ANATOMI

PALPEBRA

Fungsi Palpebra
Pelindung

mekanik bola mata.

Menghasilkan komponen lipid untuk
tear film
Membantu membasahi kornea.

THE LIDS
THE LIDS ARE COVERED
ANTERIORLY BY SKIN AND
POSTERIORLY BY MUCOUS
MEMBRANE - THE CONJUNGTIVA TARSI. THEY
CONTAIN MUSCLES,
GLANDS, BLOOD VESSELS,
AND NERVES. ALL BOUND
TOGETHER BY CONNECTIVE
TISSUE WHICH IS PARTICULARY DENSE AT THE
POSTERIOR PART WHERE IT
FORMS A STIFF PLATE THE TARSUS

THE SKIN OF THE LIDS

IS PECULIAR IN
ITS THINNES AND ITS
LOOSE ATTACH-MENT
THE CILIA OR
EYELASHES ARE
STRONG SHORT
CURVED HAIRS,
ARRANGED IN TWO OR
MORE CLOSELY SET
ROWS
THE SEBACEOUS
GLANDS ARE CALLED
ZEISSS GLANDS AND
THE SWEAT GLANDS
ARE KNOWN AS MOLLS
GLANDS

THE TARSUS
CONSISTS OF
DENSE
FIBROUS
TISSUE; IT
CONTAINS NO
CARTILAGE,
EMBEDDED IN
IT ARE SOME
ENORMOUSLY
DEVELOPED
SEBACEOUS
GLAND : THE
MEIBOMIAN
GLANDS

THE ORBICULARIS
PALPEBARUM OCCUPIES
THE SPACE BETWEEN THE
TARSUS AND THE SKIN
THE MAIN CENTRAL BOND
OF THE LEVATOR
PALPEBRAE SUPERIORIS
IS INSERTED INTO THE
UPPER BORDER OF THE
TARSUS
THE THIRD NERVE
SUPPLIES THE LEVATOR
PALPEBRAE
THE SEVENTH SUPPLIES
THE ORBICULARIS

Batas-Batas Palpebra
Batas

superior : daerah alis

dan rima orbita superior.
Batas inferior : dari rima
orbita inferior sampai ke kulit
nasojugal dan lipatan malar.
Lebar horizontal fisura =30
mm vertikal 8-10 mm.

Lipatan Palpebra Superior

(Lid

crease) :terbentuk dari perlekatan

serabut aponeurosis levator di lapisan
subkutan.
Lokasi: 7-11 mm di atas margo palpebra.

Posisi Primer Palpebra

Margo

palpebra superior, 1-2 mm di

bawah limbus superior.
Margo palpebra inferior pada limbus
inferior.

Margo Palpebra (1/2)

Panjang

25-30 mm dan lebar 2 mm.

Papila lakrimal: 6 mm lateral dari sudut
kantus medial
Gray

Line :Pertemuan
antara
epitel

berlapis gepeng
berkeratin di anterior,
epitel berlapis gepeng
tak berkeratin dan epitel
berlapis silindris di
posterior.

Margo Palpebra (2/2)

Bagian

anterior margo palpebra terdapat

otot Riolan.
Palpebra superior:cilia uk.8-12 mm jumlah
100-150.
Palpebra inferior:silia ku.6-8 mm, jumlah
50-75.
Kel sebasea Zeiss dan kel Apokrin Moll.

7 Lapisan Palpebra
Kulit

& jaringan
subkutan.
Otot protraktor.
Septum orbita.
Lemak orbita.
Otot retraktor.
Tarsus.
Konjungtiva.

Lipatan Palpebra :
Occidental vs Oriental

Kulit & Jaringan Subkutan

Sangat

tipis dan elastis.

Tidak mempunyai lapisan lemak subkutan
Lapisan dermis:
jaringan

ikat longgar yang mengandung serat

elastin,pemb darah,limfe dan saraf.

Lapisan

sebacea.

subkutan: folikel rambut & kelenjar

Otot Palpebra
Otot

Protraktor.
Otot Retraktor.

Otot Protraktor Palpebra

M.Orbikularis

okuli, melingkari fisura orbit.

Dipersyarafi saraf otak VII.
Tiga bagian :
Orbikularis orbital,
Orbikularis preseptal,
Orbikularis pretarsal.

Otot Orbicularis Orbital

Terbesar

dan tertebal, melapisi rima

orbita.
Berbatasan dengan
otot

frontalis,
proserus,
korugator superfisialis
temporalis.

Otot Orbikularis Preseptal

Terletak

di atas septum orbita.

Fungsi: menutup palpebra & berperan dalam
pompa lakrimalis.
Serabut otot preseptal atas dan bawah
membentuk tendon di raphe palpebra lateral.

Otot Orbikularis Pretarsal

Bagian

terkecil.
Fungsi: saat refleks mengedip dan berperan pada
pompa lakrimal.
Dibagi 4 bagian: bagian atas dan bagian bawah
@superfisial dan dalam
Otot tensor tarsi Horner.
Dilateral bersatu membentuk tendon kantus
lateral.

Septum orbita
Jaringan

ikat berlapis berasal dari

periosteum pada rima orbita superiorinferior di daerah arkus marginalis.
Fungsi:sebagai barier antara orbita dan
palpebra.

Lemak Orbita
Normal:

letak di posterior septum orbita

dan anterior dari aponeurosis levator.
Dapat mengalami herniasi ke palpebra.
Bantalan lemak sentral penting untuk
operasi palpebra elektif dan repair laserasi
palpebra.

Otot Retraktor Palpebra

Otot

rektraktor palpebra superior: m.

levator dan aponeurosisnya dan
m.tarsalis superior (muller).
Otot retraktor palpebra inferior: fasia
kampsulopalpebral dan m.tarsalis inferior.
Dipersarafi: saraf simpatis.

Otot Retraktor Palpebra Superior

(1/2)
M.Levator

palpebra : otot utama dan

berfungsi mengangkat palpebra superior
sekitar 15 mm.
M.Muller : fungsi memberi tambahan tonus
dan hilang bila kelelahan atau paralisis dan
palpebra turun 2 mm.
Bila mengalami overstimulasi : terjadi retraksi
2-3 mm di atas normal.

Otot Retraktor Palpebra Superior

(2/2)
Origo

m Levator: di atas anulus Zinn.

Komponen otot 20mm dan komponen
aponeurosis 14-20 mm.
Lig.Whitmall: letak di daerah transisi
m.levator dan aponeurosis levator.
Fungsi lig.Whitmall:pendukung palpebra
superior dan jaringan orbita superior.

Otot Retraktor Palpebra Inferior

(1/2)
Palpebra

inferior membuka secara pasif

karena tarikan m.rektus inferior.
Fasia kapsulopalpebral analog dengan
aponeurosis levator.
Dua bagian kepala kapsulopalpebra
membentuk lig.Lockwood.

Otot Retraktor Palpebra Inferior (2/2)

M.Tarsalis

inferior analog dengan m

Muller.
Ligamentum suspensorium forniks.

Tarsus (1/2)
Terdiri

dari jaringan padat.

Berfungsi sebagai rangka palpebra.
Ukuran tarsus superior: lebar 10 mm di
sentral,panjang 25-29mm dan tebal 1 mm.
Ukuran tarsus inferior: lebar 3.5-4 mm di
sentral,panjang 25-29 mm dan tebal 1 mm.

Tarsus (2/2)
Mengandung kelenjar
Meibom: 30-40 di
palpebra superior ,
20-30 di palpebra
inferior.

Konjungtiva
Konjungtiva

palpebra.
Konjungtiva forniks.
Konjungtiva bulbi.
Plika semilunaris.

Vaskularisasi
Suplai

vaskular padat dan banyak sirkulasi

kolateral.
Mempercepat penyembuhan.
Mudah terjadi perdarahan saat prosedur
operasi.

Vaskularisasi Arteri
Dari

a.karotis Interna melalui

a.oftalmika dan a.infraorbita.
A.karotis eksterna melalui
a.fasialis dan a.temporalis
superfisialis.
Membentuk sirkulasi kolateral
yang besar.

Vaskularisasi Vena
Terdiri

dari arkade palpebra superior

dan arkade palpebra inferior.
Vena palpebra superior dan inferior
menuju v.angularis di kantus medial.
Vena angularis membentuk
anastomosis dengan sinus
kavernosus.

Sistim Limfatik
Menuju

nodus limfatikus
preaurikular dan submandibular.
Menerima drainase dari sistem
superfisial dan profunda.
Pleksus superfisial : menerima
aliran limfa dari kulit dan otot
orbikularis.
Pleksus profunda : dari tarsus dan
konjungtiva.

Sistem Limfatik
Aspek

medial palpebra superior

inferior,sentral palpebra inferior dan
konjungtiva menuju nodus limfatikus
submandibularis.
Palpebra superior,aspek lateral palpebra
inferior dan konjungtiva menuju nodus
imfatikus preaurikular

Persarafan (1/2)
2

saraf motorik untuk gerakan palpebra.

N.III: mempersarafi m.levator palpebra
untuk mengangkat palpebra superior
dan m.rektus inferior.
N.VII mempersarafi m.orbikularis okuli.

Persarafan (2/2)
N.V

:untuk sensasi palpebra

Palpebra superior dipersarafi
oleh cab.1 n.oftalmikus
Cabang utama n. oftalmikus:
n.lakrimalis, n.supraorbita,
n.supratroklearis, dan
n.infratroklearis.

THE EXTRA OCULAR MUSCLES

A TEAM OF SIX MUSCLES
CONTROLS THE MOVEMENT OF EACH EYE
THE RECTUS MUSCLE
- THE MEDIAL RECTUS
- THE LATERAL RECTUS
- THE SUPERIOR RECTUS
- THE INFERIOR RECTUS
THE OBLIQUE MUSCLE
- THE SUPERIOR
OBLIQUE
- THE INFERIOR
OBLIQUE

 Gambar

extraocular muscle

THE RECTUS
MUSCLES HAVE THE
GENERAL ACTION
OF ROTATING THE
EYE IN FOUR
CARDINAL
DIRECTIONS : UP,
DOWN, OUT AND IN
THE OBLIQUE
MUSCLES HAVE THE
PRIMARY FUNCTION
OF ROTATION OF
THE GLOBE

THE MEDIAL
RECTUS IS
INSERTED INTO
THE SCLERA,
ABOUT 5 MM TO
THE NASAL SIDE
OF THE CORNEOSCLERAL MARGIN.
THE INFERIOR
RECTUS 6 MM
BELOW
THE LATERAL
RECTUS 7 MM TO
THE TEMPORAL
SIDE
THE SUPERIOR
RECTUS 8 MM
ABOVE

THE LACRIMAL APPARATUS

THE LACRIMAL APPARATUS CONSISTS OF

THE LACRIMAL GLANDS
THE LACRIMAL PASSAGES

THE LACRIMAL GLAND OF EACH EYE

CONSISTS OF :

THE SUPERIOR OR ORBITAL GLAND

THE INFERIOR OR PALPEBRAE GLAND
THE ACCESSORY LACRIMAL
GLANDS OR KRAUSES GLANDS

THE LACRIMAL PASSAGES CONSISTS OF :

THE
THE
THE
THE

LACRIMAL PUNCTA
CANALICULI
LACRIMAL SAC
NASAL DUCT

ANATOMY OF THE GLOBE

ANTERIOR
SEGMEN
IRIS PLANE

POSTERIOR
SEGMEN

ANATOMY OF THE EYE BALL

THE WALL OF THE EYE BALL IS COMPOSED OF A

DENSE, IMPER-FECTLY ELASTIC SUPPORTING
MEMBRANE
THE ANTERIOR PART OF THE MEM-BRANE IS
TRANSPARENT
THE CORNEA
THE ANTERIOR PART OF THE SCLERA IS COVERED
BY MUCOUS MEMBRANE
THE CONJUNGTIVA

THE CORNEA CONSIST OF FIVE

LAYERS :
- EPITHELIUM
- BOWMANS MEMBRANE
- STROMA OR SUBSTANTIA PROPIA
- DESCEMETS MEMBRANE
- ENDOTHELIUM

 THE EPITHELIUM REGARDED AS THE CONTINUATION

OF THE CONJUNGTIVA OVER THE CORNEA
THE SUBSTANTIA PROPIA REGARDED
CONTINUATION FORWARD OF THE SCLERA

AS

THE

THE STROMA FORMING 90 % OF THE TOTAL CORNEAL

THICKNESS

 DESCEMETS MEMBRANE IS A THIN ELASTIC MEMBRANE,

COVERED ON ITS POSTERIOR BY ENDOTHELIUM

THE PRIMARY MECHANISME CONTROLLING STROMAL

HYDRATION IS A FUNCTION OF THE CORNEAL ENDOTHELIUM

ENDOTHELIAL CELLS BECOME LESS IN NUMBER WITH AGE

AND INDIVIDUAL CELL ENLARGE TO COMPENSATE

 THE CORNEA IS SET INTO THE SCLERA LIKE A

WATCH GLASS SO THAT THE LATTER OVERLAPS THE CORNEA ALL AROUND THE PERIPHERY; THE JUNCTION OF THE TWO TISSUES
IS KNOWN AS THE LIMBUS
THE

CORNEA IS VERY RICHLY SUPPLIED WITH

NERVE FIBERS DERIVED FROM THE
TRIGEMINAL AND IT HAD NO BLOOD VESSEL

LINING THE INNER

ASPECT OF THE
SCLERA ARE TWO
STRUCTURES :
THE HIGHLY
VASCULAR UVEAL
TRACT
CONCERNED
CHIEFLY IN
NUTRITION OF THE
EYE

A NERVOUS
LAYER, THE TRUE
VISUAL NERVE
ENDING ONCERNED
IN THE RECEPTION
AND
TRANSFORMING OF
LIGHT STIMULL
CALLED THE
RETINA

THE UVEAL TRACT CONSIST OF THREE PARTS, WHICH

THE TWO POSTERIOR, THE CHOROID, AND CILIARY
BODY, WHILE THE ANTERIOR FORMS A FREE CIRCULAR
DIAPHRAGM : THE IRIS
THE APERTURE OF THE DIAPHRAGM IS THE PUPIL
SITUATED BEHIND THE IRIS AND IN CONTACT WITH THE
PUPILLARY MARGIN IS THE CRYSTALLINE LENS

THE ANTERIOR CHAMBER IS A SPACE FILLED

WITH FLUID, THE AQUEOUS HUMOR; IT IS
BOUNDED IN FRONT BY THE CORNEA, BEHIND BY
THE IRIS AND THE PART OF THE ANTERIOR
SURFACE OF THE LENS WHICH IS EXPOSED IN THE
PUPIL

ITS PERIPHERAL RECESS IS KNOWN AS

THE ANGLE OF THE ANTERIOR
CHAMBER, BOUNDED POSTERIORLY BY
THE ROOT OF THE IRIS AND THE
CILIARY BODY AND ANTERIORLY BY
THE CORNEOSCLERA

IN THE INNER LAYER OF THE SCLERA AT

THIS PART THERE IS A CIRCULAR VENOUS
SINUS, CALLED THE CANALIS SCHLEMM GREAT IMPORTANT - IN THE DRAINAGE OF
THE AQUEOUS HUMOR

AT THE PERIPHERY OF
THE ANGLE BETWEEN
THE CANAL SCHLEMM
AND THE RECESS OF THE
ANTERIOR CHAMBER
THERE LIES A LOOSELY
CONSTRUCTED
MESHWORK OF TISSUES,
THE TRABECULAR
MESHWORK

THERE ARE TWO UNSTRIPED MUSCLE WHICH

CONTROL THE MOVEMENTS OF THE PUPIL
THE SPHINCTER PUPILAE
A CIRCULAR BUNDLE RUNNING ROUND THE PUPILLARY
MARGIN; IS SUPPLIED BY MOTOR NERVE FIBERS DERIVED
FROM THE OCULOMOTOR NERVE

THE

DILATATOR PUPILLAE
ARRANGED RADIALLY NEAR THE ROOT OF THE IRIS. THE
MOTOR NERVE FIBRES ARE DERIVED FROM THE CERVICAL
SIMPHATHETIC CHAIN

THE INNER SURFACE OF THE CILLIARY BODY

IS DIVIDED INTO TWO REGION

THE PARS PLICATA

THE PARS PLANA

THE ANTERIOR PART WHICH IS CORRUGATED WITH A

NUMBER OF FOLDS
THE POSTERIOR PART WHICH IS SMOOTH

THE CHIEF MASS OF THE CILLIARY BODY IS

COMPOSED OF THE UN-STRIPED MUSCLE FIBERS CALLED - THE CILLIARY MUSCLE
THE CILLIARY BODY EXTENDS BACK WARD AS FAR
AS THE ORA SERRATA, AT WHICH POINT THE
RETINA BEGINS ABRUPTLY

THE CHOROID IS EXTREMELY VASCULAR MEMBRANE IN

CONTACT EVERY WHERE WITH THE SCLERA. THERE IS A
POTENTIAL SPACE BETWEEN THE TWO STRUCTURE CALLED - THE EPICHOROIDAL SPACE
THE INNER SIDE THE CHOROID IS COVERED BY A THIN
ELASTIC MEMBRANE - CALLED- THE LAMINA VITERA OR
MEMBRANA OF BRUCH

THE RETINA CONSISTS OF 10 LAYERS

1. PIGMEN EPITHELIUM
2. LAYER OF ROD AND CONES
3. EXTERNAL LIMITING
MEMBRANE
4. OUTER NUCLEAR LAYER
5. OUTER PLEXIFORM LAYER
6. INNER NUCLEAR LAYER
7. INNER PLEXIFORM LAYER
8. GANGLION CELL LAYER
9. OPTIC NERVE FIBER
LAYER
10. INTERNAL LIMITING
MEMBRANE

AT THE POSTERIOR
POLE OF THE EYE
WHICH IS SITUATED
ABOUT 3 MM TO THE
TEMPORAL SIDE OF
THE OPTIC DISC, A
SPECIALLY
DIFFEREN-TIATED
SPOT IS FOUND IN
THE RETINA, THE
FOVEA CENTRALIS, A
DEPRESSION OR PIT,
AND IN HERE ONLY
CONES ARE PRESENT
IN THE NEURO
EPITHELIAL LAYER

THE FOVEA IS THE

MOST SENSITIVE PART
OF THE RETINA, AND IT
IS SURROUNDED BY A
SMALL AREAS, THE
MACULA LUTEA OR
YELLOW SPOT.
WHICH ALTHOUGH NOT
SO SENSITIVE, ITS
MORE SENSITIVE THAN
OTHER PARTS OF THE
RETINA
AT THE OPTIC DISC THE
FIBERS OF THE NERVEFIBER LAYER PASS INTO
THE OPTIC NERVE

THE LENS IS A BICONVEX MASS OF PECULIARLY

DIFFERENTIATED EPITHELIUM, IT IS SURROUNDED BY A
HYALINE MEMBRANE, THE LENS CAPSULE, IT IS HELD IN
PLACE BY THE SUSPENSORY LIGAMENT OR ZONULES OF
ZINNI CONSISTS BUNDLE OF STRANDS WHICH PASS FROM
THE SURFACE OF THE CILLIARY BODY TO THE CAPSULE

THERE IS A TRIANGULAR SPACE BETWEEN THE BACK OF

THE IRIS AND THE ANTERIOR SURFACE OF THE LENS AND
ITS BOUNDED ON THE OUTER SIDE BY THE CILLIARY BODY
- CALLED - THE POSTERIOR CHAMBER AND CONTAINS
AQUEOUS HUMOR

BEHIND THE
LENS THERE IS
LARGE VITREUS
CHAMBER
CONTAINING THE
VITREUS
HUMOR, A JELLY
LIKE MATERIAL,
CHEMICALLY OF
THE NATURE OF
INNERT GEL
CONTAINING A
FEW CELLS AND
WANDERING
LEUCOCYTES

DURING ACCOMODATION
THE CILIARY MUSCLES CONTRACTS
DRAWING TOWARD THE CHOROID
RELAXING THE SUSPENSORY LIGAMENT
DIMINISHES THE TENSION OF LENS
CAPSULE
INCREASE THE CONVEXITY OF THE LENS

PHYSIOLOGY OF THE EYE

MECHANISM OF ACCOMODATION.

THE LENS IS AN ELASTIC

STRUCTURE WHEN RELASE FROM
THE FLATTENING INFLUENCE OF ITS
SUSPENSORY LIGAMENT TENDS TO
ASSUME A SPHERICAL SHAPE

CIRCULATION OF THE
AQUEOUS HUMOR
AS THE GREATER
PART OF FLUIDS IS
FORMED IN THE
CILLIARY REGION,
IT IS SECRETED
INTO POSTERIOR
CHAMBER, IT FLOWS
FROM THE
POSTERIOR
CHAMBER THROUGH
THE PUPIL INTO THE
ANTERIOR CHAMBER
AND ESCAPES
THROUGH THE
DARINAGE
CHANNELS AT THE
ANGLE, AND THEN
INTO THE
EPISCLERAL VEIN

THE INTRA OCULAR PRESSURE

(IOP)
PROLONGED CHANGES ARE ESSENTIALLY
CAUSED BY TWO FACTORS :
AN ALTERATION IN THE FORCES
DETERMINING THE FORMATION OF THE
AQUEOUS
ALTERATIONS IN THE RESISTANCE TO ITS
OUTFLOW
FROM THE CLINICAL POINT OF VIEW, THE
LATTER IS THE MORE IMPORTANT

A RISE IN THE IOP MAY BE CAUSED BY AN

INCREASE IN THE PRESSURE IN THE
EPISCLERAL VEIN OR BY ANY PROCESS
WHICH BLOCKS THE SEEPAGE OF AQUEOUS
INTO THE CANAL OF SCHLEMM, SUCH AS
SCLEROSIS OF THE TRABECULAE OR THEIR
OBSTRUCTION BY EXUDATES OR ORGANIZED
TISSUE
GLAUCOMA

THE IOP PRESSURE

THE IOP NORMALLY
VARIES FROM 10 TO 20
MM HG
IT IS ACCURATELY
MEASURED BY A
MANOMETER
CLINICALLY BY
TONOMETRY