ANATOMY &

PHYSIOLOGY of
THE EYES
Trilaksana N.
Dept. of Ophthalmology
Faculty of Medicine Diponegoro University
 Outline
ANATOMI:
ORBIT
BOLA MATA & OTOT EKSTERNAL
ADNEKSA
SYARAF
FISIOLOGI
 PENDAHULUAN
Anatomi !!! pemahaman peny dg
manifest pd mata
Surgical & postmortem + MRI,
OCT, USG, dsb
Fisiologi fungsi struktur2 terkait
 ORBIT
Outline:
Dinding Orbita
Apeks Orbita
Pendarahan
Orbit:
Piramid, 4 ddg, ddg medial paralel
Rim < lingkaran di dlmnya proteksi
Volume (dws) 30 ml 1/5 bl mata, 4/5 jar periokuler
(lemak, otot, syaraf)
Bts anterior: Septum Orbita
Bts sinus: s. frontalis (atas), s. maxillaris (bwh), s.
ethmoidalis & s. sphenoidalis (med)
Ddg med & dsr orbita tipis ruptur herniasi
 Dinding Orbita
Atap (roof) Orbita:
Tlg Frontal (utama) klj lakrimal di
fossa lacrimalis
Tlg Sphenoid (lesser wing)
Ddg lateral:
Bts dg roof fissura orbital superior
Bag antor tlg Zygomatic (Malar)
strongest
 Dinding Orbita
Dasar Orbita:
Bts dg lateral fissura orbitalis infor
Lempeng orbital tlg Maxilla (utama, sentral)
blowout fractures
Antor (Rim orbita infor) tlg Maxilla (medial) +
tlg Zygomatic (lateral)
Postor processus orbital tlg Palatina
(triangular)
Ddg Medial:
Tlg ethmoid paper thin ke antor menebal
Tlg sphenoid (body) postor aspect
Apex & Annulus of Zinn
 Blood Supply
Arteries:
Intracranial Internal Carotid a. 1st
branch: Ophthalmic a. passes
beneath & accompanies N II, branches
as:
Central Retinal a. enters the N II, 8 15
mm behind the globe
Lacrimal a. lacrimal glds
Long & Short postor Ciliary a.
Muscular branches antor Ciliary a.
 Blood Supply
Arteries:
Short postor Ciliary a. N II + choroid
Long postor Ciliary a. ciliary body +
major arterial circle* of the iris
(anastomose w/ antor Ciliary a.)
Antor Ciliary a. antor sclera, episclera,
limbus, conjunctiva, *
Most antor branches of Ophth a.
arterial arcade of the eyelids
 Blood Supply
Veins:
Supor & Infor Ophthalmic v.
Vortex v.
Communicate w/ Cavernous sinus &
Pterygoid venous
Drain the skin of the periorbital skin
lethal cavernous sinus thrombosis
(in cellulitis periorbital)
Antor Ciliary v.
Central Retinal v.
 The Eyeball
AP 24,2 mm
Components:
The Conjunctiva
Tenons Capsule (Fascia Bulbi)
The Sclera & Episclera
The Cornea
The Uveal Tract
The Lens
The Anterior Chamber Angle
The Aqueous
The Retina
The Vitreous
 The Eyeball
The Conjunctiva:
Transparent
Covers postor palp & antor surface of
sclera
Continuous w/:
The lid margin (mucocutaneous junc)
Palpebral conj
Fornices (supor & infor)
The limbus (corneal epithelium) Bulbar
conj
 The Eyeball
The Conjunctiva:
Palpebral Conj firmly adherent to the
tarsus
Bulbar Conj loosely attached to
Tenons capsule
Plica / semilunar
fold & caruncle
 The Eyeball
...The Conjunctiva:
Epithelium:
Stratified columnar: basal & superficial
(goblet cells)
Stratified squamous: limbus, caruncle,
mucocutaneous junc
Stroma:
Adenoid (superficial): lymphoid tissue &
follicle-like NOT develop 2 3 mo of life
Fibrous (deep): attaches to the tarsal plate
Krause (fornix) & Wolfring (supor tarsus)
accessory lacr glds
 The Eyeball
...The Conjunctiva:
Blood, lymphatic, Nerve Supply:
Blood supply: Conjunctival arteries (from a.
Ciliaris & Palpebralis). Veins ~ arteries
Lymphatic: join w/ lymphatic of the eyelid
Nerve supply: 1st div (Ophthalmic) of N V
 The Eyeball
Tenon's Capsule (Fascia Bulbi):
Fibrous membrane, envelopes from
limbus to N II
Limbus Conj, Tenon's, Episclera fixed
together
Posteriorly lies the sclera, contact w/
orbital structure & muscle cone
 The Eyeball
...Tenon's Capsule (Fascia Bulbi):
Pierced by extraocular tendons reflected
surrounding structure orbital bone limit
extr.oc muscle Check ligaments
Inferiorly:
thicker
fuses w/ fascia of the IR m & IO m form
the suspensory ligaments of the eyeball
(Lockwood ligament)
 The Eyeball
The Sclera & Episclera:
Fibrous (collagen)
Antor cornea; postor scleral foramen
(lamina cribrosa) pass the axon
bundle of the N II
Antor sclera episclera (thin, elastic,
blood vessels)
Inner surface lamina fusca (pigment,
outer layer of suprachoroidal space)
 The Eyeball
The Sclera & Episclera:
Thickness: 0,3 mm (at insertion of muscle)
0,6 mm
Penetrated around the N II:
Short & long postor ciliary arteries
Short & long ciliary nerve
Long postor ciliary a. & long ciliary n. pass in
shallow groove at 3 & 9 oclock meridians
Vortex veins postor equator, 1 each quadrant
4 antor ciliary a. & v. penetrate 4 mm from
limbus
Nerve supply: ciliary nerve
The Eyeball
The Cornea:
550m thick in center, 11,75mm
horizontally & 10,6mm vertically
Nutrition: Aqueous,
tears, limbus vessel
Transparency:
Uniform structure
Avascular
Deturgescence
 The Eyeball
The Corneas layers:
Epithelium 5-6 layers of cells
Bowmans membrane modf of stroma
Stroma 90% of corneal thickness, collagen
fibers, proteoglicans
Descemets membrane basal lamina of
endothelium
Endothelium one layer, maintain
deturgescence, loss w/ aging
Nerve supply: 1st div of N V
 The Eyeball
The Uveal Tract:
Iris:
Pigmented, Extension of ciliary body
Dividing the COA & COP
Central round aperture Pupil balance of
parasympathetic (m. Sphincter pupillae, N
III) & sympathetic (m. Dilator pupillae)
activity
Blood supply: Major circle of the iris
Nerve supply (sensory): Ciliary nerve
 The Eyeball
The Uveal Tract:
The Ciliary body:
Pars plicata (2 mm, anteriorly) ciliary process
aqueous formation
Pars plana (4 mm, posteriorly)
Epithelium: nonpigmented (internal, contd of
neuroretina), pigmented (external, contd of RPE)
Ciliary muscle:
Circular & radial fibers contract & relax zonular fibers
Longitudinal fibers open pore of TM
Blood & nerve supply:
= Iris, through Vortex veins
 The Eyeball
The Uveal Tract:
The Choroid:
Postor segment of Uveal tract between
retina & sclera
Internally: Bruchs membrane; Externally:
Sclera
Choroidal blood vessels:
Chorio-capillaris fenestrated, nourishes the
outer neuroretina
Drainage: Vortex veins
The Eyeball
The Lens:
4 mm thick, 9 mm , Biconvex,
avascular, colorless, almost completely
transparent
65% water, 35% protein + trace
minerals
Supported by zonule of Zinn at equator
corpus ciliaris
Capsule: semipermeable membrane
 The Eyeball
The Lens:
Subcapsular epithelium anterior
concentric lamella fibers
The Y suture lines:
End to end joining of the lamellas
Upright anteriorly, inverted posteriorly
Potassium >> in the lens
Ascorbic, Glutathione
The Eyeball
The Anterior
Chamber Angle:
Junc of peripheral
cornea & iris root
Schwalbes line (SL)
trabecular
meshwork (TM)
scleral spur (SS)
 The Eyeball
SL end (peripheral) of corneal
endothel
TM Uveal meshwork (internal
portion) & Corneoscleral meshwork
(external portion) Schlemms
canal 30 collector channels + 12
aqueous veins episcleral venous
system
SS inward extension of sclera
 The Eyeball
The Aqueous:
Produced by ciliary
body
Entering postor
chamber pupil
antor chamber
antor chamber angle
 The Eyeball
The Retina:
Semitransparent, multilayered, 2/3
postor inner aspect of globe
Ora serrata (OS):
anterior edge of retina (ragged edge)
6,5 mm behind SL (temporal), 5,7 mm
(nasal)
Subretinal space retinal detachment
At the PN II & OS ret & RPE firmly
bound limiting ret detachment
 The Eyeball
The Retina:
Suprachoroidal space choroidal detachment
extend to anterior (SS)
Thickness: 0,1 mm at OS, 0,56 mm at postor
pole
Macula:
Postor pole, 5,5 6,0 mm
> 1 layers of ganglion cells
3 mm center macula lutea w/ fovea centralis
Xanthophyll >>>, photoreceptors >>>
1,5 mm center retinal avascular zone
0,25 mm center foveola (thinnest part of retina)
 The Eyeball
The Retina:
Blood supply:
Choriocapillaris:
1/3 outer + fovea irreparable damage when RD
Fenestrated
Blood barrier RPE
Central retinal artery
2/3 inner
Nonfenestrated blood retinal barrier
 The Eyeball
The Vitreous:
Clear, avascular, gelatinous body (99%
water, 1% collagen + hyaluronic acid),
2/3 volume & weight of the eyeball
Outer surface hyaloid membrane
contact w/ postor lens capsule, zonular
fibers, pars plana epithelium, retina, N
II head
Vitreous base (attachment): pars plana
epithelium & retina just behind the ora
serrata
 The Extraocular Muscles
Insertions of
Rectus Muscles:
spiral of Tillaux
 The Extraocular Muscles
Blood Supply:
Ophthalmic artery (muscular branch)
Also:
Lateral rectus m. Lacrimal artery
Inferior Oblique m. Infraorbital artery

Nerve Supply:
N III SR, MR, IR, IO
N IV SO
N VI LR
 The Ocular Adnexa
Eyebrows:
The folds of thickened skin
Covered w/ hair
The Glabella hairless between 2 eyebrows
Eyelids:
1. Skin Layer
2. Orbicularis Oculi Muscle (OOM)
3. Areolar Tissue
4. Tarsal Plate
5. Palpebral Conjunctiva
 The Ocular Adnexa
Eyelids:
1. Skin Layer:
Thin, loose, elastic
Few hair follicles
NO subcutaneous fat
2. OOM:
Concentric close the lids
Inside the lid: Pretarsal & Preseptal portion
Outside the lid: Spread around the orbital
margin (orbital portion)
Supplied by N VII
 The Ocular Adnexa
Eyelids:
3. Areolar Tissue:
Submuscular communicates w/
aponeurotic layers
4. Tarsal Plate:
Main supporting structure of the lids
dense fibrous & elastic tissue
Lateral & medial attached to orbital
margins by palpebral ligaments
Upper & Lower thin fascia (Orbital
Septum)
 The Ocular Adnexa
Eyelids:
5. Palpebral Conjunctiva:
Adhere firmly to the tarsal plate

GRAY LINE splits the lids into:

Anterior Lamella (Skin + OOM)
Posterior Lamella (Tarsal Plate + Palp
Conjunctiva)
 The Ocular Adnexa
The Lid Margins:
GRAY LINE mucocutaneous junction
Anterior Margin:
Eyelashes upper, upward; lower,
downward
Glands of Zeis sebaceous glds at base of
Glands of Moll sweat glds eyelashes
Posterior Margin:
Small orifices of meibomian / tarsal glds
Lacrimal Punctum:
Medial end of the postor margins
 The Ocular Adnexa
Palpebral Fissure:
Lateral canthus 0,5 cm from orb rim
Medial canthus more elliptic,
surround lacrimal lake:
Lacr caruncle modf. sweat & sebaceous
glds
Plica semilunaris 3rd eyelid of lower
animal sp
Epicanthus:
Normal in Asian population & Young infants
Hiding caruncle
 The Ocular Adnexa
Orbital Septum:
Lies between Orb rim & tarsus
Serves as barrier
Pierced by:
the several vessels & nerves (lacrimal,
supra/infratrochlear, supraorbital)
Levator palp superior muscle (LPSM)
Blends w/:
Supor: Tendon of LPSM & supor tarsus
Infor: infor tarsus
 The Ocular Adnexa
Lid Retractors:
Musculofacial complex (striated & smooth
muscles) Opening the eyelids
Upper lid m. Levator Palp Supor, divided
into:
Aponeurosis (antor) elevate antor lamella
Mullers muscle (smooth m. fibers) elevating postor
lamella
inserting supor eyelid into postor surface of OOM
upper lid skin crease
Lower lid m. Rectus Infor
Smooth muscle innervated by sympathetic
nerves
Striated muscle innervated by N III
 The Ocular Adnexa
Sensory Nerve Supply to eyelids:
1st (ophthalmic):
Lacrimal, Supraorbital, Supra/Infratrochlear,
External Nasal nerves
2nd (maxillary) divisions of N V:
Infraorbital, Zygomaticofacialis,
Zygomaticotemporal nerves
 The Ocular Adnexa
Blood Supply & Lymphatics:
Arteries:
Lacrimal & Ophthalmic arteries (lat & med
branches) anastomoses: submusc.
Areolar tissue
Veins:
Arranged in pre & post tarsal plexuses
Into Ophthalmic veins
Lymphatics:
Lateral side preauricular & parotid nodes
Medial side submandibular l.n.
 The Ocular Adnexa
The Lacrimal Apparatus:
The lacrimal complex:
The Main Lacrimal glds
The Accessory Lacrimal glds
The Canaliculi
The Lacrimal sac
The Nasolacrimal duct
 The Ocular Adnexa
The Main Lacrimal Glands:
Orbital portion:
In the lacrimal fossa
Separated from palp. portion by lateral horn
of m. Levator Palp
Palpebral portion:
Just above the temporal segment of the
supor conj fornix
Secretory ducts w/ 10 orificies connects orb
& palp portion to the supor conj fornix
 The Ocular Adnexa
The Accessory Lacrimal Glands:
Krause & Wolfring glds subs propria
palp conj
Drainage of tear:
Lacr lake upper/lower puncta
canaliculi lacr sac nasolacr duct
meatus nasal cavity
Mechanism: capillary attraction, gravity,
blinking & pumping action by Horners
muscle
 The Ocular Adnexa
Blood & Lymphatic supply:
Arteries: Lacrimal artery
Veins: joins w/ Ophthalmic vein
Lymph drainage: joins w/ conj lymphatic
preauricular l.n.
Nerve supply:
Sensory: Lacrimal nerve (1st div of N V)
Secretory: Great Petrosal nerve (from supor
salivary nucl)
Sympathetic nerve: accompanying the
Lacrimal artery & nerve
 The Ocular Adnexa
Related Structure:
The medial palpebral ligament
connects the upper & lower tarsal plate
to Frontal process at medial canthus
antor to lacr. Sac
Below the ligaments lacr. Sac covered
by few fibers of OOM little resistance
swollen in acute dacryocystitis
The angular vein & artery 8 mm from
medial canthus incision should be 2-3
mm
 The Optic Nerve
The Intra ocular:
1,5 mm
The Intra orbital:
25 30 mm; 3 mm
The Optic Chiasm:
Near the top of sella
tursica
Decussation
The Retrochiasmatic
The Optic
Nerve
The pupillary
reflex arc