Anatomy of the Eye

I. ORBIT
pyramidal space located on either side of the face APEX is the optic foramen BASE is the strong, anterior margin

Boundaries of the Orbit

SUPERIORLY frontal bone LATERALLY frontal bone and zygomatic bone INFERIORLY zygomatic bone, maxillary bone and palatine bone MEDIALLY = frontal bone, lacrimal bone, sphenoid and ethmoid bone

Measurement of a Normal Orbit

Transverse 37 mm Vertical 31 mm Depth 44 mm Volume 38 cc

THREE (3) OPENINGS AT THE POSTERIOR PORTION OF THE ORBIT AND THE STRUCTURES PASSING THROUGH THEM
1. Optic Foramen
Optic nerve Ophthalmic artery

2. Superior Orbital Fissure (Sphenoid fissure)

Ophthalmic veins Nerves supplying the ocular muscle First branch of the trigeminal nerve

3. Inferior Orbital Fissure (Spheno-maxillary)

Maxillary nerve Infraorbital nerve

Cavities Surrounding the Orbit

SUPERIORLY
frontal sinus, frontal lobe of the brain

LATERALLY
temporalis muscle fossa temporal lobe of brain

INFERIORLY
maxillary sinus

MEDIALLY
ethmoid sinus sphenoid sinus nasal cavity

Contents of the Orbit

1. 2. 3. 4. 5. EYEBALL and OPTIC NERVE EXTRA-OCULAR MUSCLE LACRIMAL GLAND and LACRIMAL SAC BLOOD VESSELS and NERVES FATS and FASCIAE

Vascular and Nerve Supply of the Orbit

ARTERY
ophthalmic artery

VEINS
ophthalmic veins

NERVES
MOTOR NERVES: CN III, IV, VI SENSORY NERVES: 1st and 2nd branches of CN V

LYMPATHIC
None

II. EYELIDS
modified folds of skin that covers the eyeball FUNCTIONS OF THE EYELID: 1. Protects the eye from foreign objects 2. Regulates the amount of light entering the eye. 3. Distributes tears.

Layers of the Lids

1. Skin
Thin and delicate Attached to the subjacent muscle by the second layer (loose CT) Contains sweat glands, hair follicles and sebaceous glands (zeis and moll)

2. Loose Connective Tissue

extravasation of blood and edematous swelling occurs

3. MUSCULAR LAYER
levator palpebrae superioris muscle orbicularis oculi muscle palpebral involuntary muscle (Mullers muscle)
unstriped muscular tissue inserted in the proximal margin of the tarsal plates.

4. TARSUS AND FASCIAE

dense fibrous tissues that give firmness to the lids. contains Meibomian gland origin of chalazion or internal hordeolum secrets oil into the tear film that retards evaporation of tears.

5. CONJUCTIVA inner surface of the lid and meets the skin and the lid margin. - divided into three (3) portions a. palpebral b. fornix c. bulbar - receives arterial vessels from the: a. muscular branches of the ophthalmic b. anterior ciliary c. marginal and peripheral palpebral arcades - aqueous veins pass thru the conjunctiva to drain aqueous humor from the eye. - Lymphatic Drainage: a. pre-auricular b. sub maxillary c. parotid

Orbicularis oculi muscle is divided into: 1. PRE- SEPTAL - deep and superficial which originates from the anterior lacrimal crest. 2. PRE-TARSAL - inserts anterior and posterior to the lacrimal sac which provides the pumping mechanism to drain tears. 3. ORBITAL PORTION - interwined with frontalis muscle and corrugator supercilli muscle and are involved in the moment of the eyeball - in normal blinking (pre-tarsal and pre-septal) - in tight lid closure (orbital)

ARTERIAL SUPPLY OF THE LID: > ophthalmic and facial artery VENOUS DRAINAGE : > Ophthalmic veins > Temporal veins > Facial veins LYMPHATIC DRAINAGE: > pre-auricular gland > sub-maxillary gland > parotid gland NERVE SUPPLY: > III C.N. > IV C.N.I > Sympathetic nerve > V C.N.

D. LIDS HAVE A SINGLE ROW OF EYELASHES AND A MEDIAL AND LATERAL CANTHUS E. PALPEBRAL FISSURE - 15 mm. In height F. CARUNCLE AT THE INNER CANTHUS AND THE PLICA SEMILUNARIS G. LACRIMAL PUNCTUM AT THE MEDIAL OF BOTH LIDS

LACRIMAL SYSTEM

COMPOSED OF THE SECRETORY AND EXCRETORY

1. SECRETORY ARE: - main lacrimal gland - accessory lacrimal gland 2. EXCRETORY :
(LAC RIMAL PASSAGES)

- puncta - canaliculi - lacrimal sac -naso-lacrimal duct

A. LACRIMAL GLAND
(a.) MAIN LACRIMAL GLAND - at the supero-lateral aspect of orbit - arises from the surface ectoderm of the conjunctive - specialized outgrowth of the upper fornix of the conjunctiva - developed in the second month of gestation - empty tears into the superior fornix by a series 10-12 ducts - nerve supply lacrimal nerve - artery supple lacrimal artery - veins lacrimalveins - lymphatics- pre-auricular nodes (b.) ACCESSORY LACRIMAL GLANDS 1. KRAUSEdevelop as growth of the basal cell of conjunctiva 2. WOLFRINGdevelop at 6 months of gestation

B. LACRIMAL PASSAGES - drains excess tears into the nose

1. PUNCTI- medial end of the lid - inferior is lateral to the superior - kept round by a fibrous tissue continuous with the tarsus 2. LACRIMAL CANALICULI 10mm in length a. vertical 2mm b. horizontal 8mm - enter the sac at the level of the medial canthal ligament 2-3 below the fundus of the sac. 3. LACRIMAL SAC lies in bony lacrimal fossa - 12 mm length - 2-3 mm width - 4-8 m from the front back 4. NASO- LACRIMAL DUCT runs 15 mm in bone and 5 mm in middle meatus of the nose -valves are present in the duct with the most consistent fold at the nasal end (Valve of Hanser )

A . VASCULAR SUPPLY OF SAC AND UPPER DUCT : 1. superior and inferior palpebral branches of the ophthalmic artery 2. angular branches of the facial artery 3. infraorbital artery - the lower duct - nasal branch of the sphenopalatine artery B. LYMPATHIC DRAINAGE - submaxillary node C. NERVE SUPPLY OF SAC AND UPPER DUCT 1. Infratrochlear branch of the ophthalmic nerve 2. V C.N. (1st division)

EXTRAOCULAR MUSCLES

GENERAL CHARACTERISTICS:
1. HISTOLOGICALLY a. finer b. smaller c. uniform d. run the entire length of the muscle 2. RICH IN ELASTIC TISSUE 3. RICH IN MOTOR NERVES 4. RICH IN BLOOD SUPPLY a. muscular branch of the ophthalmic artery b. anterior ciliary arteries 5. PHARMACOLOGICALLY a. extremely sensitive to drugs - curare-paralytic - acetylcholine excitatory b. very powerful group of muscles

IANATOMICAL FACTS OF IMPORTANCE

1. EOM- DIVIDED INTO 3 PAIRS a. horizontal pair b. vertical pair c. oblique pair 2. ALL EOM ORIGINATE FROM THE ANNULUS OF ZINN EXCEPT THE INFERIOR OBLIQUE MUSCLE 3. ALL EOM INSERT INTO THE EYEBALL 4. OF ALL RECTI MUSCLE, THE SUPERIOR RECTUS IS THE LONGEST AND THE INFERIOR RECTUS IS THE SHORTEST. 5. OF ALL EOM, THE SUPERIOR OBLIQUE MUSCLE IS THE LONGEST AND WTIH THE LONGEST TENDON AND INFERIOR OBLIQUE MUSCLE IS TEH SHORTEST AND NO TENDON.

muscle

Distance from limbus 5.5 mm

Length of tendon

Width of tendon

Medial rectus

3.7 mm

10.3 mm

Inferior rectus

6.5 mm

5.5 mm

9.8 mm

Lateral rectus

6.9 mm

8.8 mm

9.2 mm

Superior rectus

7.7 mm

5.8 mm

10.8 mm

Primary function Medial rectus Lateral rectus Superior rectus Inferior rectus Superior oblique Inferior oblique adduction abduction elevation depression incycloduction excycloduction

Secondary function

Tertiary function

incycloduction excycloduction depression elevation

adduction adduction abduction abduction

> the vertical recti muscles are adductors > The oblique muscles are abductors >The superior muscles are incycloductors >The inferior muscles are excycloductors

NERVE SUPPLY:
a. III C.N. Superior Rectus - Inferior Rectus - Medial Rectus - Inferior Oblique b. IV C.N. Superior Oblique c. VI C.N. Lateral Rectus

THE EYEBALL

I. COMPOSED OF THREE BASIC LAYERS 1. Cornea an Sclera 2. Uvea 3. Retina II. MEASUREMENTS: - Transverse 24 mm - Vertical 23 mm - Antero- posterior- 24.5 mm - Volume 6-7 ml

III. A. CORNEA
- Protrudes like a dome over the iris - Diameter of 14 mm -Thickness of 1 mm 1. LAYERS OF THE CORNEA: a. Epithelium b. Bowmans Membrane c. Descements Membrane d. Endothelium

2. CORNEA IS DEVOID OF BLOOD VESSELS 3. NUTRITION COMES FROM THE a. capillary loops around the circumference of the cornea from the anterior ciliary artery. 4. CORNEA IS RICHLY SUPPLIED WITH NERVES DERIVED FROM THE CILIARY NERVES. (TRIGEMINUS)

B. SCLERA
1. fibrous layer of the eye - it is strong - opaque - inelastic - serves to maintain the form of the eye - 1 mm thick 2. Posteriorly, it is pierced by the optic nerve and that part is known as the LAMINA CRIBROSA.

3. The Sclera per se has scanty vascular supply, but the episcleral tissue contains numerous vessels. 4. Layers of the Sclera a. Episclera b. Sclera Proper c. Lamina Fusca

IV. UVEA
-Provides nourishment to the eye - Form before backwards: 1. Iris 2. Ciliary body 3. Choroid

A. IRIS
colored circular membrane hanging behind the Cornea and infront of the lens with opening at the center called the Pupil. has abundant blood and nerve supplies color depends upon the pigment in the stromal cells and partly on the cells of the retinal layer.

1. MUSCLE OF THE IRIS: a. SPHINCTER PUPILLAE MUSCLE- 1mm wide b. DILATOR PUPILLAE MUSCLE 2. BLOOD SUPPLY OF THE IRIS: -long posterior ciliary arteries 3. NERVE SUPPLY OF THE IRIS: -III CN - nasal branch of the ophthalmic nerve - sympathetic nerve 4. FUNCTIONS OF THE IRIS: a. regulate amount of light entering the eye b. separates anterior and posterior chamber c. cut off marginal rays of light that interfere with the sharpness of retinal image

B. CILIARY BODY
extends from the base of the iris to the anterior part of the choroid It is triangular in shape with a narrow base directed forward giving origin to the iris 1. COMPOSED OF TWO PARTS a. CILIARY MUSCLE (MUSCLE of ACCOMODATION) b. CILIARY PROCESS (SECRETE AQUEOUS HUMOR)

- The ciliary muscle are non striated muscles running in different directions (1.) MERIDIONAL (2.) RADIAL (3.) CIRCULAR - The proportion between the circular and longitudinal fibers varies according to the reflective condition of the eye. = The circular set is well developed in hyperopia but atrophied in myopia

- The ciliary process are extremely vascular and nourishes: (1.) cornea (2.) lens (3.) part of the vitreous 2. BLOOD SUPPLY OF THE CILIARY BODY a. greater circle of the iris from the anterior ciliary arteries 3. THE CILIARY BODY IS RICHLY SUPPLIED WITH NERVES

C. THE CHOROID:
dark, brown membrane between the sclera the retina extends from ora serrata to the opening of the optic nerve consist mainly of blood vessels united by connective tissue with numerous pigmented cells.

1. LAYERS OF THE CHOROID: a. Suprachoroid b. Layer of the large vessels (Hallers) c. Layer of medium sized vessels d. Layer of the chorio capillaries e. Lamina Vitrea ( Bruchs membrane) 2. FUNCTION OF THE CHOROID IS CHIEFLY AS NUTRIENT ORGAN FOR THE: a. Retina b. Vitreous c. Lens

V. PUPIL
opening at middle of the iris normally, it is circular and regular in outline both pupils must have equal size its movements are contraction and dilation

1. PUPIL CONTRACTS UPON EXPOSURE TO: a. light (direct or consensual) b. accommodation c. convergence 2.PUPIL DILATES UPON a. shading the eye b. divergence

VI. THE RETINA

delicate, transparent and thin membrane consist of expansion of the optic nerve located between the hyaloids membrane and the choroids attached at the ora- serrata and the optic nerve head

1. THE RETINA PRESENTS THE FOLLOWING STRUCTURES a. MACULA LUTEA and FOVEA CENTRALIS b. OPTIC NERVE HEAD (PAPILLAE or DISC) c. CENTRAL RETINAL ARTERY 2. KINDS OF TISSUES FOUND IN THE RETINA a. NERVOUS TISSUES b. SUPPORTING TISSUES

3. TEN LAYERS OF THE RETINA (in-out) a. INTERNAL LIMITING MEMBRANE b. NERVE FIBER LAYER c. GANGLION CELL LAYER d. INNER PLEXIFORM LAYER e. INNER NUCLEAR LAYER f. OUTER PLEXIFORM LAYER g. OUTER NUCLEAR LAYER h. EXTERNAL LIMITING MEMBRANE I. LAYER OR RODS AND CONES (light perceiving) j. PIGMENT CELL LAYER

4. RODS ARE NUMEROUS THAN CONES EXCEPT AT THE MACULA WHERE CONES PREDOMINATES AND NO RODS AT THE FOVEA CENTRALIS - Cones are responsible for visual acuity and color discrimination at high intensity of illumination. - Rods are responsible for vision at low degrees of illumination. 5. THE OPTIC DISC CONSIST MAINLY OF OPTIC NERVE FIBERS AND HAS NO POWER OF SIGHT (blind spot).

VII. OPTIC NERVE

= (45 mm ) divided

into: 1. INTRAOCULAR 1 mm 2. ORBITAL - 25 mm 3. I NTRACANAL 9 mm 4. INTRACRANIAL 10 mm

VIII. THE LENS

- Transparent body and biconvex in shape with a diameter of 9 mm and thickness of 5 mm. - suspended anteriorly between the aqueous and vitreous chambers - it has an anterior and posterior surface - devoid of blood vessels except in fetal life.

- it is enclosed in a transparent capsule held in position by the suspensory ligament . - nourishment comes from the intraocular fluid - adult lens has a cortex and nucleus = The cortex is semi-solid , softer and colorless = The nucleus is harder and has yellowish tint = As the age advances, the nucleus increases in size and cortex diminishes in proportion.

1. FUNCTION OF THE LENS : - to focus rays of light so that they form a perfect image in retina 2. VARIATIONS IN PHYSICAL CHARACTERISTICS OF THE LENS: a. FETUS spherical and softer b. ADULT anterior surface less convex than posterior - substance is firmer c. OLD AGE increase in size - flattened - yellowish tint - tougher - less transparent d. ADVANCE YEARS unable to change shape

IX. VITREOUS HUMOR

- fills the posterior chamber - the outer surface is a thin, structureless condensation known as the hyaloids membrane - it is transparent , colorless and gelatinous - devoid of blood vessels - traverse by the hyaloids canal - nourished by the: a. choroid b. ciliary body c. retina

X. AQUEOUS HUMOR
- produced by the ciliary process - fills the anterior and posterior chambers 1. FUNCTIONS: a. nutrition cornea and lens b. maintain intraocular pressure c. optical d. osmotic

2. AQUEUOS CONTAINS: a. more electrolytes ( Na and Chloride) b. more ascorbic and citric acid c. less protein d. less non- electrolytes (urea and sugar)