristics
o Metabolism
o Lens proteins
o Theories of transparency
o Regeneration
o Ageing changes in composition
Choroid
o Functions
o Physiological relationships with retina
Vitreous
o Function and physical characteristics
o Metabolism
o Ageing changes in composition
Clinical microbiology:
General immunology
• Antigens and antibodies
• Non-specific immunity
• Specific immunity
• Hypersensitivity responses
• Autoimmunity
• Normal flora and it´s disorders
• Vaccinations
Virology
o Structure and morphology
o Classification
o Viral diseases
o Immunity
o Laboratory diagnosis
Bacteriology
o Structure and morphology
o Gram staining
o Anaerobic and aerobic bacteria
o Physiological processes of bacterial growth
o Bacterial diseases
o Pathological mechanisms of bacterial infection
o Immunity
o Laboratory diagnosis
Mucology
o Biology of fungi
o Mycotic diseases
o Laboratory diagnosis
Parasitology
o Acanthamebia
o Toxoplasma
o Onchocercus
o Toxicariasis
o Phtiriasis
Eye examination techniques:
-Direct ophthalmoscopy
structure, (illumination and viewing systems, apertures, filtters), methods, recommend clinical prosedure and use, field of view and magnification, optimal periphery examination, normal fundus appearance
-slit lamp microscopy:
structure, (illumination and viewing systems, apertures, filtters), methods, recommend clinical prosedure and use -Keratometry and topography:
structure and principal, image formation, measurements, astigmatism; amount and position, normal cornea features, principal of topography, measurement and different maps, normal cornea appearance and variations, including eccentricity
-Pupil reactions: methods, recording, normal values and functioning, factors affecting pupil size, Horner syndrome, Adie, III cranial nerve paresis, physiological anisocoria
-Intra ocular pressure, measurement, non-contact tonometers, air pressure and rebound tonometer: structure, methods, recommend clinical prosedure and use, normal values
-Cornea thickness measurements with non contact methods: structure, methods, recommend clinical prosedure and use, normal values

Location and time

Autumn semester 2024.

INVESTIGATIVE TECHNIQUES: The practical exercises included in the study course are done in a controlled schedule and order in the campus training facilities. Tasks and exercises cannot be done under the supervision of working life.

Materials

The tasks and materials prepared by the teacher are covered by copyright law (Tekijänoikeuslaki 404/61), which guarantees the ownership of these materials to the teacher. Tasks and MATERIALS are not permitted to be used for purposes other than for individual studying. Dissemination of these materials is only allowed with the permission given by the teacher.

CLINICAL MICROBIOLOGY:
Clinical microbiology: material in Moodle
Oppiportti: Mikrobiologia, Immunologia, Infektiosairaudet
Karhumäki, E., Jonsson, A. & Saros, M.: Mikrobit hoitotyön haasteena, Edita, 2016


ANATOMY AND PHYSIOLOGY OF THE EYE:
- Lecture handouts
- Saari KM ym: Silmätautioppi. Kandidaattikustannus (selected parts)

INVESTIGATIVE TECHNIQUES:
- Investigative Techniques and Ocular Examination toim. Doshi S. and Harvey W. 2003. Chapters 4. Principles of the slit-lamp biomicroscope, Chapter 5. Clinical use of the slit-lamp biomicroscope, Chapter 7 Examination of intraocular pressure, Chapter 9 Exmination of the fundus (as applicable).
- Johnson&Johnson Vision: https://www.jnjvisioncare.co.uk/slit-lamp-techniques/slit-lamp-overview

Teaching methods

Lectures
Guided practicals and assignments
Written assignments x 2

Exam schedules

Eye anatomy and physiology exam 2.12.2024
retakes:
1. retake: EXAM-exam is open between 7.-19.1.2025 (registration starts 13.12.2024)
2. retake: EXAM-exam is open between 17.2.-2.3.2025 registration starts 26.1.2025)

Investigative techniques, written exam 17.12.2024
Retakes will be done in the EXAM-system, timing to be announced.

International connections

N/A

Student workload

2 op Clinical microbiology theory 20h, written assignment and independent work 34h.
0,5 op Communication: bibliography references 4h, written assignment 10h.
3 op Ocular anatomy and physiology: theory 24h and 1,5h written examination, and independent work 54h.
1,5 op Investigative techniques: theory 15h + 2h written examination, and independent work 23h.
1 op Integrated written assignment: Ocular anatomy and physiology/ Investigative Techniques: 27h.
2 op Investigative techniques practicals (including independent practicals): 9 x 3= 27h,independent work 27h.

Further information

Instructions on the use of artificial intelligence during the course are given separately. Students should familiarise themselves with Metropolia's AI guidelines and follow them in their study attainments.

Evaluation scale

0-5

Assessment criteria, satisfactory (1)

The student is able to:
- display learning in core content
- use individual professional concepts correctly
- find information for a specific situation
- distinguish between non-theoretical and theoretical information
- act in individual professional situations as instructed - display learning in his professional field
- show that he has achieved the targets for core competence
- follow safety instructions
- display learning in the ethical principles of his professional field
- operate as a member of a student group

Assessment criteria, good (3)

The student is able to:
- display an understanding of concepts and professional knowledge in the field
- assess and limit the amount of information needed
- operate well in typical professional duties and contexts
- operate in a multicultural environment
- operate safely
- act according to professional ethics
- operate in a student group

Assessment criteria, excellent (5)

The student is able to:
- use concepts and knowledge in his field systematically
- assess and use various information sources
- apply professional information in professional assignments
- work in various duties in a variety of operating environments
- act independently and responsibly in professional contexts
- to take safety issues into consideration in his action
- argue his choices on the basis of professional ethics
- organise the activities of a group of students

Assessment criteria, approved/failed

The student is able to:
- display learning in core content
- use individual professional concepts correctly
- find information for a specific situation
- distinguish between non-theoretical and theoretical information
- act in individual professional situations as instructed - display learning in his professional field
- show that he has achieved the targets for core competence
- follow safety instructions
- display learning in the ethical principles of his professional field
- operate as a member of a student group

Assessment methods and criteria

2,5 ECTS Clinical microbiology written assignment (including literature reference): 1-5, 30% of total grade.
3 ECTS Anatomy and physiology of the eye, written examination: 1-5, 40% of total grade.
1,5 ECTS Examination techniques, written examination: 1-5, 30% of total grade.
1 ECTS Written assignment of Anatomy and physiology of the eye and Investigative techniques: pass/rewrite.
2 ECTS Clinical practicals, including independent practicals: pass/rewrite. All work sheets must be returned at the end of the period and approved by the lecturers. Pass/redo.

Qualifications

General Anatomy and Physiology

Objective

Knowledge base
Students are able to

• describe anatomy and physiology of the eye with in detail and describe the developement of the eye in the area of: (1) orbit, (2) extraocular muscles (basics), (3) ocular blood supply, (4) ocular and orbital nerves, (5) eyelid, (6) eyebrow, (7) conjunctiva, (8) lacrimal system, (9) cornea, (10) sclera and episclera, (11) anterior chamber and angle, (12) iris, (13) pupil and posterior chamber, (14) ciliary body, (15) lens and zonules, (16) choroid, (17) vitreous, (18) retina (basics) (19) optic nerve, and (20) visual pathways (basics).

• describe the basic features of microbiology and immunology in the area of (1) virology, (2) bacteriology, (3) mycology, (4) parasitology, (5) antigens and antibodies, (6) complement system, (7) non-specific immunity, (8) specific immunity, (9) hypersensitivity response, and (10) autoimmunity (11) vaccinations

• describe the basic features of the eye examination equipments, methods of examinations techniques, use of them when exam the healthy structure of the eye and recognize the abnormal signs of the eye. (1) slit lamp microscopy, (2) direct ophthalmoscopy, (3) pupil reactions tests, (4) keratometry, (5) topography, (6) non- contact tonometry (air pressure) and rebound tonometry

Clinical/practical
Students are able to (basic)
• assess anterior parts of the eyes with slit lamp using the basic illumination techniques
• assess fundus with direct ophthalmoscopy
• measure keratometry values and topography
• measure intra ocular pressure
• assess pupil reactions
• measure thickness of the cornea without anesthesia
• concerning measurements above; make the records and identify the normal values

Content

Anatomy of the eye:
Orbit
o Location of bones and openings
o Anatomical relationships among orbital structures (extraocular muscles, nerves, blood vessels, fat compartments, fascia)
Extraocular muscles
o Names, origins, insertions
o Innervation, blood supply
Ocular blood supply
o Branches of internal and external carotid arteries related to the orbit, eyelid and upper face
o Branches of the internal and external jugular veins
o Dural sinuses
Ocular and orbital nerves
o Intracranial and extracranial course, branches and functions of cranial nerve I, III, IV, V, VI, VII
o Parasympathetic and sympathetic nerves (coursse, branches, tissue innervated)
Eyelid
o Structures of the layers, muscles and glands
o Blood supply and drainage, lymphatic drainage
o Innervation
Eyebrow (structure and function)
Conjunctiva
o Structures of the layers, cell types and glands
o Blood supply and drainage, lymphatic drainage
o Innervation
o Composition of plica semilunaris and caruncle
o Relationship with adjacent structures
Lacrimal system
o Lacrimal gland (structure, innervation, blood supply)
o Accessory lacrimal glands (location, function)
o Composition and structure of the tear film
o Drainage of tears
o Location of lacrimal fossa and nasolacrimal canal
Cornea
• Normal dimensions
• Temperature
• Composition and ultrastructure of epithelium, Bowmans’s membrane, stroma, Descemet’s membrane and endothelium
• Innervation
• Wound healing and regeneration
Sclera
o Dimensions and colour
o Relationship to adjacent structures
o Composition of layers
o Location and content emissaria
o Structure of lamina cribrosa
Anterior chamber and angle
o Shape and dimensions
o Composition of ultrastructure of the trabecular meshwork, juxtacanalicular tissue, Schlemm’s canal, the scleral spur and Schwalbe’s ring
Iris
o Dimensions, zones and coloration
o Composition and ultrastructure of anterior border, anterior epithelium, stroma and posterior epithelium
o Composition and ultrastructure of sphincter an dilatator muscles
o Blood supply, venous drainage
o Innervation
Pupil and posterior chamber
o Locations and dimensions
Ciliary body
o Dimensions and relationship to adjacent structures
o Locations and components of pars plana and pars plicata
o Ultrastructure of the epithelium and stroma and the ciliary muscle
o Blood supply, venous drainage
o Innervation
Lens and zonules
o Ultrastructure and composition of capsule, epithelium and cortex
o Location of nuclei and sutures
Choroid
o Extent and thickness
o Ultrastructure of choriocapillaris
o Composition of stroma
o Blood supply, venous drainage
o Innervation
o Location and composition of Bruch’s membrane
Vitreous
o Composition, ultrastructure, volume and shape
o Attachments to retina and lens (ultrastructure)
o Locations of patellar fossa, anterior and posterior hyaloids
o Location and origin of hyaloid canal
Retina
o Components and ultrastructure of each layer
o Relationship between retinal pigment epithelium and Bruch’s membrane and photoreceptor outer segments
o Synaptic connections within retina
• Location, names and function of glial cells
o Blood supply, venous drainage
o Location, size and ultrastructure of areea centralis, parafovea, fovea, foveola, macula lutea, ora serrata
Optic nerve
o Composition and blood supply of the prelaminar, laminar and retrolaminar portion
o Location of central retinal artery and vein
o Normal surface and optic disc/cup features
Visual pathway
o Localisation of retinal fibres along visual pathway, optic nerve, chiasm, optic tract, lateral geniculate body, optic radiations, cisual cortex
o Layers of lateral geniculate body
o Layers of visual cortex, areas
o Blood supply
Developement of the ocular and visual pathway:
Orbit, extraocular muscles, eyelid, conjunctiva, lacrimal system, cornea, sclera iris, ciliary body, lens and zonules, choroid, vitreous, retina, optic nerve, and visual pathway
Circulation
o Haemodynamic patterns (resistance, trans mural pressure, flow rate, critical closing pressures)
o Autoregulation
o Autonomic nervous system control
o Unique environment of the eye (high extravascular pressure)
o Uveal blood flow: choroid, ciliary body, iris (unique characteristics of each, functions of each)
o Retinal blood flow (unique characteristiscs, dual supply, functions)
Eyelids
o Blink reflexes and protective functions
o Role in production, distribution and drainage of tears
Tears
o Physical characteristics
o Function of tears
o Source and function of each layer of tears
o Basic and reflex tear secretion
Cornea
o Physical characteristics (water content, protein content, cells, resistance to trauma)
o Permeability characteristics of various layers
o Metabolic characteristics of various layers
o Factors influencing cornreal thickness/hydration and theories of transparency
o Physiological parameters, necessary to maintain corneal integrity
o Physiological charcteristics of corneal nerves
o Ageing changes of the cornea

Intraocular pressure
o Mean values and diurnal variation
o Association to corneal thickness
o Factors controlling aqueouss production and outflow
o Nervous system regulation of IOP
o Systemic factors influencing IOP
Aqueous
o Function of aqueous
o Physical characteristics
o Formation (ultrafiltration, active transport)
o Factors influencing rate of flow
o Composition
o Blood aqueous barriers location, ultrastructure, function)
Lacrimal apparatus
o Regulation of basic and reflex tear secretion
Pupillary pathways
o Sympathetic and parasympathetic pathway to iris
o Functional relationship between pupillary pathways and central nervous system
Lens
o Function and physical characteristics
o Metabolism
o Lens proteins
o Theories of transparency
o Regeneration
o Ageing changes in composition
Choroid
o Functions
o Physiological relationships with retina
Vitreous
o Function and physical characteristics
o Metabolism
o Ageing changes in composition
Clinical microbiology:
General immunology
• Antigens and antibodies
• Non-specific immunity
• Specific immunity
• Hypersensitivity responses
• Autoimmunity
• Normal flora and it´s disorders
• Vaccinations
Virology
o Structure and morphology
o Classification
o Viral diseases
o Immunity
o Laboratory diagnosis
Bacteriology
o Structure and morphology
o Gram staining
o Anaerobic and aerobic bacteria
o Physiological processes of bacterial growth
o Bacterial diseases
o Pathological mechanisms of bacterial infection
o Immunity
o Laboratory diagnosis
Mucology
o Biology of fungi
o Mycotic diseases
o Laboratory diagnosis
Parasitology
o Acanthamebia
o Toxoplasma
o Onchocercus
o Toxicariasis
o Phtiriasis
Eye examination techniques:
-Direct ophthalmoscopy
structure, (illumination and viewing systems, apertures, filtters), methods, recommend clinical prosedure and use, field of view and magnification, optimal periphery examination, normal fundus appearance
-slit lamp microscopy:
structure, (illumination and viewing systems, apertures, filtters), methods, recommend clinical prosedure and use -Keratometry and topography:
structure and principal, image formation, measurements, astigmatism; amount and position, normal cornea features, principal of topography, measurement and different maps, normal cornea appearance and variations, including eccentricity
-Pupil reactions: methods, recording, normal values and functioning, factors affecting pupil size, Horner syndrome, Adie, III cranial nerve paresis, physiological anisocoria
-Intra ocular pressure, measurement, non-contact tonometers, air pressure and rebound tonometer: structure, methods, recommend clinical prosedure and use, normal values
-Cornea thickness measurements with non contact methods: structure, methods, recommend clinical prosedure and use, normal values

Qualifications

General Anatomy and Physiology