This presentation describes the unique anatomy and physiology of
the vascular beds that serve the eye. The needs for an unobstructed
light path from the cornea to the retina and a relatively fixed
corneal curvature and distance between refractive structures pose
significant challenges for the vasculature to provide nutrients and
remove metabolic waste. To meet these needs, the ocular vascular
beds are confined to the periphery of the posterior two thirds of
the eye and a surrogate circulation provides a continuous flow of
aqueous humor to nourish the avascular cornea, lens and vitreous
compartment. The production of aqueous humor (and its ease of
egress from the eye) also generates the intraocular pressure (IOP),
which maintains the shape of the eye. However, the IOP also exerts
a compressing force on the ocular blood vessels that is higher than
elsewhere in the body. This is particularly true for the
intraocular veins, which must have a pressure higher than IOP to
remain patent, and so the IOP is the effective venous pressure for
the intraocular vascular beds. Consequently, the ocular circulation
operates at a lower perfusion pressure gradient than elsewhere in
the body and is more at risk for ischemic damage when faced with
low arterial pressure, particularly if IOP is elevated. This risk
and the specialized tissues of the eye give rise to the fascinating
physiology of the ocular circulations. Table of Contents:
Introduction / Anatomy / Blood flow measuring techniques / Ocular
perfusion pressure, IOP and the ocular Starling resistor effect /
Ocular blood flow effects on IOP / Local control of ocular blood
flow / Neural control of ocular blood flow / Summary
General
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