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oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni

Subject: Ophthalmology Topic: Anatomy of the eye
Date: June 19, 2008 Lecturer: Trans Group: juday and forever friends

ORBIT • The lid margins contain a muco-cutaneous border, the
• The socket that is intended to house the eyeball for which grayline, 3 rows of lashes or cilia, the opening of the
protection and space for its movement are provided meibomian glands, & the superior & inferior punctum
• The space through which the muscles, the blood vessels • An incision made along the grayline will split the lids into
and nerves going to the eyeball pass through a posterior part containing the tarsal plate & conjunctiva
• The cavity of the orbit is roughly quadrangular pyramid and an anterior part containing the orbicularis oculi
lying on its side muscle, skin, & hair follicles
• Has a roof, medial, & lateral sides, a floor, an apex • Opening into the follicle of each cilium are the ducts of
pointing to the midcranium, & a base forming the bony the sebaceous gland of Zeiss and the modified sweat
margin of the face gland of Moll
• There are many pain fibers near the lid margin making
• The entire cavity is lined with periosteum called
that portion the most sensitive part of the eyelid
periorbita, which extends anteriorly to the tarsus and • Behind the subcutaneous connective tissue are the
canthal ligaments forming the orbital septum
muscles of the eyelids: orbicularis oculi, levator palpebrae
• The entire orbital contents are completely enclosed
superioris, & the palpebral smooth muscle of Muller
except at the palpebral fissures Orbicularis oculi – innervated by CN VII; has two parts:
• Traversed by fibrous extensions from the periosteum peripheral orbital part which serves to squeeze the eyelid shut
(orbital fascia) that divides it into 4 compartments and the central palpebral part that is necessary for the
• Pathway for CN II, III, IV, V, VI involuntary blinking
Levator palpebrae superioris – closely related to the
4 compartments or the orbit: superior rectus muscle in its origin and course; innervated by
CN III
1. SUBPERIOSTEAL SPACE Superior & Inferior palpebral muscles of Muller –
• Potential space between periorbita and bone supplied by sympathetic nerves
• At the apex, the periorbita is firmly attached to the
dural sheath of the optic nerve; in front it becomes
• Tarsus – plate of fibroelastic tissue that gives form to the
continues with the periosteum over the forehead and eyelids; contains parallel rows of sebaceous glands
face (meibomian glands)
• Between these attachments, the periorbita is readily • Blood supply: lacrimal and ophthalmic arteries; wide
peeled off from the bone, thus facilitating the anastomosis provided by branches of the external carotid
surgical removal of orbital contents – exenteration artery through the facial, superficial temporal, and
2. MUSCLE CONE infraorbital arteries
• Space formed by the recti muscles and their
intermuscular membranes with Tenon’s capsule • Venous return: into the cavernous sinus or into the
• Aka: central surgical space internal jugular vein via te superior & inferior ophthalmic
• The base of this cone is the posterior part of the veins
eyeball, while its apex is towards the optic foramen • Lymphatics: medial 2/3 of lower lid & medial 1/3 of
• Tumors or growth in this space will proptose the upper lid drain into the submaxillary lymph glands;
eyeball directly forward lateral 1/3 of lower eyelid & lateral 2/3 of upper lid drain
3. PERIPHERAL SURGICAL SPACE into the peri-auricular lymph glands
• Space located between the periorbita and the muscle • CN V (first or ophthalmic division) provides sensory
cone innervationto the upper lid and lateral portion of lower
• Limited anteriorly by the orbital septum, the canthal lid. Remaining portion innervated by the maxillary
ligaments, & the condensation of the Tenon’s capsule division through the infraorbital nerve.
• This space contains the orbital fat that serves as a
cushion for the eyeball and its delicate structures LACRIMAL APPARATUS
• Any effusion of fluid or blood into this space Secretory - produces tears and pre-corneal film which is
produces an early lid swelling of both upper and formed by a deep mucoid-mucin, a middle watery-tears
lower eyelids (thickest layer), & superficial oily secretion
• However, chronic fatty swelling may produce Excretory - provides the normal passageway for the
proptosis as in thyrotrophic exophthalmos conduction of tears from the conjunctival cul-de-sac to the
4. EPISCLERAL SPACE inferior meatus of the nose
• The potential space between the sclera and Tenon’s
capsule SECRETORY SYSTEM
Two types:
EYELIDS 1. BASIC SECRETORS
• Nature’s curtain which consist of skin, subcutaneous • Mucin secretors – conjunctival goblet cells, crypts of
tissue, muscles, tarsus, & conjunctiva Henle, & glands of Manz
• Not only to protect the globe from external injury & • Lacrimal secretors – exocrine glands in the
excessive light but also to distribute tears uniformly over subconjunctival tissue: glands of Krausse & glands of
the anterior surface of the eye Wolfring
• The skin is thin and elastic, joined to the underlying • Oily secretors – made up of meibomian glands,
muscle by loose areolar tissue, which makes this area glands of Zeiss, & glands of Moll; oily layer lessens
prone to ecchymosis and excessive swelling the evaporation of the watery layer of the tears
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oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni

Subject: Ophthalmology Topic: Anatomy of the eye
Date: June 19, 2008 Lecturer: Trans Group: juday and forever friends

CORNEA
• Transparent anterior structure of the eye
2. REFLEX SECRETORS • This is the major refracting structure of the eye
• Are the amin lacrimal gland in the upper temporal (estimated total power 40 diopters)
portion of the orbit and the adjacent palpebral gland • The cornea forms part of the boundary in the anterior
• Exocrine glands that have efferent parasympathetic chamber angle
nerve supply
• Serous acinous glands similar to the salivary glands
• Infections and inflammations in the anterior chamber
• Always involved primarily in true hypersecretion area can produce fibrosis attaching the cornea to the iris
and commonly called anterior synechiae (similarly, the
iris can produce attachments to the anterior lens capsule
Schirmer’s test – standard in secretion test
and is called posterior synechiae)
Schirmer’s I – test the basic secretion; with anesthetic
• Layers of the cornea:
Schirmer’s II – test for reflex secretion; without anesthetic
1. epithelium
EXCRETORY SYSTEM • Anteriormost layer of the cornea near the tear film
a. lacrimal pump – consists of the movements of the • It regenerates in 24-72 hours & responsible for
orbicularis oris muscles to direct the flow of tears to the maintaining corneal hydration anteriorly
punctal area in the nasal side of the eye • If destroyed by trauma, infections & inflammations,
b. superior & inferior punctum – opening of the drainage corneal edema amy be evident that may extend up
system to the stromal layer
c. ampulla 2. bowman’s membrane
d. superior & inferior cannaliculus – 8mm 3. corneal stroma or substancia propria
e. common cannaliculus – present in 80% of individuals • 90% collagen; 5% cells (keratocytes & 5%
f. lacrimal sac – 10mm mucopolysaccharides
g. nasolacrimal duct (NLD) – 12mm; runs between the • thickest part of the cornea
anterior & posterior lacrimal crests of the lacrimal bone in 4. descemet’s membrane
the medial wall of the orbit; exits in the inferior meatus 5. endothelium
of the nose • a monolayer of mesodermal cells
h. valve of Rosenmuller – one way valve found between the • innermost layer of the cornea
common cannaliculus & lacrimal sac • responsible for maintaining deturgescence by acting
i. valve of Hassner – one way valve between the NLD & as a mechanical barrier & as a pump wherein it is
inferior meatus responsible for exchange of water and electrolytes
between the cornea and the aqueous humor
CONJUNCTIVA • Has a rich sensory nerve supply, which is part of the
• mucosal lining of the inner part of the lids & anterior protective mechanism of the eye. Thus pain is the most
portion of the eyeball common symptom of corneal dse.
• has 2 divisions: palpebral & bulbar portion separated by • Avascular and it is entirely dependent on air and tears
the fornix anteriorly & aqueous humor posteriorly for its nutrition
• palpebral portion has 3 sections:
marginal – groove near the lid margin to which it is ANTERIOR CHAMBER
adherent Angle structures:
tarsal – vascular portion attached to the tarsus 1. Schwalbe’s line – most anterior part of the angle; it
orbital - which is loosely connected to the palpebral is the posterior part of the cornea at the area of the
muscle limbus
• bulbar portion – thin layer that overlies the Tenon’s 2. Anterior TM – nearest the cornea; angles are closed
capsule but becomes fixed to it near the limbus if it’s only the TM (trabecular meshwork) structure
• has an epithelium of non-keratinized cells varying from 3- seen in angle examination (gonioscopy)
5 layers thick 3. Posterior Tm – angles are open if this area is viewed
clearly in gonioscopy
GLOBE 4. Scleral spur – part of the posterior sclera seen in the
• the anterior one third of the globe externally is occupied posterior angle
by the cornea and the posterior 2/3 is the sclera 5. Iris processes – peripheral part of the iris that
attaches to the scleral spur
• the junction of the two structures is called limbus, which
6. Ciliary body – longitudinal muscles and part of the
is the anatomical location of the trabecular meshwork ciliary body are seen as the most posterior part of
internally the angle
• limbusthe average axial length is 23.5mm. longer axial *pars plicata – w/ ciliary epithelium & muscle
lengths can produce myopia and shorter lengths can *pars plana – no structures like muscles; just
produce myopia and shorter lengths can produce connects ciliary body & uveal tract
hyperopia. Normal lengths are called emmetropias. *ciliary muscles – constricted with use of pilocarpine
• The central/paracentral area (spherical) is where the light
bends TRABECULAR MESHWORK
• Light does not bend in the peripheral area (flat) • The main site of the drainage of aqueous humor
• Three layers that make up the meshwork:
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oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni

Subject: Ophthalmology Topic: Anatomy of the eye
Date: June 19, 2008 Lecturer: Trans Group: juday and forever friends

1. uveal meshwork • Innermost layer of the eye
2. corneoscleral meshwork • A delicate structure where the image of the objects from
3. cannalicular meshwork – studies on open angle the outside world is focused and converted into a nerve
glaucoma determined this structure as the main site impulse which is transmitted to the visual center of the
of obstruction brain
• The photoreceptors or visual cells which receive the light
PATHWAY OF AQUEOUS HUMOR FLOW energy are located at the posterior portion of the retina
a. Non-pigmented epithelium of the ciliary body • Light consequently has to traverse the whole thickness
b. Posterior chamber of the retina in order to reach the visual cells which
c. Pupil converts the light energy to the electrical energy of the
d. Anterior chamber nerve impulse
e. Trabecular meshwork • Layers of the retina:
f. Schlemm’s canal a. Inner limitng membrane – closest the vitreous body
g. Episcleral vessels b. Nerve fiber layer – contains the axons of the optic
nerve
*milky color of the aqueous humor may be 2O to inflammation c. Ganglion cell layer – cell body of the optic nerve
*increase intraocular pressure may cause blurred vision axons and displaced amacrine cells
d. Inner plexiform layer – axons of bipolar cells;
LENS transmits signals vertically
• Crystalline biconvex soft structure behind the iris-pupil e. Inner nuclear layer – nuclei of bipolar, horizontal and
diaphragm and in front of the vitreous body. amacrine cells
• Composed of central hard nucleus (older lens fibers) and f. Outer plexiform layer – rods and cones axons
a peripheral soft cortex (newer lens fibers) enclosed by a g. Outer nuclear layer – cell bodies of rods and cones
capsule h. Potoreceptor layer
• Held in position by zonular fibers coming from the ciliary • RODS – responsible for night vision and spatial
body that fused with the capsule at the region of the orientations; numerous throughout the retina;
equator occupies most of the peripheral retina
• It contributes 20 diopters of refractive power • CONES – responsible for acute and color vision
• Parts include the following: i. Retinal pigment epithelium – involved in the
a. Anterior capsule phagocytosis of the outer segments of the rods and
b. Lens epithelial cells – beneath the anterior capsule & cones (rods before sunrise and cones at sunset) and
is responsible for the growth of lenticular fibers is also involved in the vitamin A cycle where it
c. Lens stroma – anterior & posterior cortex and isomerizes all trans retinal to 11 cis retinal that are
nucleus used by photoreceptors; also serves as the external
d. Posterior capsule mechanical barrier for blood flow from the
choriocapillaries to the retina and maintains
CHOROID homeostasis in the retina by supplying small
• Layer anterior to the posterior sclera and the posterior molecules such as ascorbic acids and glucose
part of the uveal tract (iris, ciliary body, choroids) j. Outer limiting membrane
• Contains the blood supply to the retina
Muller cells - glial cells that run almost through the entire
VITREOUS HUMOR length of the retina (ganglion cells to layers of rods and
• Clear, gel-like structure that occupies the posterior cones); provides nutritive and physical support to retinal
spacein front of the retina structures and recently been described as ‘nature’s fiber
• Strong attachments are seen in the following structures: optics’ due to its ability to transmit light through the
a. Vitreous base thickness of the retina to the rods and cones pesteriorly
b. Optic disc
c. Macula • Parts of the retina:
d. Blood vessels a. Ora serrata – anteriormost part of the retina near the
• Retina tears and detachments are often seen in these pars plana of the ciliary body; can be seen with the
areas in case of trauma, aging, dystrophies, use of a gonioscope
degenerations, & high myopia b. Equator of the eye – middle part of the retina; can
• Opacities are sometimes observed in this structure due to be seen wit the use of indirect ophthalmoscope
deposition of inflammatory cells in endophthalmitis and c. Posterior pole – most posterior part of the retina;
posterior uveitis, calcium (asteroid hyalosis) in can be seen with the use of direct & indirect
hypercalcimic conditions and cholesterol deposit ophthalmoscope
(synchisis scintillans) in hypercholesterolemic • Macula – central part of the posterior pole
conditions which can cause blurring of vision responsible for acute vision; central part is
• TORCH - TOxoplasma, R, Chlamydia, H ;causes called the fovea (its center is known as foveola)
congenital glaucoma • Optic nerve head – 1.5mm in diameter and
• Syneresis (??) – liquefaction of vitreous humor located 2.5 disc diameter from the macula;
bleedingcauses blurring of vision where all nerve fibers exit
• Central retinal arteries and veins
RETINA  Superior temporal vessels
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oldie.Buff.Mona.AM.Maan.Adi.KC.Peng.Karla.Alphe.Aaron.Kyth.Anne.Eisa.Kring.Candy.Isay.Marco.Joshua.Fars.Rain.Jassie.Mika.Shar.Erika
.Macky.Viki.Joan.Precious.Kate.Katrina.Ams.Memay.Pau.Rachelle.Esther.Joel.Glenn.Toni

Subject: Ophthalmology Topic: Anatomy of the eye
Date: June 19, 2008 Lecturer: Trans Group: juday and forever friends

 Inferior temporal vessels • Optic radiations to the occipital lobe – when the
 Nasal vessels radiations from the parietal & temporal lobes meet as it
 Papillomacular approaches the visual cortex, the defect can be a
• Cottonwood spots – non-profused areas of the retina; quadrantanopsia or a congruous hemianopsia
pale retina with cherry red spot (CRAO-central retinal • Visual cortex – a quadrantanopsia if the lesion is above or
artery occlusion) below the calcarine fissure; a congruous hemianopsia if
• Macula divides into temporal and nasal visual fields; the lesion is the left or right visual cortex; macular
retinal nerve divides the structures into temporal & nasal sparing which are often seen in lesions of the cisual
sides cortex are due to predominance of macular fibers of the
tip of the visual cortex & its dual supply (middle &
OPTIC NERVE posterior cerebral artery) sparing them from damage in
Parts: the mild to moderate ischemia of the occipital cortex;
a. Intraocular ON – 1.75mm in length and is divided complete hemianopsia if it affects the whole half of the
into 3 layers: visual fields of both eyes
• Prelaminar layer – central part of the head is
called the optic cup, which is devoid of nerve
fibers & vessels. Enlargement of this area may
be 2O apoptosis of nerve fibers in glaucoma and
ischemic optic neuropathies
• Laminar layer – oriented beside the lamina
cribrosa of the posterior sclera
• Postlaminar layer – thickening of the diameter to
3-4mm 2O to myelination of the optic nerve
b. Intraorbital ON – 25-30mm in length
c. Intracannalicular ON – 5-6mm in length; adherent of
the dura of the optic canal; site of injury in direct
and indirect trauma of the orbit
d. Intracranial ON – 10-12mm; unites as optic chiasm
just above the pituitary gland

VISUAL PATHWAY
• Nerve fiber layer of the retina
1. superior arcade – retinal lesions in this area can
produce unilateral inferior defect
2. inferior arcade – unilateral superior field arcuate
defect
3. nasal fibers – temporal wedge defect
4. papillomacular bundle – central (<5 degrees in field)
& paracentral (10-15 degrees) visual field defect;
involvement of the papillomacular & inferior or
superior bundles can produce altitudinal field defect
(superior or inferior half of field)
• Optic nerve – unilateral visual field loss
• Optic chiasm – bitemporal hemianopsia; junctional
scotoma wherein there is a visual loss of one eye &
superotemporal quadrant of the other eye secondary to
compression of one side of the chiasm where inferonasal
fibers of the less involved eye as it crosses the chiasm
travels a short distance posteriorly as Willbrand’s knee
• Optic tract – posterior to the chiasm & produce an
incongruous hemianopsia (temporal loss: laterality of the
hemianopsia and nasal VF loss: laterality of the lesion in
the optic tract); visual pathway field loss respects the
vertical meridian, crossing the macular area or central
field while optic nerve fiber type defects respects the
horizontal meridian and oriented/connected with the
physiologic blindspot. One way to identify lesion in this
area is presence of relative afferent pupillary defect
(RAPD or Marcus Gunn pupil)
• LGB of the thalamus
• Optic radiations to the parietal lobe – pie on the floor
effect
• Optic radiations to the temporal lobe – pie in the sky
defect
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