ANATOMY AND PHYSIOLOGY OF THE EYE

Department of Ophthalmology Fatima College of Medicine

ORBIT
BONY CAVITY WHICH HOUSES THE EYEBALL 4 WALLS - ROOF,FLOOR, MEDIAL AND LATERAL WALL 30 mL in volume HAS AN APEX WHERE NERVES AND VESSELS EMERGE

Orbital Walls

ORBITAL WALLS
ROOF
COMPOSED OF THE LESSER WING OF THE SPHENOID, AND ORBITAL PLATE OF THE FRONTAL BONE INTIMATELY RELATED TO THE FRONTAL SINUS

ORBITAL WALLS
LATERAL WALL
SEPARATED FROM THE ROOF BY THE SUPERIOR ORBITAL FISSURE COMPOSED OF THE GREATER WING OF THE SPHENOID, ZYGOMATIC BONE STRONGEST PART OF THE BONY ORBIT

ORBITAL WALLS
FLOOR
SEPARATED FROM THE LATERAL WALL BY THE INFERIOR ORBITAL FISSURE INTIMATELY RELATED TO THE MAXILLARY SINUS COMPOSED OF MAXILLARY BONE, ZYGOMATIC BONE AND PALATINE BONE ORBITAL CONTENTS CAN HERNIATE INTO THE MAXILLARY SINUS IN TRAUMA CASES

ORBITAL WALLS
MEDIAL WALL
INTIMATELY RELATED TO THE ETHMOID AND SPHENOID SINUSES COMPOSED OF THE ETHMOID BONE, SPHENOID BONE, LACRIMAL BONE AND MAXILLA

ORBITAL APEX
SERVES AS A PORTAL FOR NERVES AND VESSELS SITE OF ORIGIN OF ALL EOMS EXCEPT INFERIOR OBLIQUE

Orbital Apex

SUPERIOR ORBITAL FISSURE

LATERAL PORTION
SUPERIOR OPHTHALMIC VEIN LACRIMAL NERVE FRONTAL NERVE TROCHLEAR NERVE

MEDIAL PORTION
SUPERIOR AND INFERIOR DIV. OF OCULOMOTOR NERVE

ORBITAL APEX
OPTIC CANAL
TRANSMITS OPTIC NERVE AND OPHTHALMIC ARTERY

SUPERIOR ORBITAL FISSURE

ALSO TRANSMITS THE INFERIOR OPHTHALMIC VEIN

BLOOD SUPPLY OF THE ORBIT

OPHTHALMIC ARTERY
CENTRAL RETINAL ARTERY LACRIMAL ARTERY MUSCULAR BRANCHES LONG AND SHORT POSTERIOR CILIARY ARTERY MEDIAL PALPEBRAL ARTERIES

Blood Supply of the Eyeball

BLOOD SUPPLY
SHORT POSTERIOR CILIARY ARTERY
CHOROID, OPTIC NERVE

LONG POSTERIOR CILIARY ARTERY

SUPPLY CILIARY BODY, ANASTOMOSE WITH EACH OTHER AND ANTERIOR CILIARY ARTERY TO FORM THE MAJOR ARTERIAL CIRCLE

BLOOD SUPPLY
Anterior ciliary artery
derived from muscular branches of the rectus muscles anterior sclera, episclera, limbus, conjunctiva

Venous Drainage of the Orbit

Superior and Inferior Ophthalmic Veins Vortex veins Anterior Ciliary Veins Central retinal Veins

Venous Drainage of the Eyeball

Venous Drainage
The ophthalmic veins communicate with the cavernous sinus via SOF and the pterygoid venous plexus via the inferior orbital fissure. The SOV is formed from the supraorbital and suparatrochlear veins which drain the skin. * potential communication between skin infection and cavernous sinus causing thrombosis

Eyeball
Roughly spherical approximately 24.5 mm (less than an inch) in length about 5mL in total volume

Eyeball

Histological Cross Section of the Eyeball

Conjunctiva
Thin transparent mucous membrane which covers the posterior surface of the eyelid (palpebral conjunctiva) and the anterior surface of the sclera (bulbar conjunctiva) composed of two to five layers of stratified columnar epithelial cells contains glands which help in ocular lubrication

Conjunctiva
Blood Supply
anterior ciliary artery palpebral aretries

Nerve Supply
first division of the trigeminal nerve

Upper Eyelids

Lower Lid Retractors

Tenons Capsule
A fibrous membrane that envelopes the globe from the limbus to the optic nerve continuous with the EOMs thickens to form check ligaments

Sclera
Fibrous outer protective coating of the eye composed of dense bands of well hydrated connective tissue

Episclera
Fine elastic tissue containing blood vessels and covers the anterior surface of the sclera

Cornea
Transparent tissue which accounts for most of the refractive power of the eye thicker at the limbus, and thinner at the center 5 layers
epithelium Bowmans layer Corneal stroma Descemets layer Endothelium

Cornea

Cornea

Uveal Tract
Iris Ciliary Body Choroid

Posterior View of Uveal Tissue

Iris
Flat anterior extension of the ciliary body has a central round aparture known as the pupil divides the anterior from the posterior chamber

Iris

Ciliary Body
Extends from the choroid to the iris divided into the pars plicata and pars plana point of suspension of the lens produces aqueous humor

Aqueous Flow

Choroid
Posterior segment of the uveal tract in between the retina and sclera joins the ciliary body anteriorly choroidal blood vessels nourish outer portion of the retina

Ora Serrata

Choroidal Circulation

Lens
Biconvex, avascular, colorless and transparent structure second most powerful refractive tissue held in place by suspensory ligaments known as zonules accommodates to facilitate near vision

Lens Accommodation

Lens in the Young

Lens in the Aged

Anterior Chamber Angle

Schwalbes line Schlems canal Trabecular meshwork Scleral spur

Anterior Chamber Angle

Trabecular Meshwork

Aqueous Flow

Optic Nerve Cupping

Retina
Thin, semitransparent, multilayered sheet of neural tissue lines the inner aspect of the posterior two thirds of the globe terminates anteriorly as the ora serrata

Fundus

Posterior Pole

Layers of the Retina

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Internal limiting membrane Nerve fiber layer Ganglion cell layer Inner plexiform layer Inner nuclear layer Outer plexiform layer Outer nuclear layer External limiting membrane Photoreceptor layer (rods and cones) Retinal pigment epithelium

Retinal Layers

Macula
Center of the posterior retina responsible for fine central vision has yellow pigment (xantophyll) histologically empty space tends to the accumulation of extracellular material that cause thickening

Photoreceptors

Blood Supply of the Retina

Choriocapillaries
outer third of the retina

Central Retinal Artery

inner two thirds of the retina

Embryonic Eye

Embryonic Eye

Vitreous
Clear, avascular, gelatinous body comprises 2/3 of the volume of the eye 99% water ; 1% hyaluronic acid and collagen firmly attached to the pars plana and ora serrata

Eyeball

External Anatomic Landmarks

Limbus - point of referance , site of incision for basic cataract extraction Ora Serrata - 6mm from the limbus on the nasal side ; 7mm from the limbus on the temporal side Pars plana - 4mm from the limbus Pars plicata - 2-3 mm from the limbus

Extraocular Muscles
Rectus Muscles
superior rectus inferior rectus medial rectus lateral rectus

Oblique Muscles
Superior oblique Inferior oblique

Extraocular Muscles

Nerve Supply of EOMS

Oculomotor nerve innervates medial, inferior and superior rectus muscles as well as the inferior oblique muscle Abducens nerve innervates the lateral rectus muscles Trochlear nerve innervates the superior oblique muscle

Blood Supply of the EOMS

Muscular branches of the ophthalmic artery Lateral rectus also receives additional supply from lacrimal artery Inferior oblique also receives additional supply from the infraorbital artery

Ocular Adnexa
Eyebrows
thickened skin covered with hair

Eyelids
modified folds of skin closes to protect the eyeball blinks to lubricate cornea

Eyelids

Eyelids
Skin Layer Orbicularis Oculi Areolar tissue Tarsal plate Palpebral conjunctiva

Orbicularis Muscle

Lid Margins
Eyelashes Glands of Zeis Glands of Moll Meibomian glands lacrimal punctum

Palpebral Fissure
Elliptical space between the two eyelids terminates at the lateral and medial canthi

Orbital septum
Fascia behind the portion of orbicularis muscle and serves as a barrier between the lid and the orbit

Eyelids

Eyelid Anatomy

Lid retractors
Responsible for opening the eyelids
levator palpebrae superioris muscle
aponeurosis meullers muscle

Lower lid retractor

inferior rectus, extends with the inferior oblique and insert into the lower border of the tarsal plate

Upper Eyelids

Lower Lid Retractors

Nerve Supply of the Eyelid

First and second division of the trigeminal nerve Ophthalmic
lacrimal, supraorbital, supratrochlear,infratrochlear, external nasal nerves

Maxillary
Infraorbital, zygomaticofacial, zygomaticotemporal nerves

Eyelids
Blood Supply
lacrimal and ophthalmic areteries

Venous drainage
ophthalmic vein

Lymphatic drainage
Temporal eyelids - pre-auricular and parotid nodes Nasal eyelids - submandibular nodes

Lacrimal Apparatus
Lacrimal glands accessory lacrimal glands of Krauss and Wolfring Puncta Canaliculi Lacrimal sac Nasolacrimal duct

Lacrimal Apparatus

Lacrimal Gland
Blood supply - lacrimal artery Venous drainage - ophthalmic vein Lymphatic drainage - preauricular lymph nodes Nerve supply - lacrimal nerve, great superficial petrosal nerve, sympathetic nerves

Lacrimal Apparatus

Optic Nerve
Consists of 1 million axons from ganglion cells of the retina emerges from the sclera on the nasal portion of the globe 25 - 30mm long in the orbital segment goes through optic canal 10mm intracranial course joins optic chiasm

Optic Nerve

Vascular Supply of the Optic Nerve

Visual pathway
Retina Optic nerve Optic chiasm Optic tract Optic radiation Occipital lobe (Visual center)

Visual Pathway