You are on page 1of 115

Anatomy & Embryology of the

EYE

Dr. Tonjun B. Espino
Diplomate in Ophthalmology
Overview
External Eye
Eye lids and lashes
Lacrimal System
Conjunctiva and sclera
Bony Orbit
Sinuses
Eyeball
Cornea
Aqueous humor
Iris and pupil
Lens
Uveal tratc
Choroid
Vitreous
retina
Overview
Extra-ocular muscles
Movement and action
Innervation
Embryology
Schematic drawing of the Eye
External Eye
The external eye can be
considered to be all that
you see when looking at an
eye externally. This can
include the eyebrows,
eyelids, eyelashes,
conjunctiva, and
sclera. Although the iris
and cornea are visible, they
are also part of the anterior
chamber of the eyeball.
The eyebrows consist of hairs that horizontally line
the junction between the forehead and the upper
eyelid. They can serve a protective function when
the eyelids squint or are closed. Eyebrows also serve
a major roll in facial expression. Movement of the
eyebrow is controlled by the frontalis, corrugator
supercilia, and orbicularis oculi muscles. Innervation
of these muscles comes from the seventh cranial
nerve.
The Eyelids and Eyelashes
The medical term for
eyelids is
palpebrae. The basic
function of eyelids is to
protect the eyeball from
foreign matter and from
too much light. The
eyelids play a major roll
in the lubrication of the
external eye.
The vertical opening
between the upper and
lower lids is called the
palpebral fissure. The
size of this opening
plays a role in the
evaluation of the
condition of the lids,
contact lens fitting, and
evaluation of proptosis.

The juncture of the upper and lower lids is
called the canthus. The juncture that is
toward the nose is called the medial
canthus. The juncture toward the ear is called
the lateral canthus. These are landmarks that
serve as points of reference. For example,
"the patient complains of irritation at the
medial canthus." In the medial canthus is a
small area called the caruncle.
The caruncle has sebaceous (oil) glands that
contribute to the tear layer. It has small hairs
that serve to trap foreign matter. Next to the
caruncle is the plica semilunaris (half-moon
shape) which forms the junction of the
conjunctiva in the medial canthus.

In their normal positions, the
upper and lower lids should
cover 1-2 mm of the upper and
lower cornea respectively. If the
resting position of the upper lid
lags lower than normal, the
condition is called "ptosis". If
the resting position of the lower
lid lags lower than the limbus,
the condition is called "scleral
show". The lids should be able
to close together when blinking,
if they cannot the condition is
called "lagophthalmos".
The anterior portion of the upper
eyelid is made up of skin and the
obicularis oculi muscle, which lowers
the lid. The antagonist of the
obicularis oculi muscle is the levator
palpebrae superioris muscle (not
pictured), which raises the lid.
The posterior side of the lid is formed
by the tarsus and the palpebral
conjunctiva. The posterior side of the
lid has meibomian glands which duct
to the lid margin. These tarsal glands
supply the oil layer of the tear film.
Eyelids
Palpebral fissure: 12 mm. H, 30 mm. W
Epicanthal fold: vertical tag of skin.
Glands:
Glands of Zeiss: sebaceous w/c open to follicles of
cilia
Glands of Moll: sweat glands
Skin: thinnest in body
Eyelids
Muscles:
Orbicularis oculi: closure of lids: CN VII
Levator Palpebra Superioris: CN III: elevates lid
Muller muscle: sympathetic system to elevate lid
Palpebral smooth muscle
Eyelids
Tarsal Plates: 1mm thick 25 to 30 mm long.
Upper lid: 11 mm H
Lower lid: 5 mm H
Provides framework and contour of lid.
The Lacrimal Secretory System
The Tear Film The tear film covers the corneal epithelium
and the conjunctiva, and it has the following functions:It is the
initial refractive interface of the eye. In order to provide
optimum optical performance, the tear film must be clear and
perfectly smooth. It provides metabolic functions to the outer
corneal tissues, bringing nutrients and oxygen, and carrying
away waste products. It provides some antibacterial proteins
that serve as a barrier to disease for the cornea and
conjunctiva. It provides moisture for the epithelial cell layers
of the cornea and for the conjunctiva.
The tear film has three layers:
The lipid (oily) layer is the outermost layer. It
is produced by the meibomian glands of the
eyelids. This layer retards evaporation of the
tears and promotes a smooth surface area.
The aqueous layer is the middle layer of the tear
"sandwich". This layer provides the bulk of the tear
volume and serves to transport nutrients and oxygen
to the outer corneal tissues. It is produced by the
lacrimal gland and by the accessory lacrimal glands in
the conjunctiva. The lacrimal gland produces
"reflexive" tears. These are the tears that flood the
eye when there is irritation to the cornea or an
emotional disturbance (crying).
Mucins play a role in tear film stability and they can be found
in different concentrations in the aqueous layer. The highest
concentration of mucins, forming the "mucin layer", is found
at the corneal surface, next to the corneal epithelium. Mucins
are produced by goblet cells in the conjunctiva. The corneal
epithelial cells produce a substance called glycocalyx that bind
the mucin cells to the corneal epithelial cells. It is this mucin
binding that creates a smooth sheet of tear film on the
corneal surface. Any disruption in this binding causes a break
up in the tear film, as measured by "tear break up time". A
break up of the tear film causes dry eye symptoms and
inflammation of the cornea.
The Lacrimal Excretory (tear drainage)
System
The tears are distributed over the
external eye by the motion of the
eyelids. The tears move toward
the medial canthus where the
tear drainage system begins. The
punctum is a small hole on the lid
margin of the upper and lower
lids, near the medial
canthus. Tears pass through the
punctum into the canaliculus
(superior and inferior), which is a
canal that empties into the
nasolacrimal sac.
From the nasolacrimal sac, the tears drain
through the nasolacrimal duct which opens
into the nasal passage. From the nose, the
tears drain down the back of the throat. Some
patients will notice that they can "taste" eye
drops as they drain through the nose and
down the throat.
The Conjunctiva
The bulbar conjunctiva is a vascular mucous
membrane that covers the anterior globe up to the
corneal limbus. The epithelial layer of the
conjunctiva is actually continuous with the epithelial
layer of the cornea. The normal bulbar conjunctiva is
clear and loose fitting, with blood vessels running
through it. Goblet cells in the conjunctiva produce
mucins which lubricate the external eye and play an
important role in the makeup of the tear layer on the
cornea.
The conjunctiva reacts to irritation and
infection by becoming red, which is termed
"hyperemia", or "hyperemic". If the condition
is severe, the conjunctiva may swell, becoming
"chemotic", or demonstrating
"chemosis". The conjunctiva can also produce
excess mucus and/or pus, which in general is
termed "exudation" or "discharge".

The palpebral conjunctiva is attached to the
tarsal plate of the eyelid. It is not loose fitting
like the bulbar conjunctiva. The palpebral
conjunctiva is continuous with the bulbar
conjunctiva. The junction of the two forms
two pockets called the superior fornix and the
inferior fornix or cul de sac.
Sclera
It is a tunic coat which forms the fibrous layer
of the eyeball. Function is protection.
It is 1mm thick but thinner at muscle
insertions.
The sclera is covered by the tenons capsule
and the conjunctiva to which it is joined by the
episclera.
Sclera

Bony Orbit
The anatomy of the
medial orbital wall.
Key: ALC, anterior
lacrimal crest; LF,
lacrimal fossa; PLC,
posterior lacrimal
crest; LP, lamina
papyracea; AEF,
anterior ethmoidal
foramen; PEF, posterior
ethmoidal foramen;
OC, optic canal; MES,
maxilloethmoid suture.
The bony orbit provides protection for the
eyeball. The orbit is shaped roughly like a
pyramid, with the base of the pyramid at the
front (on the face) and the apex in the back
(toward the brain). The orbit is lined by fatty
tissue, which provides lubrication for
movement within the orbit. The eyeball is
suspended by the extraocular muscles within
the orbit.
There are four basic regions to the orbit: the roof, the floor, the medial
wall, and the temporal wall. There are 7 bones that make up the
orbit. Unfortunately for test takers, the bones are not nicely divided into
regions. As shown on the schematic below, the orbital bones connect
together like a puzzle. The 7 bones are as follows, and are identified on
the schematic by colors and their first letters.
frontal
maxilla
zygoma
sphenoid
ethmoid
lacrimal
palatine

Right orbit
The white circle on the schematic
indicates the location of the
orbital rim. Notice that the
sphenoid bone (green) has two
"wings", the greater wing and the
lesser wing. The hole (black) in the
lesser wing is the optic foramen,
through which the optic nerve
and the ophthalmic artery
pass. The space (black) between
the two wings of the sphenoid is
the superior orbital fissure,
through which pass cranial nerves
III, IV, V, and VI.
The regions of the orbit
The floor - Three bones make up the floor: the
maxilla (or maxillary), the zygoma (or zygomatic), and
the palatine. The maxillary bone occupies the most
space on the floor. The orbital floor is the weakest
region of the orbit. A concussive force, such as a fist
to the eye, can fracture the orbit floor and entrap the
inferior rectus muscle. The is called a blow-out
fracture.
A blow-out fracture is characterized by a history of
concussive trauma, swelling of the soft tissues of the
orbit, and the inability of the eye to look upward due
to the entrapped inferior rectus muscle.
The regions of the orbit
The roof - The frontal bone forms the roof of the
orbit.
The medial wall - Four bones make up the medial
wall of the orbit: the maxilla, lacrimal, ethmoid, and
sphenoid (lesser wing) bones.
The lateral wall - The zygomatic bone makes up the
anterior lateral wall, and the greater wing of the
sphenoid bone makes up the posterior lateral
wall. The zygoma is also part of the jaw.
Openings in the orbit
Optic foramen (or optic canal) - The
optic nerve enters the eye through
the optic foramen, which is a hole at
the apex (back) of the orbit.
Orbital fissures - The superior and
inferior orbital fissures are "cracks" at
the back of the orbit. These are
shown as black areas in the center.
Cranial nerves III, IV, V, and VI, and the
superior ophthalmic vein pass
through the superior fissure. The
inferior ophthalmic vein passes
through the inferior fissure.

Openings in the orbit
Supraorbital foramen - There is a
hole at the top of the orbit which
is called the superorbital
foramen, which is more like a
notch located just under the
eyebrow. The supraorbital nerve,
the supraorbital artery, and the
supraorbital vein pass through
this notch.
Infraorbital foramen - This is a
hole in the high cheek area
through which pass the
infraorbital nerve, the infraorbital
artery, and the infraorbital vein.
Sinuses
The paranasal sinuses are air filled spaces within the
bones of the face. The spaces open into the nasal
cavity and they surround the orbit except on the
temporal side. In the x-ray image below, the orbits
are identified with the letter "O", the maxillary
sinuses are labeled with "M", and the ethmoid
sinuses are labeled with "E". Sphenoid and frontal
sinuses are not shown. Inflammation, blockage, and
drainage of the sinuses are commonly associated
with allergies and colds.
Sinus: coronal View CT scan
Globe: Introduction
The anterior segment of the eye includes the lens of
the eye and every structure anterior to the lens. This
would include the lens, the iris, the anterior
chamber, the ciliiary body, and the cornea. The
anterior segment can be divided into two chambers,
the anterior chamber and the posterior
chamber. The anterior chamber contains all
structures anterior to the iris, but the term is often
used to refer only to the space that contains
aqueous. The posterior chamber contains the lens.
Globe: Introduction

Globe: Introduction
The posterior segment of the eye includes structures
posterior to the lens. This includes the vitreous, the
retina, the optic nerve, the choroid, and the
posterior sclera. The area that is occupied by the
vitreous is sometimes referred to as the posterior
chamber. Therefore, we have some potential
terminology confusion. The posterior chamber of
the anterior segment contains the lens. The
posterior chamber of the posterior segment contains
vitreous
Cornea
The cornea is the window to the eye. It is
analogous to the front lens of a multi-element
camera lens. It is a five layer tissue structure
that is remarkable in that it is crystal clear in
its normal state. The cornea provides two-
thirds of the refractive power of the eye,
about 42 diopters. Diopter is unit of refractive
power.
Cornea
The horizontal diameter of the cornea is about
12mm and the vertical diameter is about
11mm. The cornea is thicker at the edge,
about 1mm, than it is in the center, about
.53mm. The shape of the cornea is not
spherical, it is aspherical, meaning the shape
is steeper at the center and it flattens out
toward the edge. The steep central portion is
called the corneal cap and it is about 4mm
wide.
Cornea

Cornea
The shape of the corneal cap is what is measured by
the keratometer. If the cap is spherical, then the
cornea is said to be spherical. If the cap is not
spherical, then the cornea is said to be
astigmatic. Astigmatism means that the curvature of
the cap is steeper in one primary meridian than it is
in the other primary meridian. If the astigmatism is
regular, then the primary meridians are 90 degrees
apart (e.g. 90 and 180). If astigmatism is irregular,
then the primary meridians are not exactly 90
degrees apart
Layers of the Cornea

Cornea: Epithelium
The epithelium is a layer of cells that cover the surface of the
cornea. It is only about 5 to 6 cell layers thick, comprising about
10% of the cornea's total thickness, and filled with tiny nerve
endings. The epithelium quickly regenerates when the cornea is
injured. If the injury penetrates deeply into the cornea, it may
leave a scar.
The epithelium blocks the passage of dust and germs and
provides a smooth surface that absorbs oxygen and cell nutrients
from tears, and then distributes these nutrients to the rest of the
cornea. The basement membrane is the part where the epithelial
cells anchor and organize.
Cornea: Bowmans membrane
Bowman's membrane lies just beneath the
epithelium. It is transparent and composed of
strong layered fibers of collagen. Because
Bowman's membrane is very tough and
difficult to penetrate, it protects the cornea.
Once injured, Bowman's layer can form a scar
as it heals.
Cornea: Stroma
The stroma is the thickest layer of the cornea and lies
just beneath Bowman's membrane. (~85%) . It
consists primarily of water (78 percent) and collagen
(16 percent), and does not contain any blood vessels.
The tiny collagen fibrils of the stroma run parallel to
each other. This special formation of the collagen
fibrils gives the cornea its clarity, strength, elasticity,
and form.


Cornea: Descemets Membrane
Descemet's membrane lies between the stroma and
the endothelium. It is a thin but strong sheet of
tissue that acts as protection against infection and
injuries. Descemet's membrane is composed of
collagen fibers (different from those of the stroma)
and is made by the endothelial cells that lie below it.
Descemet's membrane is regenerated readily after
injury.


Cornea: Endothelium
The endothelium is just underneath Descemet's and is only
one cell layer thick. This layer pumps water from the cornea,
keeping it clear. In a healthy eye, a perfect balance is
maintained between the fluid moving into the cornea and
fluid being pumped out of the cornea. If damaged or
diseased, the cells of the endothelium will not regenerate.
Too much damage to endothelial cells can lead to corneal
edema (swelling caused by excess fluid) and blindness ensues,
with corneal transplantation the only available therapy.


How is it that the cornea is clear?
1. There are no blood vessels in the cornea
(Avascular). The cornea receives most of its oxygen
from the air, through the tear layer. What blood
supply there is comes from capillaries that barely
cross the limbus and then loop back. Some
nourishment is received via the aqueous. The
oxygen supply to the cornea can be compromised
by contact lens wear. If oxygen deprivation is
severe, the cornea will grow new blood vessels
(neovasularization) into the corneal tissue to try to
increase the oxygen supply.
How is it that the cornea is clear?
1. - Try to recall.
2. nerves (trigeminal) that supply the cornea
are de-myelinated once they cross into the
corneal tissue. Myelin is an insulating
sheath that is present on most of the nerves
in the body.


How is it that the cornea is clear?
1. -- Avascular
2. -- Try to recall... Forgetful students!
3. The normal state of the corneal tissue is that of
relative dehydration. In this state, the corneal
fibrils, which are collagen tissue similar to the
tissues of the sclera, are clear. If the corneal tissue
becomes hydrated due to injury or disease, then
the tissue becomes opaque.


Aqueous humour
The aqueous humour is a watery fluid that fills the chamber
called the "anterior chamber of the eye" which is located
immediately behind the cornea and in front of the lens, and
also the "posterior chamber of the eye" which is a very
narrow compartment located between the peripheral part of
the iris, the suspensory ligament of the lens, and the ciliary
processes.
The aqueous humour is very slightly alkaline salt solution that
includes tiny quantities of sodium and chloride ions.
It is continually produced, mainly by the capillaries of the
ciliary processes, and drains away into Schlemm's canal,
located at the junction of the cornea and the sclera.

The space in the chamber is
filled with a watery fluid
called the aqueous
humor. This fluid is
produced by the ciliary
processes which lie behind
the iris. The aqueous
circulates through the pupil,
within the anterior
chamber, and then exits
through the angle formed
by the cornea and the iris.

Functions of The aqueous

1. It provides a clear refractive media through
which light passes to be focused on the
retina.
2. It carries nutrients which serve the
metabolism of the cornea and the lens.
3. It creates an intraocular pressure which
serves to maintain the shape of the globe.

The Iris and the Pupil
the iris of the eye expands and contracts to
control the size of the opening. The opening
in the iris is called the pupil.
The Iris and the Pupil
A simple description of the iris is that it is a coloured
diaphragm of variable size whose function is to adjust the size
of the pupil to regulate the amount of light admitted into the
eye. It does this via the pupillary reflex (which is also known
as the "light reflex"). That is, when bright light reaches the
retina, nerves of the parasympathetic nervous system are
stimulated, a ring of muscle around the margin of the iris
contracts, the size of the pupil is reduced (Constrict), hence
less light is able to enter the eye. Conversely, in dim lighting
conditions the pupil opens due to stimulation of the
sympathetic nervous system that contracts of radiating
muscles, hence increases the size of the pupil (Dilate).
IRIS
Blood supply:
2 long posterior ciliary
arteries
7 anterior ciliary arteries
Nerve Supply:
Long ciliary nerves of the
sympathetic nervous
system
The Ciliary Body
The ciliary body (Uveal
Body) lies along the wall
of the globe, behind the
iris and in front of the
retina. It has two
artificially divided
sections: the pars
plicata and the pars
plana.
The Ciliary Body
The pars plicata is the anterior
section of the ciliary body. It is
made up of the ciliary processes
and the ciliary muscle.

The ciliary processes have two
functions. They serve as an
anchor for the zonules which are
the cables that suspend the lens
behind the iris. The processes
also secret aqueous fluid.
The ciliary muscle contracts and
relaxes to make the lens fatter
and thinner to provide
accommodation, which we use to
focus from far to near.

The pars plana is simply the
posterior part of the ciliary
body. The pars plana extends to
the ora serrata, which is the
anterior edge of the retina.
Contraction and relaxation
of the ciliary muscle alters
the curvature of the lens
The correct term for the
adjustment of the shape of
the lens to change the focus
of the eye is
"accommodation".
This process may be
described simply as the
balance existing at any one
time between between two
states:
Ciliary Muscle relaxed:
The suspensory ligaments
attached to the ciliary body that
hold the lens in place are
stretched, causing the lens to be
relatively flat.
This enables the eye to focus on
distant objects.
Ciliary Muscle contracted:
The tension on the suspensory
ligaments attached to the ciliary
body is reduced allowing the lens
to be relatively round.
This enables the eye to focus on
close objects (near to the eye).


The ciliary body connects the choroid with the iris, and
consists of three zones.
They are:

1. The ciliary ring - which is attached to the choroid,

2. The ciliary processes - which forms part of the attachment to
the lens,

3. The ciliary muscle - which controls the curvature of the lens,
and therefore its accommodation to enable us to view both
close and distant objects according to where our vision is
focused.
The Lens
bi-convex in shape.
The adult lens measures about 10mm in diameter
and about 4mm in thickness. The lens has a plus
power of about 16 diopters in its "thin" shape, which
accounts for about one third of the total diopteric
power of the eye. By accommodating, or becoming
"fatter", the lens adds plus power. Accommodative
ability is greatest in childhood (over 10 additional
diopters) and it becomes gradually less and less as
we age.

The lens has four layers:
1. The capsule is a thin elastic layer that constitutes
the outer shell of the lens.
2. The epithelial layer is one cell thick and it lies on the
inner side of the capsule. As epithelial cells are
produced, they migrate toward the center of the
lens, adding to the density of the lens.
3. The lens cortex is a thick layer made up of relatively
younger cell matter.
4. At the center of the lens is the nucleus, the older
cells at the very center

Choroid
The choroid is the layer of the eyeball located
between the retina and the sclera
Choroid
It is a thin, highly vascular
(i.e. it contains blood
vessels) membrane that is
dark brown in colour and
contains a pigment that
absorbs excess light and so
prevents blurred vision (due
to too much light on the
retina).
The choroid is loosely
attached to the inner
surface of the sclera by the
lamina fusca. The side of
the choroid closest to the
centre of the eyeball is
attached to the retina. This
transparent innermost layer
of the choroid is called
Bruch's Membrane.

Choroid
The structure of the
choroid itself consists
mainly of a dense
capillary plexus and of
many arterioles and
venules transporting
blood to and from this
plexus.
Layer of large veins:
Hallers veins
Layer of smaller veins:
Sattlers veins

Choroid supplies blood
to outer 1/3 of retina.
Vitreous
The vitreous is a clear, gelatin-like substance
that accounts for about 75% of the mass of
the eye. There are normally no blood vessels
in the vitreous, and the vitreous is normally
optically transparent
Vitreous
Vitreous does not regenerate, and it shrinks
with age, being replaced by other fluid. At a
young age, the vitreous is attached to the
retina. As the vitreous shrinks with age, it
pulls away from the retina. This normal
process is called a vitreous detachment.
Retina
The retina is a thin (.5mm) film of
photosensitive cells that faces the vitreous
and lines the back of the posterior segment of
the eye. The retina is analogous to the film in
the camera.
Retina
The function of the retina is not just to be the screen
onto which an image may be formed , but also to
collect the information contained in that image and
transmit it to the brain.

The retinal "screen" is therefore a light-sensitive
structure lining the interior of the eye. It contains
photosensitive cells (called rods and cones) and their
associated nerve fibres that convert the light they
detect into nerve impulses that are then sent onto
the brain along the optic nerve.
Retina
The surface of the retina is only interrupted by the optic nerve
head. This "optic disk" is where the nerve fibers, the retinal
arteries, and the retinal veins enter the eye and fan out over
the surface of the retina.
The retina has a complex structure that specialist texts
describe in terms of ten layers labelled (from contact with the
vitreous humour, outwards) as:
1. Internal Limiting Membrane.
2. Nerve Fiber Layer (stratum opticum).
3. Ganglionic layer, consisting of nerve cells.
4. Innerplexiform , or molecular, layer.
5. Inner nuclear layer, or layer of inner granules.
6. Outer plexiform , or, molecular layer.
7. Outer nuclear layer, or layer of outer granules.
8. External Limiting Membrane.
9. Jacob's membrane (layer of rods and cones).
10. Pigmentary layer Retinal Pigment Epithelium (RPE)

Retina 2 portions
Neuro-Sensory retina
Modulator cells: Bipolar,
horizontal & amacrine
Transmitter cells: Ganglion
cells
Supporting astroglia: Muller
cells, astrocytes,
oligodendrycite like cells
which are skeltal support of
retina
Photoreceptor Cells:
Cones: 6.3 6.8 M
Rods: 111 to 130 M




Retinal Pigment epithelium
Single layered Hexagonal cells
Cobbled stone in appearance.
Provides the retinoin for
retianl metabolism
The RPE lies beneath the
neurosensory retina. This
layer cells is what gives the
retina coloration. Those
people with darker skin color
also have a darker color
to the retina.
Retinal Blood supply
The central retinal artery and the central retinal vein branch
from the ophthalmic artery and come into the eye through
the optic nerve head. Each then branches from the optic
nerve head to serve four main quadrants of the retina. These
vessels provide the blood supply for the inner two thirds of
the retina.
Retina: Macula
The very center of the macula, the fovea, is avascular,
and no nerve fibers run above the cones in this bulls-
eye of maximum acuity that is 1.5 mm in diameter.
This absence of tissue above the cones in the fovea
insures that nothing will distort or block light on the
way to the cones. The macular area appears darker
than the surrounding retina on fundus photos. This
is because the underlying pigment layer (RPE) is
more dense in the macula.

Extra-Ocular Muscles
Each eye has six muscles attached to it that
together can turn the eyes in almost any
direction. They are the medial rectus (MR),
lateral rectus (LR), superior rectus (SR),
inferior rectus (IR), superior oblique (SO), and
inferior oblique (IO).
Terminology EOM

The movement of one eye by itself is called a duction.
The movement of the two eyes in the same direction is
termed a version.
If the eye looks toward the nose (nasally), it is called
adduction.
If the eye toward the ear (temporally), it is called abduction.
When both eyes look to the right, the movement is called
dextroversion. Left gaze is called levoversion. Both eyes in
upgaze is termed supraversion. Downgaze is called
infraversion.
EOM
The rectus muscles attach (insert), with tendons, to the globe
5.5 (MR) to 7.7 mm (SR) behind the limbus. Each rectus
muscles extends approximately 41mm to its origin at the back
of the orbit at the Annulus of Zinn.
Muscle movement
When the LR muscle contacts, the MR muscle
must relax, otherwise the muscles would be
working against one another and the eye
would not move. Therefore, the MR is the
antagonist of the LR and the antagonist of the
action of abduction.
The MR of the right eye and the LR of the left eye are called
yoke muscles. These two muscles work at the same time and
in the same direction to create levoversion (the movement of
both eyes in left gaze) and dextroversion ( the movement of
both eyes in right gaze).
Planes of action and axes of rotation
Horizontal plane Vertical plane
Planes of action and axes of rotation
Intortion and extortion The other EOMs are called
cyclovertical muscles. Each of
these muscles has more than one
action. They act in the vertical
plane as well as the horizontal
plane, and they also intort or
extort the globe. This will be
illustrated for each of the
cyclovertical muscles. These
muscles each have a primary
action (1), a secondary action
(2), and a tertiary action (3).
Muscle primary
action
secondar
y action
tertiary
action
testing
position
LR abduction none none abduction
MR adduction none none adduction
SR elevation intortion adduction up and out
IR depression extortion adduction down and
out
IO extortion elevation abduction up and in
SO intortion depression abduction down and in
Innervation

Muscles work only when they are innervated. That is, they contract or
relax after receiving a nerve impulse.
Cranial nerves III, IV, and VI are the motor nerves that control the
extraocular muscles.
Nerve Function
III oculomotor MR, SR, IR, IO
LPS muscles
iris sphincter muscles

IV trochlear SO

VI abducens LR

The Medial Rectus
The MR is the strongest of the EOMs. It has the most mass,
and it has the most anterior insertion into the globe (for
greater leverage). It is used often to converge the eyes into
near (reading) gaze.
The Lateral Rectus
The lateral rectus (LR) originates in the annulus of Zinn and
inserts about 7mm behind the limbus on the temporal side of
the globe. The LR works only on the horizontal plane of
action. When the LR contracts, the eye rotates temporally
(abduction). The LR is the only muscle innervated by CN VI,
the "abducens nerve".
The Superior Rectus
The SR is innervated by CN III. The SR inserts superiorly on
the globe about 8mm behind the limbus. Notice that the
tendon of the SO muscle passes underneath the SR muscle
The primary action of the SR is elevation of the globe. 2ndary
is intortion then tertiary is adduction.
The Inferior Rectus
The inferior rectus (IR) is very similar to the SR, except that it
inserts underneath the globe instead of on top. It also travels
at a 23 degree angle to the primary position visual axis. It's
insertion is about 6mm behind the limbus
The secondary action of the IR is extortion, and the tertiary
action is adduction
The Oblique Muscles

The oblique muscles have two primary
functions. The first is intortion or extortion of the
globe to keep the eyeballs level as the head tilts.
The other major function is to create a
counterbalancing force to that of the rectus
muscles. The rectus muscles are pulling the globe
inward toward the back of the bony orbit. The
oblique muscles pull outwardly to keep the globe
"floating" in the orbital cavity

The Superior Oblique
The SO is the longest of the EOMs at about 60mm. The other
muscles are about 40mm in length. The SO has to be longer
because it passes through a "pully" called the trochlea, which
redirects the action of this muscle
The Superior Oblique
the primary action of the SO is intortion
depression of the globe around the horizontal axis. This is
the secondary action of the SO.
Abduction is the tertiary action of the SO
The Inferior Oblique
You may remember that all of the EOMs originate in the
annulus of Zinn, except for IO.
The IO originates in the inferior nasal orbital rim and travels
slightly posteriorly to the insertion point underneath the
globe.
The Inferior Oblique
Extortion: the primary action of the IO.
the secondary action of the IO is elevation
The tertiary action of the IO is abduction
Embryology
Weeks 3-4: The eyes begin to form from a
population of cells from the anterior neural
plate. These make the eye fields.
Embryology
Weeks: 5-6: Cutting the embryo in the indicated plane
illustrates the lens placode and the adjacent portion of the
optic vesicle as it begins to invaginate.
The invaginating lens placode forms the lens vesicle that
pinches off the surface ectoderm. Invagination of the optic
vesicle forms the bilayered optic cup that remains connected
to the forebrain via the optic stalk.
Weeks: 7-8: The anterior chamber of the eye forms as a
space develops between the lens and its closely associated
iridopupillary membrane and the cornea
Week 9-15: The iris forms from the outer rim of the optic
cup
Weeks: 8-10: By the end of the embryonic period, eyelids
begin to form
3 primitive embryonic layers
1. Surface ectoderm: gives rise to
Lens, lacrimal gland, conjunctiva, corneal
epithelium, epidermis of the eyelids and ocular
adnexa
2. Neural Crest: responsible for the following
Corneal endothelium, trabecular meshwork,
stroma of iris and choroid, ciliary muscle, vitreous
and optic nerve meninges
3 primitive embryonic layers
3. Neural Ectoderm: gives rise to
Optic vesicle and optic cup, formation of retina,
RPE, optic nerve fibers.

* Mesoderm is now thought to contribute to
EOM and ocular and orbital vascular
endothelium.
Whew
Finally
At last
Thank you for sleeping.
I mean listening.