Points from Snell’s Ocular Anatomy compiled by Dr. Ali.

CORNEA
Regarding Corneal Epithelium:

1. Stratified (5 Layers)
2. Superficial Cells: St. Sq. Non-Keratinized
3. Deepest cells: Columnar CellsSingle LayerAttached to basement membrane by
HemidesmosomesBasement Membrane attached to Bowmann’s Layer strongly
4. At Limbus: Layers increase up to 10
5. Greater part of epithelium: No dendritic competent cells
6. Langerhans’s cells present at periphery
7. Complete turnover of corneal surface epithelium in 7 days
8. At limbus: epithelium thrown into radial folds called Palisades of Vogt: these are sites of
regeneration as they contain stem cells.

General Points regarding Cornea:

1.Hassal Henle Bodies: at periphery of cornea, there are minute protrusions from Descemet’s
Membrane into the anterior chamber. They occur with increasing age. They are called Hassall Henle
Bodies

2. Endothelium plays major role in controlling normal hydration by both barrier function and active
transport mechanism

3. Cornea has naked axons which are sensitive to pain and cold

4. Cornea is avascular and devioid of lymphatic drainage.

5. Cornea is Nourished: 1) Diffusion from aqueous humor 2) Diffusion from Capillaries present at its
edge

6. Cornea more commonly curved in vertical than in horizontal plane

EYEBROWS
1. Movements:
  Upwards: Frontalis
 Downwards: Orbicularis oculi
 Medially: Corrugator supercilli
2. Lymphatics:
 Medially: Submandibular Nodes
 Lateral End: Superficial Parotid
3. In hypothyroidism: Lateral third of eyebrow hair lost

EYELIDS:
1. In upper eyelid: greyish line seen between eyelashes and opening of the ducts of tarsal
(Mebomian Glands). It serves as a plane in which eyelid can be split open with minimal scarring.
2. Eyelashes: 150 in upper lid, 75 in lower lid, replaced in 100-150 days.
3. Glands of Eyelids:
 Sebaceous Gland of Zeis: Anterior most, open into each follicle.
 Ciliary Gland of Moll: Modified sweat gland: opens into follicle or in eyelid margins.
 Tarsal (Mebomiann Glands): Ducts open posterior to eyelashes/ eyelid margin. They are
20-25 in number, embedded in tarsal plate, seen as yellowish lines in everted lid,
Modified Sebaceous Glands, oily secretion, forms the outer layer of precorneal tear film,
hinders rapid evaporation of tears.
4. Orbital Septum:
 Separates eyelids from contents of orbital cavitysuperiorly continuous with
periosteum
 Medially: Posterior to Medial Palpebral Ligament
 Laterally: Anterior to Lateral Palpebral Ligament. Posterior to Lateral Palpebral Raphe
5. Tarsal Plate:
 10mm in upper lid
 Attached to upper edge: orbital septum+ smooth muscle portion of levator palpebrae
superioris.
6. Medial Palpebral Ligament:
  Attaches medial end of tarsi to lacrimal crest+ frontal process of maxilla
 Lies anterior to lacrimal sac
7. Lateral Palpebral Ligament: attaches lateral end of tarsi to marginal tubercle.
8. Lateral Palpebral Raphe:
 Lies superficial to lateral palpebral ligament.
 Consists of interlacing fibers of palpebral part of orbicularis oculi.
9. Sub tarsal Sulcus: shallow groove about 2mm posterior to the posterior margin of lid. Traps
foreign bodies.
10. Levator Palpebrae Superioris: Has Two Parts:
i. Striated Part: Supplied by Superior Branch of Occulomotor Nerve.
ii. Smooth Muscle Part: supplied by sympathetic fibers from Sup. Cervical Sympathetic
Ganglion
11. Fornices: Distances from limbus:
 Superior fornix: 10mm
 Inferior fornix: 8mm
 Medially: Absent
 Laterally 14mm (extends back to the equator of eyeball)
12. Layers of eyelids according to Snell’s:
 SkinS/c Tissue striated muscle of orbicularis oculiOrbital septum+tarsal
platesmooth muscleconjunctiva
13. While making an incision through medial canthus to approach lacrimal sac, avoid : angular vein,
which is formed by the union of supratrochlear and supraorbital veins.

BULBAR CONJUNCTIVA:

1. Corneal Limbus: where cornea fuses with sclera

2. Conjunctival limbus: site where conjunctiva fuses with cornea. 1mm anterior to corneal limbus
3. Bulbar limbus: site of fusion of bulbar sheath with sclera. 1.5mm posterior to corneal limbus.
4. Site where conjunctiva becomes loosely attached to fascia bulbi and sclera: 3mm posterior to
corneal limbus.
5. Conjunctival epithelium: Stratified columnar.
6. Goblet cells found scattered along conjunctiva: most numerous inferonasally.
LACRIMAL APPARATUS:
1. Lacrimal Gland has 12 ducts. They open into superior conjunctival fornix.
2. Lymph drainage of lacrimal gland: superficial parotid lymph nodes
3. Nerve supply: Autonomic + Sensory
i. Autonomic:
A. Parasympathetic Secretomotor: Lacrimatory nucleus of facial nerveFacial
nerve Greater Petrosal nerve Nerve of pterygoid canal Pterygopalatine
ganglionMaxillary Nerve Lacrimal Nerve
B. Sympathetic: Postganglionic sympathetic via sup. Cervical sympathetic
ganglionjoin Deep petrosal nerve nerve of pterygoid canalMaxillary
nerve  Zygomaticotemporal nerve  Lacrimal nerve
C. Sensory: Lacrimal nerve branch of ophthalmic division of trigeminal nerve.
4. Tears Contain: Lyzozyme, IgA, Beta Lysin
5. Lacrimal canaliculi:
 10mm long (each)
 Enter lateral aspect of lacrimal sac: 2.5mm inferior to its apex
6. Lacrimal sac: 12mm long
7. Nasolacrimal Duct:
 18mm long
 Narrower at middle than at the end
 Opens in anterior part of inferior nasal meatus
8. Capacity of Conjunctival sac: 25-30ml (when volume of tears exceeds this volume, clinical
tearing occurs)

ANTERIOR CHAMBER:
1. Volume of anterior chamber: 0.2ml
2. Volume of posterior chamber: 0.06ml
3. Aqueous humor is formed mainly by active transport by non-pigmented cells of ciliary
epithelium.
 4. Aqueous humor also has glucose and amino acids

LENS:
1. Elastic Capsule:
 Thinnest at posterior pole
 Has type 4 collagen
 Chief function: Alters the shape of lens in response to pull of zonular fibers
 Capsule cannot stretch beyond the diameter of 12mm
2. Lens Epithelium:
 Cuboidal
 Found only on anterior surface
 At equator, these cells elongate and form columnar cells
 At equator, lens epithelial cells are transformed into lens fibers
 At equator, lens mitotic activity is maximum
3. Lens continues to grow throughout life: 6.5mm diameter @ birth 10mm diameter in adult
4. Convexity of anterior surface of lens is less than its posterior surface
5. Refractive power of lens reduces with age: (Normally 15 D)
 40years: drops to 8 diopters
 60 years: 1-2 diopters

RANDOM:
1. Fascial sheath of eyeball thickened inferiorly and is called as Suspensory ligament of Lockwood.
2. Anteroposterior diameter of eyeball is 24mm

LIMBUS:
1. Distances of insertion of recti muscles from limbus:
 Medial Rectus: 5.5mm
 Inferior Rectus: 6.5mm
  Lateral Rectus: 6.9mm
 Superior Rectus: 7.7mm
2. Sinus Venosus (canal of Schlemm) has no blood
3. Trabecular Meshwork begins just posterior to Schwalbe’s line
4. Principal resistance to aqueous outflow is trabecular meshwork
5. Mechanisms involved in drainage of aqueous humor from trabecular. Meshwork to canal of
Schlemm:
 Transcellular channels formed by giant cytoplasmic vacuoles (greatest volume)
 Between endothelial cells
 Active transport across endothelial cells
6. Two pathways of drainage of canal of Schlemm:
I. 25-35 collector channels deep scleral venous plexus intra+ episcleral plexus
anterior ciliary vein
II. Few collector channels bypass deep plexus pass directly through sclera (called
aqueous veins) conjunctival veins
7. Anatomical limbus: defined by Schwalbe’s line
8. Surgical Limbus: Beginning of bluish area, marking transition of cornea and sclera, surgical
limbus is slightly anterior to anatomical limbus.

SCLERA:
1. Forms posterior 5/6th of eyeball
2. Three apertures of sclera with structures:
I. Anterior: Branch of Anterior ciliary arteries
II. Middle: Exit of vortex veins
III. Posterior: Long and short ciliary nerves
3. Scleral opacity: irregular arrangement of scleral collagen.
4. Sclera thinnest just posterior to recti insertion : 0.3mm

CHOROID:
1. Bruch’s Membrane: 2-4Micrometers thick (innermost layer of choroid)
2. Choroid blood supply: Mainly Posterior ciliary artery + Recurrent branch of anterior ciliary artery
RETINA:
1. Retinal Pigment Epithelium represents outer layer of optic cup
2. Rods and cones develop from inner layer of optic cup
3. In between these two layers, is a potential space, which is basically remains of cavity of optic
vesicle. This is potentially weak site where retinal detachment occurs.
4. Neural Retina: Structure:
I. Photoreceptors (rods and cones)
II. Bipolar cells: 1st order link rods and cones to ganglions cells and amacrine cells)
III. Ganglion cells: 2nd order (multipolar cells)
5. Axons of ganglion cells become myelinated after they have passed lamina cribrosa. They are
myelinated by oligodendrocytes.
6. They terminate in lateral geniculate body. From here 3 rd order neurons arise and they terminate
in visual cortex.
7. RODS:
 100-120 micrometers long
 Outer segment: in contact with RPE. Have laminar discs which contain
photosensitive pigments Rhodopsin attached on membranes. These discs are
formed at base of outer segments, they are eventually pushed up as they reach RPE,
they are phagocytosed by RPE cells. This occurs in 24hrs cycle, most discs shed early
in morning.
 Connecting stalk: Modified Cilium
 Inner Segment: has two parts:
I. Ellipsoid: Has numerous mitochondria
II. Myoid: ribosomes + Golgi cells
8. CONES:
 65-75 micrometers in length
 Tips on cones are NOT phagocytosed by RPE cells, Unlike rods.
 Photosensitive pigment is iodopsin
9. Layers Of Retina
I. Outer Pigmented Epithelium (RPE)
II. Rods and Cones layer
III. External Limiting Membrane (zona adherence between photoreceptor cells and radial
processes of Muller cells)
IV. Outer Nuclear Layer: Nuclei of rods and cones
V. Outer plexiform layer: synapse between rods and cones termination+ bipolar +
horizontal cells
VI. Inner nuclear layer: nuclei of bipolar, horizontal, amacrine, muller cells
VII. Inner plexiform layer: synapse between bipolar+ ganglion+ amacrine cells
VIII. Ganglion cell layer: Nuclei of ganglion cells
IX. Nerve fiber layer: axons of ganglion cells
X. Internal Limiting Membrane: expanded terminations of muller cells covered by
basement membranes
10. Tight junctions in RPE cells prevent the movement of choroidal tissue fluid into retina.
11. Retina is:
 Continuous posteriorly with optic nerve
 Extends forward to become ciliary epithelium of ciliary body and iris.
 Outer surface in contact with: Bruch’s Membrane
 Inner surface in contact with vitreous
 Attached firmly to the margins of optic disc and anterior termination of ora serrata.
12. Ora serrata is closer to the limbus medially.
13. Optic disc: rods and cones completely absent blind spot
14. Fovea: rods absent, cones maximum (140,000/mm2)
15. Yellow color of the macula is due to a pigment called Xanthophyll
16. Fovea is the depressed center at center of macula. Sides of depression are called clivius. Floor of
depression is called foveola.
17. Fovea is avascular.
18. Outer segment of rods and cones interdigitates with RPE.
19. Inner neurosensory layer, outer pigmented layer derived from neuroectoderm.
20. Arteries lie superficial to veins in retina. (i.e towards vitreous side)
21. There are no lymphatic vessels in retina
 22. Retinal attachment is weak just posterior to ora serrata
23. Erroneously stated: that attachment of retina is weak at macula. This is not true, but anyhow,
subretinal fluid tends to accumulate in this area.
24. Blood Supply:
 Up to inner nuclear layer (starting from outside): diffusion from choroidal capillaries.
 Rest of the internal retina: central retinal artery and veins.
25. CRAO:
 commonly occurs at the level of lamina cribrosa, just before artery enters the retina.
Here the artery has structure of medium sized artery and is subject to atherosclerosis.
 Once the central artery divides into four major fundal arteries, they have the structure
of arteriole.
 Total arterial occlusion of 1.5hrs leads to irreversible retinal degeneration.
 Changes begin in inner vitreal half.

IRIS:
1. Periphery of iris attached to anterior surface of ciliary body: called ciliary margin
2. Iris is thickest 2mm away from pupillary margin called collarette
3. Iris is thinnest at ciliary margin.
4. Iris anterior surface:
 Is devoid of epithelium
 Has trabeculae called Fuch’s Crypts  aqueous humor has direct communication with
tissue spaces of iris through these.
5. Iris Posterior surface:
 Two epithelial layers  derived from neuroectoderm. Both layers are pigmented.
6. Sphincter pupilae: nerve supply: Post ganglionic parasympathetic via short ciliary nerve
(oculomotor nerve)
7. Dilator Pupilae:
 these are myoepithelial cells derived from anterior layer of pigment epithelium that
covers posterior surface of iris. Muscle processes are fusiform in shape.
 Nerve supply: post ganglionic fibers: superior cervical sympathetic ganglion via long
ciliary nerve.
 8. During accommodation: pupil also constricts restricting incoming light to central part of lens so
that spherical aberration is diminished.
9. Anterior synechia: adhesions between endothelium of iris and trebacular meshwork
10. Posterior synechia: adhesions between lens and iris

CILIARY BODY:
1. Pars Plicata: part of ciliary body that gives rise to ciliary processes
2. Distance between equator of lens and ciliary process: 0.5mm
3. Ciliary epithelium: two layers of cubical cells: inner non pigmented, outer pigmented.
4. Ciliary Muscle layers:
 Meridonial: Most external, close to sclera
 Oblique or Radial: radiate out from scleral spur
 Circular Fibers: like a sphincter
5. Ciliary muscle innervation: Post ganglionic parasympathetic fibers derived from oculomotor
nerve. Nerve fiber reach muscle via short ciliary nerves.

VITREOUS:
1. Vitreous has saucer shaped depression for lens called hyaloid fossa
2. Vitreous attachments:
 Pars plana of ciliary body+ adjacent ora serrata vitreous base
 Margins of optic disc
 To lens along periphery of hyaloid fossa
3. Narrow channel 1-2mm diameter extends from optic disc to posterior pole of the lens: Hyaloid
canal
 During fetal life it contains hyaloid artery
 Hyaloid artery disappears 6 weeks before birth, canal becomes filled with fluid.

EXTRAOCULAR MUSCLES:
 1. The origins of superior and inferior oblique muscles are attached with the dural sheath of optic
nerve. Explains the pain of retrobulbar neuritis experienced with movements of eyeball
2. Endomysium: connective tissue around each muscle fiber
3. Perimysium: around groups of muscle fibers
4. Epimysium: around whole muscle
5. Lateral rectus: longest tendon among recti: 8.8mm
6. Medial rectus: shortest tendon among recti: 3.7mm

ORBIT:
1. Medial wall: Four bones: anterior to posterior:
 Frontal process of maxilla
 Lacrimal bone
 Orbital plate of ethmoid
 Part of body of sphenoid
2. Roof:
 Orbital plate of frontal bone
 Lesser wing of sphenoid posteriorly
3. Roof separates orbit from anterior cranial fossa
4. Optic canal:
 lies in lesser wing of sphenoid
 4-10mm long
 Transmits: optic nerve and ophthalmic artery
5. Superior Orbital Fissure Contents: (between greater and lesser wings of sphenoid)
 From lateral to medial, outside common tendinous ring: LFTS(ONA)
I. Lacrimal Nerve
II. Frontal Nerve
III. Trochlear Nerve
IV. Superior Ophthalmic Vein
 Within common tendinous ring:
I. Superior branch of oculomotor
II. Inferior branch of oculomotor
III. Nasociliary nerve
 IV. Abducent nerve
6. Inferior orbital fissure: (between greater wing of sphenoid and maxilla). Transmits:
I. Maxillary nerve (which changes its name to infraorbital nerve)
II. Zygomatic nerve
III. Inferior ophthalmic vein
IV. Branch of pterygopalatine ganglion
7. Orbital Muscle of Muller:
 Thin smooth muscle that bridges inferior orbital fissure
 Vestigial: Function unknown
 Nerve supply from sympathetics

OPTIC NERVE:
1. 12,00,000 axons make up optic nerve.
2. Does not have Schwann cells: unable to regenerate
3. Optic disc does not have muller cells (like surrounding retina, in which they hold the nerve fibers
together) for this reason optic disc easily swells in people with papilledema leaving surrounding
retina flat.
4. Intraocular portion:
 1mm long
 Receives its blood supply from short posterior ciliary arteries (not supplied by central
retinal arteries)
 Axons originating in peripheral part of retina take peripheral position in optic nerve and
those from central retina take central position.
5. Orbital Portion:
 25mm long
 6mm longer than distance between sclera and optic canal. Allows free movement of
eyeball.
 Ciliary ganglion lies between lateral border of nerve and lateral rectus muscle
6. Intracanalicular portion:
 5mm long
 Optic canal in lesser wing of sphenoid
OPTIC CHIASMA:
1. Relations:
 Anteriorly: Anterior cerebral artery and anterior communicating artery
 Posteriorly: tuber cinereum with infundibulum below and floor of third ventricle above
 Laterally: internal carotid artery
 Superiorly: Lamina terminalis (anterior wall of 3 rd ventricle) and cavity of third ventricle
 Inferiorly: Diaphragm Sellae+ hypophysis cerebri
2. At optic chiasma:
 Nerve fibers from inferior nasal retina cross at anterior part of optic chiasma
 Nerve fibers from superior nasal retina cross posterior part of optic chiasma

OPTIC TRACT:
1. Most of the neurons in optic tract terminate in Lateral Geniculate Body
2. 10% fibers pass medially in superior branchium below the pulvinar of the thalamus to enter
superior colliculus (involved in visual body reflexes) and pretectal nucleus (light reflex)

LATERAL GENICULATE BODY:

1. Connected to superior colliculus by superior branchium
2. Has 6 layers where nerve fibers of optic tract terminate
3. Nerve fibers that cross midline terminate in layers 1,4 and 6
4. Nerve fibers that do not cross midline terminate in layers 2,3 and 5.

VISUAL CORTICAL AREAS:

1. Primary visual area: Area 17
 1.5mm thinner than other cortical regions
 Cortex receives fibers from temporal half of ipsilateral and nasal half of contralateral
retina
2. Secondary visual areas: Area 18 and 19
  Relates visual information received by primary visual area to past experience
 Integrates two halves of visual fields by means of commissural fibers that cross midline
in the splenium of corpus callosum

OTHER AREAS:
1. Wernicke’s area:
 Usually in Left Dominant hemisphere
 Mainly in Superior Temporal gyrus
 Connected to Broca’s Area by Arcuate fasciculus

OPTIC PATHWAY:
 1st order neuron: Bipolar cells of retina
 2nd order neuron: Ganglion Cells
 3rd order neuron: Lateral Geniculate Body
 Optic nerve, chiasma, tract are extension of white matter of brain with no regenerative property
 Only part of optic pathway equivalent to peripheral nerve: Bipolar Cells