ANATOMY OF

ANTERIOR
CHAMBER
FORMATION AND
DRAINAGE OF
AQUEOUS HUMOR
PRESENTER- DR. VAISHALI BANSAL (JR1)
MODERATOR- DR.(PROF.) LUXMI SINGH
ANATOMY OF ANTERIOR
CHAMBER
• It is the part of Anterior Segment of
eyeball.
The Anterior Segment of eyeball
includes-
• Cornea
• Anterior chamber (filled with aqueous
humor)
• Iris
• Posterior chamber (filled with aqueous
humor)
• Crystalline lens (which is suspended
from the ciliary body by zonules)
 ANTERIOR CHAMBER
• It is a triangular space.
• Anteriorly- bounded by the back of
cornea
• Posteriorly- bounded by anterior
surface of iris and part of ciliary
body.
• It communicates with posterior
chamber through the pupil.
• Depth- It is about 2.5 mm deep in
the centre in normal adults.
Chamber depth decreases by
0.01mm/year of life.
• Diameter- 11.3 to 12.4mm
• Volume- Contains about 0.25 mL of
the aqueous humor.
Chamber volume decreases by 0.11
microliter/year.
• Angle of anterior chamber- Formed
by-
Root of iris
Anterior-most part of ciliary body
Scleral spur
Trabecular meshwork
Schwalbe's line (prominent end of
Descemet's membrane of cornea)
 Shallow anterior chamber is seen in-
a. Chamber depth is slightly diminished
during accommodation due to-
• Increased lens curvature
• Forward translocation of lens
b. Children
c. Older people
d. Hypermetropes
e. Narrow angle Glaucoma
f. Pupillary block
g. Corneal perforation
h. Adherent leucoma
Deep Anterior Chamber is seen in-
1. Myopia- Deepens by 0.06mm for
each dioptre of Myopia.
2. Pseudophakia
3. Aphakia
4. Keratoconus
5. Keratoglobus
6. Megacornea
7. Buphthalmos
8. Total posterior synechiae

POST-OP HYPERDEEP AC
ANGLE OF ANTERIOR CHAMBER

• Formed by-
Root of iris
Anterior-most part of ciliary body
Scleral spur
Trabecular meshwork
Schwalbe's line (prominent end of
Descemet's membrane of cornea)
• Plays an important role in the process of
aqueous drainage.
• The angle width varies in dfferent
individuals and plays a vital role in
pathomechanism of different types of
Wide angle of anterior chamber-
• Angle between iris and surface of the
trabecular meshwork is between 20 to
45 degrees.

Narrow angle of anterior chamber-

• Angle between iris and surface of the
trabecular meshwork is less than 20
degrees.
SHAFFER’S SYSTEM OF GRADING THE ANGLE WIDTH

SL= Schwalbe's line,

TM= Trabecular meshwork,
SS = Scleral spur
CBB = Ciliary body band
 GONIOSCOPIC VIEW CONFIGURATION OF ANGLE IN
CROSS SECTION OF ANTERIOR
CHAMBER
SL= Schwalbe's line
TM= Trabecular meshwork
SS = Scleral spur
CBB = Ciliary body band
ROI- Root of Iris
STRUCTURES IN THE ANGLE OF
ANTERIOR CHAMBER-

1. SCLERAL SPUR-
• Wedge shaped circular ridge.
• Composed of a ring of collagen
fibers that run parallel to the limbus.
• Projects slightly into the anterior
chamber.
• White to yellowish in most eyes.
• Lies posterior to trabecular
meshwork.
• Gives attachment anteriorly to
cornealscleral network and
posteriorly to ciliary muscle.
2. TRABECULAR MESHWORK-
• Located between the scleral
spur and Schwalbe’s line.
• Circular sponge work of
connective tissue lined by
trabeculocytes.
• Function- It behaves as a sieve-
like structure through which
aqueous humor leaves the eye.
• It consists of three layers, which
from inside out are-
Uveal meshwork
Corneoscleral meshwork
Juxtacanalicular meshwork
a) Uveal meshwork-
• Innermost part of trabecular meshwork.
• Extends from the iris root and ciliary body to the Schwalbe's
line.
• The arrangement of uveal trabecular bands create openings of
about 25µ to 75µ.
b) Corneoscleral meshwork-
• It forms the larger middle portion
• Extends from the scleral spur to the lateral wall of the scleral
sulcus.
• It consists of sheets of trabeculae that are perforated by
elliptical openings which are smaller than those in the uveal
meshwork (5µ-50µ).
c. Juxtacanalicular meshwork-
• Forms the outermost portion of
trabecular meshwork
• Consists of juxtacanalicular
space (filled with ground
substance) and cells.

3. SCHLEMM’S CANAL
• The trabecular meshwork
bridges the scleral sulcus
converting it into a tube, which
is known as Schlemm’s canal.
• Diameter- 190 to 350 μm
• It is a circumferential channel
within the perilimbal sclera.
• The inner wall (trabecular side) is
lined by irregular spindle shaped
endothelial cells containing infoldings
(giant vacuoles).
• The outer wall (scleral side) is
lined by smooth flat cells
contains the openings of collector
channels, which leave the canal at
oblique angles and connect
directly or indirectly with
episcleral veins.
• Septa commonly divide the lumen
into 2–4 channels.
• Function- Collects aqueous and drains
it into the venous system
4. SCHWALBE’S LINE
• When trabecular meshwork inserts
in to the periphery of cornea, a ridge
is created, known as Schwalbe’s line.
• It also marks the prominent end of
Descemet’s membrane of the
cornea.
• Therefore, it is the anterior border
of the trabecular meshwork and the
posterior border of Descemet’s
membrane.
• Width- 50 to 150 μm
• There is also a transition from Sampaolesi’s line
the scleral curvature to the
steeper corneal curvature at
Schwalbe’s line, which can
cause a settling of pigment in
this area.
Pigments along Schwalbe’s
line are known as
Sampaolesi’s line. E.g. in
Pigmentary Glaucoma
• Schwalbe’s line is seen as
glistening white line on
gonioscopy.
5. ROOT OF IRIS-
• Iris is the anterior most part of the
uveal tract.
• At periphery, the iris is attached to
the middle of anterior surface of
the ciliary body.
• It divides the space between the
cornea and lens into anterior and
posterior chambers.
 MACROSCOPIC APPEARANCE-
• Anterior surface of the iris can be divided into a ciliary zone
and a pupillary zone by a zigzag line called collarette.
MICROSCOPIC APPEARANCE-
The iris consists of four layers, which
from anterior to posterior are-
1. Anterior limiting layer
2. Iris stroma
3. Anterior pigment epithelial layer
4. Posterior pigment epithelial layer
6. CILIARY BODY
• Forward continuation of the choroid
at ora serrata.
• Lies behind the iris.
• There are two major muscle groups
in the ciliary body:
Circular muscle fibers-
Responsible for accommodation
• Longitudinal muscle fibers-
Control the outflow of aqueous by
pulling open the trabecular
meshwork and Schlemm’s canal.
• The ciliary body face is the portion of
the ciliary body that borders on the
anterior chamber.
 • Occupying the innermost and
anterior most portion of this
structure, in a region called pars
plicata, are the ciliary processes.
• The ciliary processes are the sites of
aqueous humor production.
FUNCTIONS-
Manufacture of aqueous humor
Control of accommodation
Regulation of aqueous outflow
Secretion of hyaluronate into the
vitreous MAC, major arterial circle; ACA, anterior ciliary
Maintenance of a portion of the arteries; LPCA, long posterior ciliary artery; LCM,
longitudinal (fibers) ciliary muscle; CCM, circular
blood-aqueous barrier. (fibers) ciliary muscle; CE, ciliary epithelium
FORMATION AND DRAINAGE
OF AQUEOUS HUMOR

AQUEOUS OUTFLOW SYSTEM

• It includes
The trabecular meshwork
Schlemm's canal
Collector channels
Aqueous veins
Episcleral veins
COLLECTOR CHANNELS-
 Also called intrascleral aqueous vessels.
 About 25-35 in number.
 Leave the Schlemm's canal at oblique
angles to terminate into episcleral veins in
a laminated fashion.
 These intrascleral aqueous vessels can be
divided into two systems
Direct system- lt is formed by the larger
vessels (aqueous veins) which run a
short intrascleral course and terminate
directly into episcleral veins.
Indirect system- lt is formed by the
smaller collector channels which form
an intrascleral plexus before eventually
going into episcleral veins.
COMPOSITION OF AQUEOUS HUMOR

• The aqueous humor is a clear watery fluid filling the anterior chamber
(0.25 mL) and posterior chamber (0.06 mL) of the eyeball.

Constituents of normal aqueous humour are:

Water 99.9% and solids 0.1 %
Proteins (colloid content)- 5-16 mg%
Amino acid constituent- 5 mg/kg water
 Noncolloid constituents in millimoles/kg water are-
 glucose (6.0)
 urea (7)
 ascorbate (0.9)
 lactic acid (7.4)
 inositol (0.1)
 Na (144), K (4.5), Cl (10), and HCO3 (34)
 Oxygen is present in the aqueous humour in dissolved state

Aqueous humour: anterior chamber versus posterior

chamber
HCO3 - Posterior chamber aqueous>Anterior chamber aqueous
Clconcentration- Posterior chamber<Anterior chamber.
Ascorbate concentration- Posterior aqueous>Anterior chamber
aqueous.
FORMATION OF AQUEOUS
HUMOR

• Aqueous humor is derived from

plasma within the capillary network of
ciliary processes.
70%
• The normal aqueous production rate is
2.3 µL/min.
• The three mechanisms that play a part
in its production at different levels are-
Active secretion (70%)
Ultrafiltration (20%)- Passive
process
Diffusion (10%)- Passive process
1. ULTRAFILTRATION-
• Ultrafiltration is the flow of water
and water-soluble substances,
limited by size and charge, across
fenestrated ciliary capillary
endothelia into the ciliary stroma,
in response to an osmotic gradient
or hydrostatic pressure.
• Most of the plasma substances pass
out from the capillary wall and
loose connective tissue.
• Thus, the plasma filtrate (dialysate)
accumulates behind the pigmented
and non pigmented epithelium of
ciliary processes.
2. ACTIVE SECRETION-
• It is subject to the influence of the
sympathetic nervous system, with
opposing actions mediated by-
beta-2 receptors (increased
secretion)
alpha-2 receptors (decreased
secretion).
• First the dialysate from the plasma
is transported into the pigment
epithelium.
• Paired Na+/H+ and Cl-/HCO3-
antiports actively transport Na+
and Cl- from the stroma into the
cells.
• The tight junctions between the cells of the non pigment
epithelium create part of blood aqueous barrier.
• Certain substances are actively transported (secreted) across this
barrier into the posterior chamber.

• Active transport is brought about by-

Na+-K+ activated ATPase pump
Calcium and voltage gated ion channels
Carbonic anhydrase enzyme system
Aquaporins (AQPs)- Molecular water channels which aid with
rapid bulk transport of fluid or transport of fluids against an
insufficient osmotic pressure gap.
• The energy required for the transport is
generated by hydrolysis of ATP to ADP,
which is mediated by Na+-K+ ATPase, an
enzyme located in both the non
pigmented and pigmented ciliary
epithelia.
• Carbonic anhydrase, found in the non-
pigmented and pigmented ciliary
epithelia , mediates the transport of
bicarbonate across the ciliary
epithelium by the reversible hydration
of CO2 to form HCO3- and protons
through the reaction:
CO2 + H2O H2CO3 HCO3- + H+
• Bicarbonate formation influences fluid transport by affecting Na+,
possibly by regulating the pH for optimal active ion transport.
• Chloride ion is the major anion transported across the epithelium
through Cl- channels.
• So the substances that are actively transported are
Sodium
Chlorides
Potassium
Ascorbic acid
Amino acids
Bicarbonates
3. DIFFUSION
• Active transport of the substances across
the non pigmented ciliary epithelium
results in an osmotic gradient leading to
the movement of other plasma
constituents into the posterior chamber
by ultrafiltration and diffusion.
• Sodium is primarily responsible for the
movement of water into the posterior
chamber.
• As the aqueous humor passes from the
posterior chamber to Schlemm's canal,
there occurs sufficient diffusional
exchange with the surrounding structures
(ciliary body, iris, lens, cornea and
trabecular meshwork).
CONTROL OF AQUEOUS FORMATION-
• Vasopressin and adenyl-cyclase- Affect aqueous formation by
influencing active transport of sodium.
• Ultrafiltration and diffusion, the passive mechanisms of aqueous
formation, are dependent on-
the level of blood pressure in the ciliary capillaries
the plasma osmotic pressure
the level of intraocular pressure
DRAINAGE OF AQUEOUS
HUMOR

• Aqueous humor flows from the

posterior chamber into the anterior
chamber through the pupil against
slight physiologic resistance.
• From the anterior chamber, the
aqueous is drained out by two
routes-
Trabecular (conventional)
outflow
Uveoscleral (unconventional)
outflow
A. TRABECULAR (COVENTIONAL)
OUTFLOW

• Main outlet for aqueous from the

anterior chamber.
• Approximately 70-80% of the total
aqueous is drained out via this route.
• Free flow of aqueous occurs from
trabecular meshwork up to
juxtacanalicular tissue which along with
inner wall of Schlemm's canal appears to
provide some resistance to outflow.
MECHANISM OF AQUEOUS
TRANSPORT ACROSS INNER WALL OF
SCHLEMM’S CANAL-

1. Earlier passive filter mechanisms-

• Earlier it was believed that from the
juxtacanalicular space the aqueous
humor enters the Schlemm's canal
against slight resistance.
• Following mechanisms were
postulated which are now
discarded-
a) Leaky pores in endothelial cells
forming the inner wall of
Schlemm's canal.
 b) Contractile microfilaments in the endothelial cells.
c) Sondermann's channels were also suggested to be responsible
for aqueous outflow through the inner wall of Schlemm's canal.
d) Vacuolation theory- According to it, transcellular spaces exist in
the endothelial cells forming inner wall of Schlemm's canal.
These open as a system of vacuoles and pores, primarily in
response to pressure, and transport the aqueous from the
juxtacanalicular connective tissue to Schlemm's canal.

2. Aqueous outflow active pump mechanism-

• Aqueous outflow system acts as a biomechanical pump.
Aqueous outflow pump operates through oscillatory pressure
transients caused by the ocular pulse, blinking and eye
movements.
Trabecular meshwork actively moves outward and recoils back in
response to the oscillatory pressure transients. Thus, trabecular
meshwork flexibility is essential for the aqueous outflow pump
mechanism.
Aqueous valve mechanism-
 Operates at the level of inner wall of Schlemm's canal (SC).
 These valves are oriented circumferentially in SC and their
lumen is continuous with the juxtacanalicular space.
 These valves allow one way passage of aqueous humor from
the juxtacanalicular space to inside the SC and not vice-versa.
3. Working of aqueous outflow
pump system
• Flow of aqueous humor from
juxtacanalicular space to inside the
Schlemm's canal-
Cardiac diastole (IOP decreased)

Inward retraction of trabecular

meshwork

Negative pressure inside the Schlemm's

canal and opening of the aqueous valves

Flow of aqueous inside the SC

• Aqueous humour flow from SC to
collector's channels and episcleral
veins-
Cardiac systole (Rise in IOP)

Distension of trabecular meshwork

Trabecular meshwork forced outward

against SC

Aqueous valves close due to the pressure

push

Aqueous from the SC is pushed through

the collector channels in its outer wall
into the aqueous veins.
• From aqueous veins, the aqueous is pushed into the episcleral
veins by the same mechanism.
The pressure gradient between IOP (16 mm or Hg ) and
episcleral venous pressure (about 10 mm of Hg) also facilitates
this unidirectional pulsatile flow of aqueous humor.
B. UVEOSCLERAL
(UNCONVENTIONAL) OUTFLOW

• Responsible for about 20 to 30% of the

total aqueous outflow.
• The aqueous enters the ciliary body
through the iris root, ciliary body face
and uveal trabecular meshwork.
• Aqueous passes across the ciliary body
between the bundles of ciliary muscles
into the suprachoroidal space.
• It is drained by the venous circulation of
the ciliary body, choroid and sclera.
SUMMARY OF DRAINAGE OF AQUEOUS HUMOR