ANATOMY OF ANGLE OF

ANTERIOR CHAMBER
• Bounded anteriorly –back of cornea
• Posteriorly-ant.surface of iris &part of ciliary
body
 IMPORTANCE OF ANGLE OF ANTERIOR CHAMBER:
• For classification of glaucoma
• To note the extent of
neovascularization
• To assess angle recession
• History or evidence of
inflammation
• For evidence of neoplastic
activity
• Degenerative or developmental
anomaly
• For planning of treatment – iris
neovascularization and laser
procedure.
• Most anterior structure

• Signifies termination of descements membrane

• Lie in plane of posterior corneal surface

• Transition between corneal endothelium and

trabecular cells

• Appear as fine scalloped line(ring) in gonioscopy

 Clinical importance

• Mid limbal incision during cataract surgery

corresponds to schwalbes line
• In 15-20% of normal individuals appear as
hypertrophied glistening ridge-posterior
embryotoxon
 TRABECULUM
 Anterior to scleral spur

 Extends from schwalbe line to Scleral spur.

 600 micron width.

 Anterior non functional part adjacent to schwalbe line-whitish.

 Posterior functional pigmented part –grayish blue translucent

appearance.
• It is a sieve like structure
made up of connective
tissue lined by
trabeculocytes, which have
contractile and phagocytic
properties.
• Its main function is in
drainage of aqueous
humour.
• The meshwork is roughly triangular in cross section;
• Apex is at the Schwalbe’s line
• Base is formed by the scleral spur and ciliary body.
 SCELARAL SPUR
• Wedged shaped circular ridge

• marks the deep aspect of sclero-

limbal junction

• It contains mechanoceptors.

• Gonioscopically  narrow, dense,

shiny, white band.
• Attachments :
– Anteriorly  longitudinal
ciliary muscles
– Posteriorly  corneo-scleral
meshwork
• Contraction of longitudinal
ciliary muscle opens up
trabecular spaces.
• Scleral spur prevents ciliary muscle
from causing Schlemm’s canal to
collapse.
• Individual scleral spur cells are
innervated by unmyelinated
axons.
• Varicose axons characteristic of
mechano-receptor nerve measure
stress in the scleral spur due to ciliary
muscle contraction or changes in IOP.
Clinical implications
Miotic Drugs

Contraction of ciliary muscles

pulls the spur posteriorly

Opening of trabecular space

Increased drainage
• In laser trabeculoplasty - important to know
scleral spur
• If lasers are applied posterior to it - increased
reaction in anterior chamber - acute post
laser rise in IOP.
 CILIARY BODY BAND
• Posterior-most landmark

• Formed by anterior part of

ciliary body between scleral
spur and root of iris.

• Width depends on the level

of iris insertion
– Narrow in hyperopics
– Wide in myopia &
aphakia, and in angle
recession and
cyclodialysis
• Ciliary band
appears as a
grey/dark brown
band.
• It consists of longitudinal
fibres.
• The contraction of
longitudinal muscle, opens
the trabecular meshwork
and schlemm’s canal.
• Torch light examination
• SLE by Van-herricks technique
• Gonioscopy
• Ultrasound biomicroscopy
• Anterior segment OCT
 PEN TORCH EXAMINATION
• Depth of anterior chamber can be evaluated by focusing a beam of light
on the temporal limbus, parallel to the surface of iris.
• In normal or deep AC the beam will pass through directly, illuminating the
opposite limbus.
• In shallow AC, the anterior placement of or bowing forward of the iris
obstruct the light and shadow is observed on the medial half of iris.
 VAN HERRICKS GRADING
• Optical section

• 60° between observation and illumination

• Full slit length

• Magnification approximately x 15

• Low to medium illumination

• It is a slit lamp estimation of angle
• To perform this test, slit lamp is made very bright and
thin. It is offset 600 temporally to the slit lamp
oculars. The temporal sclera is illuminated and the
slit lamp beam is brought slowly towards the cornea
until the anterior chamber is first identified. The
thickness of the cornea is compared to the depth of
the peripheral anterior chamber
• At, present, this test is most widely adopted
method for evaluating the ACA in
community optometric practice.
Corneal thickness: Chamber depth
GRADING
 GONIOSCOPY
• Gonioscopy is an essential diagnostic tool and
examination technique used to visualize the
structures of the anterior chamber angle.
• All gonioscopy lenses eliminate the tear-air
interface by placing a plastic or glass surface
adjacent to the front of the eye.
• Methods of gonioscopy:
1) Direct
2) Indirect
GONIOSCOPY
1.Scheie Classification (1957)
• Oldest system based on visible posterior angle structure
• Higher the grade, narrower the angle

2.Shaffer’s System (1960)

Widely used based on angulation between posterior cornea
and iris root
• Higher the grade, wider the angle

3.Spaeth System
• Newest system
• Complex 3D evaluation
SCHEIE CLASSIFICATION
SHAFFER GRADING
SPEATH SYSTEM
 ULTRASOUND BIOMICROSCOPY
• UBM is a close contact (non-invasive) immersion
technique.
• UBM is performed with the patient supine,
positioning that theoretically causes the iris
diaphragm to fall back. This deepens the anterior
chamber and opens the angle.
• With UBM, only 1 quadrant can be imaged at a time.
• There is a risk of infection or corneal abrasion due
to the contact nature of the examination.
 ANTERIOR CHAMBER OCT
• Anterior Chamber Optical Coherence
Tomography can be used to assess and
document :

– AC Depth

– AC Internal Diameter

– AC Angle Width
• OCT is a non contact, non invasive light based
imaging modality.
• Provides image resolution higher than that of
UBM of anterior segment in cross section with
AS-OCT, 4 quadrants can be scanned at
once(multiple cross- sectional image of the
anterior chamber angle)
• The working principle of OCT is similar to
ultrasound which uses echoes to locate
structures within the body.
AQUEOUS DRAINAGE SYSTEM
• Trabecular meshwork
• Schlemms canal
• Collector channels
• Aqueous veins
• Episcleral veins
 TRABECULAR MESHWORK
Seive like structure through which aqueous
humour leaves
Bridges scleral sulcus & converts it into a tube
which accomodates schlemms canal
 Composition
• Hyaluronic acid-GAG
• Other GAGs-chondroitin,heparin,dermatan &
keratan sulphates
• Fibronectin,elastin,laminin,collagen & smooth
muscle myosin containing cells
• Fibronectin secretion-doubles after treatment
with dexamethasone
• GAG & glycoprotein composition-not constant
• Advancing age –change in composition –
pathogenesis of POAG
 MICROSCOPIC STRUCTURE
It is morphologically and
functionally divided into 3
types :
• Uveal meshwork
• Corneoscleral meshwork
• Juxtacanalicular tissue/meshwork
 1. UVEAL MESHWORK:
• Innermost part of TM
• It comprises of trabecular bands, which
have a central core that mainly consists of
collagenous fibers distributed with a few
elastic fibers, and is lined by trabecular
endothelial cells resting on a thick
basement membrane
• The trabecular bands run mostly in radial
fashion
• Trabecular apertures size is 25-75
micrometer.
• The trabeculocytes usually contain
pigment granules.
 2. THE CORNEOSCLERAL MESHWORK:
• Consists of a series of thin, flat, perforated
connective tissue sheets arranged in a laminar
pattern

• The central core consists of collagenous and

elastic fibres
• Each trabecular beam is covered by a
monolayer of trabecular endothelial cells,
supported by basement membrane.

• The pore size is smaller than the uveal

meshwork (5-50micro metre)
Ultrastructure of Meshwork:
 3. Cortical zone also called as glassy membrane
4. An outer endothelial layer provides a continuous
covering over the trabeculae.
 TRABECULAR ENDOTHELIAL CELLS
• Larger, more irregular and have less prominent borders
than corneal endothelium.
• Joined by gap junction and desmosomes, which provide
stability.
• 2 types of microfilaments:
1. Actin filaments : cell periphery, around nucleus,
cytoplasmic processes.
• Cell contraction, phagocytosis, pinocytosis and cell
adhesions. Regulating the shape and cytoskeletal
organization
• 2. Intermediate
filaments:
Numerous,
composed of vimentin
and desmin.
Imparts the contractile
and motility functions
 3. JUXTACANALICULAR MESHWORK
• Also known as cribriform meshwork
• The outermost part of TM
• Lies adjacent to the inner wall of
Schlemm’s canal

• It consists of a lose network of fine

fibrils, elastic like fibres and
elongated fibroblasts life cells and
ground substance full of
glycosaminoglycans and glycoproteins

• The spaces between cells

are upto 10micrometre.
• Mainly offers the normal resistance to
aqueous outflow
• Connects corneoscleral meshworkwith
schlemms canal
• Outer endothelial layer of JCM comprises
inner wall of schlemms canal
• Inner endothelial layer of JCM become
continous with endothelium of corneoscleral
meshwork
 SCHLEMMS CANAL
• Schlemm’s canal is a circular lymphatic
like vessel in the eye that collects
aqueous humour from the anterior
chamber and delivers it into the
episcleral blood vessels via aqueous
veins.
• Schlemm’s canal is often divided into
different parts by bridges or septa. The
septa cross the lumen of the canal
mostly in an oblique direction. They are
often fixed to the outer wall of the canal
at places where the collector channels
begin.
• The structure of the outer wall of
schlemm’s canal differs very much
from that of the inner wall.
INNER WALL OF SCHLEMM’S CANAL
• The endothelial lining of the
canal consists of a complete
monolayer of flat endothelial
cells that do not rest on a
complete basement membrane.
• The subendothelial cell layer is
not complete and consists of
elongated, star like cells oriented
predominantly in a radial
anteroposterior direction
• The lateral walls of the
endothelial cells are joined by
tight junctions
• Micropinocytotic vesicles are present at the apical and
basal surfaces of the cells
• Some “vacuoles’’ have openings on the inner and
outer sides, thus forming transcellular
microchannels.
 OUTER WALL OF SCHLEMM’S CANAL
• The endothelial lining is
single- layered, with a well
developed basement
membrane
• The cells do not possess
transcellular
microchannels.
• The adjacent stroma consists
of collagenous and elastic
like fibers intermingled with
fibroblasts.
 COLLECTOR CHANNELS
• Intrascleral aqueous vessels
• 25-35 in no.
• Leave schlemms canal at oblique angles
• Terminate in episcleral veins
• No valves
 COLLECTOR CHANNELS
• Schlemm’s canal is
connected to episcleral and
conjunctival veins by a
complex system of
intrascleral channels.
• Two systems of intrascleral
channels have been
identified:
(a) Indirect system
(b) Direct system
 INDIRECT SYSTEM
• Indirect system consists of 15- 20, finer
channels, which form an intrascleral plexus
before eventually draining into the episcleral
venous system
 DIRECT SYSTEM
• Direct system consists of
large caliber vessels, which
run a short intrascleral
course and drain directly
into the episcleral venous
system, they are about
6-8 in number and also
called as aqueous veins.
• These aqueous vessels
terminate into the episcleral
and conjunctival veins in
laminated junction- it is
called LAMINATED VEIN OF
GOLDMANN
 EPISCLERAL VEINS

Aqueous vessels

Episcleral veins

Cavernous sinus
 Innervation of aqueous outflow
system
• Parasympathetic & adrenergic autonomic
fibres & sensoryfibres
• Myelinated &nonmyelinated n.fibres
demonstrated intrabecular meshwork &
schlemms canal
Nerve endings with mechanoreceptors
in scleral spur
• Proprioceptive tendon organs for ciliary
muscle fibre inserted on scleral spur
• Contraction of myofibroblastic scleral spur cell
• Perform a baroreceptor function in response
to changes in IOP