ANATOMI DAN

FISIOLOGI HUMOR
AKUOUS

Olly Congga

Pembimbing:
Dr. dr. Noro Waspodo, Sp.M
dr. A. Tenrisanna Devi, Sp.M(K),
M.Si, MARS
 HUMOR AKUOUS
• Cairan jernih transparan yang mengisi BMD (vol rata-rata 220
µL) dan BMB (vol ± 60 µL) bola mata
• Dihasilkan oleh epitel tidak berpigmen prosessus siliaris →
kecepatan produksi rata-rata 2-3 µL/mnt melalui 3 proses
fisiologis → difusi, ultrafiltrasi & sekresi aktif.
BILIK MATA DEPAN
TRABECULAR
MESHWORK
KANALIS SCHLEMM
 Non
Vacuolate
d state

Early
Oclusion
stage of
of basal
basal
infolding
infolding

Vacuolar
transecell Macrovac
ular uole
channel formation
formation
Saluran Kolektor
KORPUS SILIARIS
Muskulus Siliaris
Vaskularisasi Korpus Siliaris
Epitel Prosesus Siliaris
PRODUKSI HUMOR
AKUOUS
Ultrafiltrasi
Sekresi / Transpor Aktif
Difusi
KOMPOSISI HUMOR AKUOUS
 Komposisi Humor Akuous
• Air 99.9%
• Konsentrasi protein (5-16mg/100ml) humor akuous <
1% dari konsentrasi plasma
• Glukosa – 75% dari konsentrasi plasma.
• Elektrolit:
–Na+  plasma = akuous
–ion bikarbonat:  BMB &  BMD
–Konsentrasi ion Cl  dari plasma & fosfat 
dari plasma
• Konsentrasi asam askorbat sangat tinggi di HA.
Growth Modulatory Factor :
The blood–aqueous barrier
ALIRAN HUMOR AKUOUS
ALIRAN HUMOR AKUOUS
FUNGSI HUMOR AKUOUS
 PENUTUP
HA mrpkn cairan jernih yg berasal dari plasma,
diproduksi o/ korpus siliaris dan mengisi BMD dan
BMB.
HA berperan penting dalam proses fisiologi mata
Drainase HA melalui dua jalur utama, yaitu : jalur
trabekula dan jalur uveoskleral
Kecepatan produksi HA harus seimbang dengan
drainase HA → TIO normal
• ADRENERGIC INNERVATION
• CILIARY EPITHELIUM DOES NOT SHOW NERVE
SUPPLY , BUT VESSELS HAVE NERVE SUPPLY
• MAJORITY OF RECEPTORS IN CILIARY BODY ARE α2
& β2 RECEPTORS
• STIMULATION OF α 2 RECEPTOR LOWER AQUEOUS
HUMOUR PRODUCTION THROUGH INHIBITION OF
ADENYLATE CYCLASE
• STIMULATION OF β 2 RECEPTOR LEADS TO INCREASE
IN PRODUCTION BY STIMULATION OF ADENYLATE
CYCLASE
• α 2 AGONIST LIKE CLONIDINE AND β2 ANTAGONIST
LIKE TIMOLOL DECREASES AQUEOUS PRODUCTION
BETA BLOCKERS
DECREASE IN AQUEOUS PRODUCTION BY BETA
2 RECEPTOR STIMULATION IN CILIARY
PROCESSES
TIMOLOL ,
BETAXOLOL ,
LEVOBUNOLOL
CARTEOLOL
PILOCARPINE → CONTRACTS LONGITUDINAL MUSCLE OF
CILIARY BODY AND OPENS SPACE IN T.M , SO
MECHANICALLY INCREASEING AQUEOUS OUTFLOW

CARBONIC ANHYDRASE INHIBITOR → BY DECREASING

AQUEOUS SECRETION → DORZOLAMIDE

PROSTAGLANDINS → ACT BY INCREASING UVEO SCLERAL

OUTFLOW OF AQUEOUS

ADRENERGIC DRUGS → SELECTIVE ALPHA 2 ADRENERGIC

AGONIST BY DECREASING AQUEOUS PRODUCTION →
APRACLONIDINE, BRIMONIDINE
• Transport across Blood-Aqueous Barrier

–Active secretion is a major contributor to aqueous

humor formation.
–Selective transcellular movement of certain cations,
anions, and other substances across the blood-aqueous barrier
formed by the tight junctions between the nonpigmented
epithelium.
–Aqueous humor secretion is mediated by transferring
NaCl from ciliary body stroma to PC with water passively
following.
 –Carbonic anhydrase mediates the transport of
bicarbonate across the ciliary epithelium through a rapid
interconversion between HCO-3 and CO2.
–Other transported substances include ascorbic acid,
which is secreted against a large concentration gradient by the
sodium-dependent vitamin C transporter 2.

• Osmotic Flow
–The osmotic gradient across ciliary epithelium, results
from active transport
–It favors the movement of other plasma constituents by
ultrafiltration and diffusion.
The biomechanical pump model. Powered by transient increases in IOP, caused by
cardiac cycle, blinking & eye movements. As pressure increases, fluid is forced into
one-way collector valves (C) that span across Schlemm’s canal. At the same time, the
increase in IOP pushes the endothelium of the inner wall of Schlemm’s canal (A, B)
outward and forces aqueous in the canal to move circumferentially into collector
channels and aqueous veins. As the pressure drops, the tissues rebound, causing a
pressure drop inside Schlemm’s canal, moving fluid from the one-way valves (C) into
the canal.
Factors influencing IOP
a) Local factors
b) General factors
Local factors
1. Rate of aqueous formation
2. Resistance to aqueous outflow
3. Increased episcleral venous pressure
4. Dilation of pupil
General factors
1. Hereditary

2. Age

3. Sex

4. Diurnal variation

5. Postural variation

6. Seasonal variation

7. Blood pressure

8. Osmotic pressure of blood

9. Effects of Drugs

10. Effects of general anesthesia

11. Systemic hyperthermia

12. Refractive error

13. Mechanical pressure on globe

 • IOP increases with age.
• Studies indicate that children have
lower pressures than the rest of the
normal population,
• But tonometric measurements may be
influenced by the level of cooperation
of the child, tonometer used, use of
general anesthesia or a hypnotic
agent.
• There may be a positive independent
Age correlation between IOP and age &
may be related to reduced facility of
aqueous outflow & decreased aqueous
production.
• Gender
–IOP is equal between the sexes in ages 20 to 40 years.
–In older age groups, the apparent increase in mean IOP with age
is more in women.

• Refractive Error
– A positive correlation between IOP and both axial length of the
globe and increasing degrees of myopia
–Myopes also have a higher incidence of COAG

Blacks have been reported to have slightly higher pressures

Ethnicity than whites.
 FACTORS EXERTING SHORT-TERM
INFLUENCE ON IOP
• Diurnal

• Postural Variation

• Exertional Influences

• Lid and Eye Movement

• Intraocular Conditions

• Systemic Conditions

• Environmental Conditions

• General Anesthesia

• Foods and Drugs

 Diurnal Variation
• IOP shows cyclic fluctuations throughout the day.
• Ranges from approximately 3 mm Hg to 6 mm Hg.
• Higher lOP is associated with greater fluctuation, and a
diurnal fluctuation of greater than 10 mm Hg is
suggestive of glaucoma.
• The peak IOP is in the morning hours
• Primary clinical value of measuring diurnal IOP variation
is to avoid the risk of missing a pressure elevation with
single readings.
Postural Variation
• The IOP increases when changing from the sitting to the
supine position, average pressure differences of 0.3 to 6.0
mm Hg.
• The postural influence on IOP is greater in eyes with
glaucoma and persists even after a successful
trabeculectomy.
• Patients with systemic hypertension have greater IOP
increase after 15 minutes in supine
 Exertional Influences
• Exertion may lead to either a lowering or an elevation of the IOP,
depending on the nature of the activity.

• Prolonged exercise, such as running or bicycling, has been reported

to lower the IOP.

• The magnitude of this pressure response is greater in glaucoma

patients than in normal individuals.

• Straining, as associated with the Valsalva maneuver, electroshock

therapy, or playing a wind instrument, has been reported to elevate
the IOP.

• May be due to elevated episcleral venous pressure and increased

orbicularis tone.
Lid and Eye Movement
• Blinking has been shown to rise the IOP 10 mm Hg,
while hard lid squeezing may raise it as high as 90 mm
Hg.
• Contraction of extraocular muscles also influences the
IOP.
• There is an increase in IOP on up-gaze in normal
individuals, which is augmented by Graves' infiltrative
ophthalmopathy.
Intraocular Conditions

• Elevated IOP is with associated glaucoma

• IOP may be reduced in Anterior uveitis,
Rhegmatogenous retinal detachment
Systemic Conditions
• Positive correlation between systemic hypertension,

• Systemic hyperthermia has been shown to cause an increased IOP.

• IOP may increase in response to ACTH, glucocorticoids, and growth hormone and it
may decrease in response to progesterone, estrogen, chorionic gonadotropin, and
relaxin.

• It is significantly reduced during pregnancy, may be due excess progesterone.

• IOP is lower in hyperthyroidism and higher in hypothyroidism.

• In myotonic dystrophy, the IOP is very low, which may be due to reduced aqueous
production & increased outflow.

• Diabetic patients have higher pressures than the general population, while a fall in IOP
is seen during acute hypoglycemia.

• Patients with HIV have lower than normal mean IOPs

• Environmental Conditions
–Exposure to cold air reduces IOP, apparently because episcleral venous
pressure is decreased. Reduced gravity causes a sudden, marked increase in IOP.

• General Anesthesia
–General anesthesia reduces the IOP,
–Exceptions are trichloroethylene and ketamine which elevate the ocular
pressure.
–In infants and children GA can mask a pathologic pressure elevation.
–Hypnotics that are used to produce unconsciousness, such as 4-
hydroxybutyrate and barbiturates and tranquilizers reduce the IOP
–Depolarizing muscle relaxants, such as succinylcholine and
suxamethonium cause a transient increase in IOP, possibly due to a combination
of extraocular muscle contraction and intraocular vasodilation.
–Tracheal intubation may also cause an IOP rise.
–Elevated pCO2causes an increase in IOP, whereas reduced pCO2 or
increased concentration of O2 is associated with an IOP reduction.
Foods and Drugs
• Alcohol has been shown to lower the IOP, more so in
patients with glaucoma.
• Caffeine may cause a slight, transient rise in IOP.
• A fat-free diet has been shown to reduce IOP, which may be related
to a concomitant reduction in plasma prostaglandin levels.
• Tobacco smoking may cause a transient rise in the IOP, and smokers
have higher mean IOPs than nonsmokers
• Heroin and marijuana lower the IOP, while LSD(lysergic acid
diethylamide) causes an IOP elevation.
• Corticosteroids may also cause IOP elevation.