ANATOMY & PHYSIOLOGY OF THE
EYE
Grace Hojilla, MD, DPBO
February 9, 2015
LIMAng French Window5
NORMAL EYE ANATOMY
 Optical media is a series of clear lenses, one on top
of the other. We have 5 clear optical media: the
cornea, aqueous humor, lens, vitreous humor,
retina. They must all be crystal clear.
 If the opacity is not within the optic axis, it will not
affect the visual acuity.
 2. Bowman’s (anterior limiting) membrane
 Approx. 2% of corneal thickness (12 μm)
 Dense mass of collagen fibrils
 Distinguished from stroma in that it does
not have any flat dendritic interconnecting
fibroblasts (keratocytes)
3. Stroma (substantia propria)
 Approx. 86-88% of corneal thickness (500
μm)
 Composed of 200-250 sequential lamellae
 Each lamellae made up of fine collagen
fibrils mainly of type 1 collagen
 Keratocytes form a coarse mesh between
CORNEA the lamellae
4. Descemet’s (posterior limiting) membrane
 Approx. 2% of corneal thickness (12 μm)
 Regarded as basement membrane of
endothelium
 Thin and apparently homogeneous
5. Endothelium (posterior epithelium)
 Single layer of squamous cells with
prominent interdigitations between
adjacent cells

 Helpful mnemonic (anterior to posterior)

 Aepithelium
 Bowman’s membrane
The cornea is the transparent front part of the eye that
 CStroma
covers the iris, pupil, lens and anterior chamber. The
cornea, with the anterior chamber and lens, refracts light,  Descemet’s membrane
with the cornea accounting for approximately two-thirds of  Endothelium
the eye’s total optical power.

 We can compare this to the glass on our watch. So we

always want to keep it clear.  Cornea is responsible for
almost 2/3 of the optical power. The principal reason for
this is that the refractive index of the cornea is markedly
different from that of air.

The cornea is composed of 5 layers:

1. Epithelium (regenerates 24-48 h)
 Approx. 8-10% of corneal thickness (50
μm)
 Usually 5-6 layers of cells
o Protect ocular surface from
mechanical abrasion
o Form a permeability barrier
o Prevent entry of pathogens
o Deepest cells (columnar with flat
bases, rounded apices, large round
nuclei)
o Intermediate cells (polyhedral)
o Superficial cells (flat)
 If there’s injury in the stroma down (or it has already ASTIGMATISM
reached the Bowman’s layer), it will leave a scar.
 During laser treatment, it’s the cornea that is being
modified since it’s responsible for 2/3 of visual clarity.
 We wear the contact lens on top of the cornea
 Cornea is avascular. Once it is injured, healing is very
poor. If the cut is deeper, it usually lasts for a lifetime.
 No such thing as eye transplant, it’s CORNEAL
transplant. Low chance of rejection because avascular.

MYOPIA

Myopia vs Hyperopia

 Multiple focal points (at least two). If myopia with

astigmatism, then there are 3 focal pts.
 Can either be myopic-astigmatic, hyperopic-astigmatic
or pure astigmatism

Myopia (near – sighted)

 Either the lens is too strong or the eye is too long
 A myopic person has no mechanism by which to focus
distant objects sharply on the retina.

Hyperopia (far – sighted)

 Either the lens is too weak or the eye is too short
 A hyperopic is capable of focusing distant objects on the
retina by the mechanism of “accommodation”.
FYI: usually 60 diopters (emmetrope) optical power of
the eyeball (according to Guyton, 59 diopters)
Simple astigmatism
 Simple hyperopic astigmatism – 1st focal line is on
the retina, 2nd focal line is located behind the
retina
 Simple myopic astigmatism – 1st focal line is in
front of the retina, 2nd focal line is on the retina

Example: if the grade of the eye is 64 diopters (myopic) Compound astigmatism

because either the lens is too strong or the eye is too long,  Compound hyperopic astigmatism – both focal
you’ll be given eye glasses with minus 4 grade in order to lines are located behind the retina
become 60 which is normal for emmetropic vision.  Compound myopic astigmatism – both focal lines
are located in front of the retina

Mixed astigmatism – focal lines are on both sides of the

retina

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 Unlike if myopia or hyperopia where the whole image is
blurred, in astigmatism there is a certain meridian that is
clear.
 Imagine an asterisk; the problem is the one opposite of
the clearest line (either 90°, 180°, or oblique).

IRIS

The iris is a thin, circular structure in the eye, responsible

for controlling the diameter and size of the pupils and thus
the amount of light reaching the retina.

 Give the color of the eye.

 Varies on the race of the patient.
 If the sun is too bright, the muscles of the iris constrict.

Pupillary zone (A); Ciliary zone (B); crypts (c); everted

“pupillary ruff” of the epithelium (d); major arterial circle
(e); incomplete minor arterial circle (f); sphincter pupillae
(g); dilator pupillae (h); radial folds (i and j); adjoining
ciliary processes (k).

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LENS
The crystalline lens is a transparent, biconvex structure in
the eye that, along with the cornea, helps to refract light to
be focused on the retina.
 This is where cataract forms. Removed during cataract
surgery and replaced by an artificial lens.
 Responsible for 1/3 of the refractive power of the eye.
 Zonules  thin, hairlike structures holding the lens in
place. Contracts to pull the lens towards the side to
decrease the lens thickness so the vision at far will be clear.
ACCOMMODATION
The lens, by changing shape, functions to change the focal
distance of the eye so that it can focus on objects at
various distances, thus allowing a sharp real image of the
object of interest to be formed on the retina.
 In children, the refractive power of the lens of the eye
can be increased voluntarily from 20 diopters to about 34
diopters (accommodation= 14 diopters). For this to be
achieved, the shape of the lens change from that of a
moderately convex lens to that of a very convex lens
 At far, the pupils are dilated. If near, it constricts.
 PRESBYOPIA  happens to patients usually 40 and
above. There’s loss of accommodation due to the
hardening of the lens as we age. They can see clearly at far
and blurry up close.
 PRESBYOPIA - when the lens remains almost totally
nonaccommodating; the eye remains focused permanently
at an almost constant distance
 As a person grows older, the lens grows larger and
thicker and becomes far less elastic (due to progressive
denaturation of the lens proteins);
 Ability of the lens to change shape decreases from
about 14 diopters in a child to less than 2 diopters by age
45-50 and 0 diopters by age 70
 Ciliary spasm  happens when you read for long
periods of time, there is hyperaccomodation where in the
lens thickens, ciliary muscle contract and the pupil constrict
for a long time so daw na unay siya so when you look at far
it takes a while for it to recover
 At a certain age (usually by age of 40), there will be loss
of the elasticity of the lens leading to difficulty in reading.
 An older person closes or squints his eyes when reading
(pinhole effect). The light is focused in one hole.
 Lens (relaxed state with no tension on its capsule)-
spherical shape
 Suspensory Ligaments
 attach radially around the lens, pulling the lens
edges toward the outer circle of the eyeball
 constantly tensed by their attachments at the
anterior border of the choroid and retina
 tension on these causes the lens to remain
relatively flat
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 Ciliary muscle CILIARY BODY
 located at the lateral attachments of the lens
ligaments to the eyeball
 2 separate set of smooth muscle fibers:
o Meridional fibers
 Extend from the peripheral ends of
the suspensory ligaments to the
corneoscleral junction
 When these contract, the
peripheral insertions of the lens
ligaments are pulled medially
toward the edges of the
cornearelease the ligaments’
tension on the lens
o Circular fibers
 Arranged circularly all the way
around the ligament attachments
 When these contract, a sphincter-
like action occurs decrease the The ciliary body is the circumferential tissue inside the eye
diameter of the circle of ligament composed of the ciliary muscle and ciliary processes.
attachments (which allows the
ligaments to pull less on the lens  In contrast to the zonules, at far, the zonules contracts
capsule) and the ciliary muscles relax.
 Ciliary body produces the aqueous humor.
 Contraction of either set of smooth muscle fibers in the
ciliary muscle relaxes the ligaments to the lens capsule  Ciliary Body has 2 major functions:
lens assumes a more spherical shape o Accommodation
o Production of aqueous humor

 Accommodation is controlled by parasympathetic  Aqueous humor

nerves.  Formed in the eye at an average rate of 2-3
Stimulation of parasympathetic nerves microliters each minute
↓  Essentially all of it is secreted by ciliary processes
Contracts both set of ciliary muscle fibers (linear folds projecting from the ciliary body into
↓ the space behind the iris where the lens ligaments
Relax lens ligaments and ciliary muscle attach to the eyeball)
↓
Lens thickens GLAUCOMA
↓
↑ refractive power 1. Increased IOP (intraocular pressure)
 Normal IOP = 10-20 mmHg (in some sources, it’s
10-21 mmHg)
2. Optic nerve damage
3. Visual field loss

 Angle - area between the cornea and the iris.

 If angle is narrowed, fluid will not come out but
accumulates inside the eye leading to increase in
intraocular pressure leading to Glaucoma.
 Weakest part of the human eye is in the optic nerve in
the area of the lamina fibrosa.
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 Tunnel vision - patients with open angle glaucoma.
 Ciliary body  flows behind the iris  out in the Effect of glaucoma to the
anterior chamber  out to the trabecular meshwork optic nerve

 Glaucoma
 Disease of the eye in which the intraocular pressure
becomes pathologically high (sometimes rising
acutely to 60-70 mmHg)
 Pressures >25-30mmHg can cause loss of vision
when maintained for long periods

↑ Pressures
↓ normal
Axons of optic nerve are compressed where they leave the
eyeball at the optic disc Effect of glaucoma to field of vision
↓
Block axonal flow of cytoplasm from the retinal neuronal
cell bodies into the optic nerve fibers leading to the brain
↓
Lack of appropriate nutrition of the fibers
↓
Death of involved fibers

 Blurring of vision in glaucoma starts at the

periphery towards the center.

 Optic cap = 0.3 or 1/3

 Patient presents with headache, hypertension, and red
eyes. Check pupils. If mid-dilated, suspect glaucoma
 Cataract - entire visual field;
 Glaucoma - peripheral vision

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VITREOUS BODY
RETINA

The retina is the light-sensitive layer of tissue at the back

of the inner eye. It acts like the film in a camera – images
come through the eye’s lens and are focused on the retina.
The retina then converts these images to electrical signals
and sends them via the optic nerve to the brain.

Layers of the Retina

The vitreous is a thick, transparent substance that fills the

center of the eye. It is composed mainly of water and
comprises about 2/3 of the eye’s volume, giving it form
and shape. The viscous properties of the vitreous allow the
eye to return to its normal shape if compressed.

 As we age, the vitreous gel becomes watery.

 Syneresis – liquefaction of the vitreous gel
 If vitreous humor comes out, the eye will lose its
integrity. But now we have silicon oil, silicon gel which can
be injected to maintain the integrity of the eye.

 Vitreous Humor/ Vitreous Body

 A gelatinous mass held together by a fine fibrillar
network composed primarily of greatly elongated
proteoglycan molecules
 Between the posterior surface of the lens and the
retina (vs. aqueous humor: lies in front of the lens)

OPTIC NERVE

The optic nerve connects the eye to the brain. It carries

the impulses formed by the retina, the nerve layer that
lines the back of the eye and senses light and creates
impulses. These impulses are dispatched through the optic
nerve to the brain, which interprets them as images.  Cones: colored vision; day; produces cone photopigment
Rods: night vision (white and black vision); produces
 Weakest part of the eye usually damaged due to rhodopsin
increase in intraocular pressure.  The area of optic nerve (optic disc) has no rods and cons:
 It’s possible for the eyes to pop because of the S-shape blind spot
segment (intraorbital segment) of the optic nerve.
 Blind spot area (optic disc): no rods and cones
 Optic nerve is devoid of any photoreceptors

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 Layers of the Retina (According to Guyton; from outside CHOROID
to the inside):
The choroid lies between the retina and sclera. It is
o Pigmented layer composed of layers of blood vessels that nourish the back
o Layer of rods and cones projecting to the pigment of the eye.
o External limiting membrane
o Outer nuclear layer containing the cell bodies of
the rods and cones
o Outer plexiform layer
o Inner nuclear layers
o Inner plexiform layer
o Ganglionic layer
o Layer of optic nerve fibers
o Inner limiting membrane

 Rhodopsin - light-sensitive chemical in the rods

 Cone/Color pigments - light-sensitive chemicals in the
cones
MACULA and FOVEA
The macula is an oval-shaped highly pigmented yellow
spot near the center of the retina of the human eye. Near
its center is the fovea, a small pit that contains the largest
concentration of cone cells in the eye and is responsible for
central, high resolution vision.
Macula – high density of cones and ganglion cells for visual
acuity and color.
Fovea – central depression consists of cones only.
 Pointing a laser to the eye will result to central scotoma
because you hit the macula of the eye.
 Fovea: center of vision, where rods and cons are seen
most.
 It is very vascular and gives nutrition to the retina.
 It is connected anteriorly in the ciliary body and also the
iris; this is the vascular coat of the eye called the UVEA
(choroid, ciliary body and iris).
SCLERA
The sclera is commonly known as the white of the eye. It is
the tough, opaque tissue that serves as the eye’s
protective outer coat.
Sclera – collagenous outer wall of eyeball.
 Outermost portion – episclera – rich vascular
network, area where bilirubin accumulates
(icterius)
 In connective tissue disease, sclera is inflamed
forming a nodule with tangled hyperemic,
episcleral and conjunctival vessels.

VISUAL PATHWAY

Vision is generated by photoreceptors in the retina, a layer

of cells at the back of the eye. The information leaves the
eye by way of the optic nerve, and there is a partial
crossing of axons at the optic chiasm. After the chiasm, the
axons are called the optic tract. The optic tract wraps
around the midbrain to get to the lateral geniculate
nucleus (LGN), where all the axons must synapse. From
there, the LGN axons fan out through the deep white
matter of the brain as the optic radiations, which will
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ultimately travel to primary visual cortex at the back of the  Optic nerve – carries retinal ganglion cell axons
brain. going to the chiasm and lateral geniculate body.
 Optic chiasm – where the optic tract starts. Sorting
of nasal retina (crossing to the other side) and
temporal retina (do not cross). Crossing fibers are
more vulnerable than the noncrossing fibers
causing bitemporal hemianopia.
 Optic tract – carries signals from contralateral
hemifield. Damage to one tract would lead to
contralateral homonymous hemianopia.
 Lateral geniculate body – synapses with retinal
ganglion cell axons and sends signals to the 1°
visual cortex. Damage is usually caused by stroke
or head trauma leading to contralateral
homonymous hemianopia.
 Optic radiations – carry axons from lateral
geniculate bodies. Located next to the lateral
ventricles of the brain. Damaged by stroke, tumor
and disorders affecting white matter.
 Primary visual cortex – for processing of shape
and luminance
 Visual association cortex – for processing of color,
texture, depth perception and movement.
 Nasal retina – transduces light from temporal
visual field  crosses the chiasm  contralateral
brain hemisphere
 Temporal retina – transduces light from nasal
visual field  ipsilateral brain hemisphere

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EXTRAOCULAR MUSCLES  Lacrimal gland – under the upper outer orbital rim
which provides tears.
 4 recti muscles  Punctum – oval opening to flow to the lacrimal sac.
o Medial, superior, inferior, lateral Lower punctum is more important.
 2 oblique muscles  Canaliculi – epithelial-lined tube carries tears to
o Superior, inferior lacrimal sac. Lower canaliculi is more important.
 Lacrimal sac – collects tears from canaliculi.
 RadSins  rectus adducts, Superior intorts o Dacrocystitis – inflammation of the
 LR6SO4  left rectus CN VI, Sup. Oblique CN IV, the rest lacrimal sac.
CN III  Nasolacrimal duct – carries tears to the nose and
ends in the inferior turbinate.
 Plica semilunaris – crescentic fold in the medial
conjunctiva lateral to caruncle. No function.
 Caruncle – modified skin, vestigial organ (third
eyelid or nictitating membrane in lower animals).

Notetakers: Dux, Ange, Alyssa

Editor: Dux

 Book notes:
 Gray’s Anatomy, 40th Edition (Chapter 40)
 Guyton’s Textbook of Medical Physiology, 11th
Edition (Chapter 49-51)
 American Academy of Ophthalmology
 Lecture Audios

Outside the Eye

"The eye is the lamp of the body. If your

eyes are healthy, your whole body will be
full of light.”

- Matthew 6:22