Orbit, Gross &

microscopic
anatomy of eye
 THE ORBIT

 The orbits are a pair of bony cavities

 Located in the upper half of the face below the anterior cranial
fossa and anterior to the middle cranial fossa
 Found on either side of the root of the nose and provides
sockets for rotatory movements of the eyeballs.
2
 Boundaries of the bony orbit

 Each orbit is a four-sided

pyramid with apex directed
behind at the optic canal and
base forward, represented by
the orbital margin.

 It presents roof, floor, lateral and

medial walls, and orbital margin

 The medial walls of both orbits

are parallel and lie about 2.5 cm
apart, separated by the nasal
cavities.
 Osteology of the Orbit
• Seven bones articulate to
make each orbit:
1. Frontal
2. Zygomatic
3. Maxillary
4. Lacrimal
5. Ethmoid
6. Palatine 6

7. Sphenoid
 Wall of orbit

• The superior wall (roof)

– is formed mainly by the orbital part of the frontal bone with
a small contribution from the sphenoid bone ,which
separates the orbital cavity from the anterior cranial fossa.

• The medial walls of the contralateral orbits are formed

primarily by the ethmoid bone. It is also formed from the
maxilla, lacrimal and sphenoid bones.

5
Boundaries of the bony orbit
 Orbits cont….
• The inferior wall (floor) is formed mainly by the maxilla and
partly by the zygomatic and palatine bones
– The inferior wall is demarcated from the lateral wall of the
orbit by the inferior orbital fissure

• The lateral wall is formed by the frontal process of the zygomatic

bone and the greater wing of the sphenoid
– This is the strongest and thickest wall, which is important
because it is most exposed and vulnerable to direct trauma
• The apex of the orbit is at the optic canal in the lesser wing of
the sphenoid just medial to the superior orbital fissure

8
 Fissures and foramina
• Numerous structures enter and leave the orbit through a
variety of openings.
• Optic canal
– Passing through the optic canal are the optic nerve and the
ophthalmic artery.

• Superior orbital fissure

– Just lateral to the optic canal is a triangular-shaped gap
between the roof and lateral wall of the bony orbit. Allows
structures to pass between the orbit and the middle
cranial fossa.
Fissures and Optic canal
foramina

Superior
orbital fissure

Inferior orbital
fissure
 Fissures and foramina
Inferior orbital fissure
• Longitudinal opening separating the lateral wall of the orbit
from the floor of the orbit.

• This long fissure allows communication between:

 the orbit and the pterygopalatine fossa posteriorly
 the orbit and the infratemporal fossa in the middle
 the orbit and and the temporal fossa anteriorly
 Passing through the inferior orbital fissure are the maxillary
nerve [V2] and its zygomatic branch, the infra-orbital vessels,
and a vein communicating with the pterygoid plexus of veins.
Fissures and
foramina
 Fissures and foramina
• Passing through the inferior orbital fissure are the maxillary
nerve [V2] and its zygomatic branch, the infra-orbital vessels,
and a vein communicating with the pterygoid plexus of veins.

• Infra-orbital foramen
• Infra-orbital nerve, a branch of the maxillary nerve [V2], and
vessels pass through this structure as they exit onto the face
Infra-orbital
foramen
 Content of orbits
Contain and protect the eyeballs and accessory visual structures
which include the:
• Eyelids, which bound the orbits anteriorly
• Extraocular muscles, which position the eyeballs and raise
the superior eyelids
• Nerves and vessels in transit to the eyeballs and muscles
• Orbital fascia surrounding the eyeballs and muscles
• Mucous membrane (conjunctiva) lining the eyelids and
anterior aspect of the eyeballs and most of the lacrimal
apparatus
• All space within the orbits not occupied by the above structures
is filled with orbital fat; thus, it forms a matrix in which the
structures of the orbit are embedded.
15
Content of orbits
 Eyelids
• Are movable folds that are
covered externally by thin skin
and internally by transparent
mucous membrane(Conjuctiva)

• When closed, the eyelids cover

the eyeball anteriorly, thereby
protecting it from injury and
excessive light.

• They also keep the cornea

moist by spreading the lacrimal
fluid.
17
 Eyelids cont..
• The space between the two eyelids is called palpebral
fissure.
 Eyelids cont..

 The free margin of

each eyelid is divided
into two parts:

 Lateral 5/6th ciliary

part, which is flat and
possesses
eyelashes

 Medial 1/6th
lacrimal part, which
is round
and does not possess
cilia
 Histology of the eyelid
1- Extremely thin Skin:
– it is very delicate type of skin
characterized by thin
epidermis and loose and
elastic dermis devoid of
hypodermis/fat, and very
small hair follicles and fine
hair.

2. Muscular layer:
–Formed of skeletal muscle
fibers of orbicularis oculi
muscle (also levator
palpebrae superioris in the
upper lid)
20
3 Tarsal plate:
– thick dense fibroelastic CT that
supports the tissue of the eyelid.

– contains the Meibomian glands that

open at its ciliary border/edge
 The eyelid
– At ciliary border (CB) of the the eyelid are a
series of large hair follicles (F) for the
eyelashes.
– Associated with these hair follicles are
small sebaceous glands and modified apocrine
sweat glands.
– Internally eyelids contain fascicles of
striated muscle (M) comprising the orbicularis
oculi muscle and closer to the conjunctiva a
thick plate of fibroelastic connective tissue
called the tarsus (T).
– This tarsal plate provides structural support
for the eyelid and surrounds a
series of large sebaceous glands, the
tarsal glands (TG) (Meibomian glands), with
acini secreting into long central ducts (D)
that empty at the free ciliary border.
 Layers of eye lid cont…
 The large modified sebaceous glands (tarsal glands) are partly
embedded on the deeper aspects of the tarsal plates.
 These glands are arranged in a single row and their ducts
open into the lid margin by minute foramina
behind the eyelashes.

 The tarsal glands secrete the lipid secretion of which

lubricates the edges of the eyelids and prevents them from
sticking together when they close
 When production is excessive, it spills over the barrier onto
the cheeks as tears.
 Clinical correlation
• Ptosis: It is the drooping of the upper eyelid due to
paralysis of levator palpebrae superioris following lesion
of occulomotor nerve, which supplies this muscle
 Conjunctiva
 It is a thin transparent mucus
membrane,which lines the inner
surfaces of eyelids (palpebral
conjunctiva)

 Front of sclera and cornea of

eyeball(bulbar conjunctiva).

 The potential space between

eyelids and eyeball when eyes are
closed is called conjunctival sac.
 Conjunctiva cont…

• The palpebral conjunctiva is highly vascular and firmly

adherent to the tarsal plates.

• On the other hand, bulbar conjunctiva is loose over the sclera

but firmly adherent to the cornea forming its anterior
epithelium (the corneal epithelium).

• The conjunctiva contains mucus-secreting goblet cells.

 Conjunctiva
 The epithelium is stratified cuboidal to columnar type with
scattered goblet cells.

 This epithelium rests on a delicate connective tissue

layer(substatia proper)
 Lacrimal apparatus
• The structures concerned with secretion and drainage of
lacrimal (tear) fluid together form the lacrimal apparatus.

• Consists of the following structures:

– Lacrimal glands
– Lacrimal ducts
– Lacrimal canaliculi
– Nasolacrimal duct
Lacrimal apparatus
 Lacrimal apparatus

• Lacrimal gland
 It is a tear-secreting tubuloacinar serous gland located
beneath the conjunctiva on the upper lateral side/the anterior
superior temporal part of the orbit.

 The acini have large lumina lined with columnar cells.

 Myoepithelial cells, located below the epithelial cells within

the basal lamina, aid in the release of tears.
• tubuloalveolar acini (A)
myoepithelial cells (M).
• blood vessels (V)
• interlobular ducts (D) eye.
X400. H&E
 Lacrimal fluid is secreted through 8 -12
excretory ducts that open into the lateral
part of the superior conjunctival fornix of
the conjunctival sac.
 Lacrimal Apparatus

 Tears then enter the lacrimal puncta, leading to the lacrimal

canaliculi.

 The fluid moistens and lubricates the surfaces of the

conjunctiva and cornea and provides some nutrients and
dissolved oxygen to the cornea; when produced in excess, it
constitutes tears.
 Lacrimal Apparatus cont…

• When the cornea becomes dry, the eye blinks

• The eyelids come together in a lateral to medial sequence
pushing a film of fluid medially over the cornea.

• Lacrimal canaliculi (L. small canals): commence at a lacrimal

punctum (opening) on the lacrimal papilla near the medial
angle of the eye and drain lacrimal fluid from the lacrimal lake
to the lacrimal sac.

• Nasolacrimal duct: conveys the lacrimal fluid to the inferior

nasal meatus.
Lacrimal apparatus
 Innervation
• The innervation of the lacrimal gland involves three different
components
• Secretomotor (parasympathetic) innervation
– Secretomotor fibers from the parasympathetic part of the
autonomic division of the PNS stimulate fluid secretion
from the lacrimal gland.

– These preganglionic parasympathetic neurons leave the

CNS in the facial nerve [VII], enter the greater petrosal
nerve ,and continue with this nerve until it becomes the
nerve of the pterygoid canal.
 Innervation

• The nerve of the pterygoid canal eventually enters the

pterygopalatine ganglion where the preganglionic
parasympathetic neurons synapse on postganglionic
parasympathetic neurons.
 Innervation

• Sympathetic innervation
– Postganglionic sympathetic fibers originating in the
superior cervical ganglion and leave as the deep petrosal
nerve and join the parasympathetic fibers in the nerve of
the pterygoid canal.
 Clinical correlation
• Epiphora: It is an overflow of tears from conjunctival sac
over the cheeks.
It may occur due to:
 Excessive secretion of tears (hyperlacrimation) following intake
of spicy food or emotional outbreak.

 Obstruction in lacrimal passages, that is lacrimal punctum,

lacrimal canaliculi, lacrimal sac and nasolacrimal duct.

 Eversion of lower eyelid (ectropion), hence that of lacrimal

papilla and lacrimal punctum due to laxity of orbicular oculi in
old age or loss of its tone due to paralysis.
 The Eyeball

 The eyeball or globe of the eye is an

organ of sight and closely resembles
a camera in its structure.

 The eyeball is made up of three

coats, and the fluid filled within it
distributes hydraulic pressure
uniformly to maintain its shape.
 The Eyeball
Location
 The eyeball occupies the anterior
one-third of the orbital cavity and is
embedded in the fat.

 It is enclosed in the thin fibrous

sheath (Tenon’s fascia), which
separates the eyeball
from the fat.

 The optic nerve emerges from it, a

little medial to its posterior pole.
 Histology of the Eyeball
1. Fibrous coat (sclera and
cornea) forming the tough
outer coat.

2. Vascular coat (choroid,

ciliary body and iris)
forming the pigmented
and vascular middle layer.

2. Neural coat (retina),

forming the innermost
layer.
 Outer fibrous coat (Cornea)
 It is transparent, avascular and forms the anterior one-sixth of
the eyeball.
 It bulges forwards from the sclera at the corneoscleral junction
called limbus.

 It is transparent and more convex than sclera because it

represents the segment of a smaller sphere. Its thickness is
about 1 mm at the periphery and 0.5 mm at the center.
 Outer fibrous coat (Cornea)
• Features
1. It is avascular and nourished by permeation of nutrients
from loops of capillaries at the limbus, aqueous humour,
and lacrimal fluid.

2. It not only permits the light to enter the eye but also
reflects the entering light.

3. It is highly sensitive and supplied by the ophthalmic

division of trigeminal nerve.
4. The nerves of cornea form the afferent limb of the corneal
reflex (closure of the eyelids on stimulation of the cornea)
Consists of five histological layers:
1. Corneal epithelium
2. Bowman’s membrane
3. Substantial propria
4. Descemet’s membrane
5. Corneal endothelium
 Anterior corneal epithelium
– Non-keratinized stratified squamous epithelium

– The epithelium is heavily innervated with many free nerve

endings and is very sensitive to stimuli specially pain, but
devoid of blood vessels.
 Anterior corneal epithelium
 Numerous mitotic figures are present in the basal layers,
particularly near the periphery of the cornea, reflecting the
epithelium's high capacity for cell renewal and repair.

 Microvilli present on the surface epithelial cells help retain the

tear film over the entire corneal surface.
 Drying of the corneal surface may cause ulceration.

 Numerous free nerve endings in the corneal epithelium provide

it with extreme sensitivity to touch.
Bowman’s membrane

 it is very thick (8–12 µm) homogenous basement membrane of

the anterior corneal epithelium
 contributes to the stability and strength of the cornea, helping to
protect against infection of the underlying stroma.
 Formed of type I collagen fibers arranged in random fashion.
 Substantia propria/Corneal Stroma

 The thickest layer

(comprising approximately
85% of the cornea's
thickness) of the cornea
 Composed of type I collagen
fibers and corneal cells
known as keratocytes
(modified fibroblasts).

 The fibers are arranged in

lamellae which run parallel
to the corneal surface.
 Descemet’s membrane

 It is basement membrane of the corneal endothelium

 It is also the posterior limiting membrane or lamina
 Contains an atypical type of collagen fibers which have elastic
character.
 Corneal endothelium

 The corneal endothelium lines the posterior aspect of the

cornea.
 It is a simple squamous epithelium with cells.
 It resorbs fluid from the stroma, thus contributing to the
transparency of the cornea, contributory to light refraction.
 Cont….

The transparency of the cornea is due to:

1. Its uniform diameter.

2. Regular arrangement of the collagen

fibers.

3. Properties of ground substance (matrix).

4. Absence of blood vessels.
 Sclera

 The sclera is the tough fibrous layer

of the eyeball covering the posterior
5/6th of the eyeball.

 It is opaque and a small portion of it

is seen as the white of the eye in
the palpebral fissure.
Functions
 Helps to maintain the shape of
the eyeball.

 Protects internal structures.

 Provides attachment to muscles

that move the eyeball.
 Canal of Schlemm

 The sclera is continuous anteriorly with the cornea.

 The junction between the sclera and cornea is termed
corneoscleral junction.
 Just behind the corneoscleral junction, within the sclera is a
circularly running canal called sinus venosus sclerae (canal of
Schlemm)
 The Sclera
 The sclera averages 0.5 mm in thickness, is relatively avascular,
and consists of tough, dense connective tissue containing flat
type I collagen bundles which intersect in various directions
while remaining parallel to the surface of the organ, with a
moderate amount of ground substance and scattered
fibroblasts.
 The middle vascular coat
 is highly vascular layer which is made up of the three components:
 the Choroid layer- the posterior 2/3rdof each half
 the Ciliary body
Anterior 1/3rd
 the Iris & pupil
 unlike the outer coat, it does not form a complete layer, rather
leaves anterior hole known as pupil.
Middle vascular coat of the eyeball(Choroid)
 Middle vascular coat of the eyeball(Choroid)
 The choroid is the posterior part of the vascular coat of the
eyeball.

 It is brown, thin, and highly vascular membrane

lining the inner surface of the sclera.

 Forms the largest part of the vascular layer of the eyeball and lines
most of the sclera.

 Anteriorly, it is connected to the iris by the ciliary body and

posteriorly, it is pierced by the optic nerve
 Middle vascular coat of the eyeball(Choroid)

• Functions of the choroid

– (a) provides nutrition to the outer layers of retina

– (b) supports the retina, absorbs the light and prevents

reflection.
 The choroid

 Rich in collagen and elastic fibers,

fibroblasts, melanocytes,
macrophages, lymphocytes, mast
cells, and plasma cells.

 The abundant melanocytes give the

layer its characteristic black
color and block light from entering
the eye except through the pupil.
 The choroid cont….

 The outer part of the choroid bound to the sclera is the

suprachoroidal lamina.

 The inner region is richer than the outer layer in

microvasculature and is called the choriocapillary lamina.
 Its microvasculature is important for nutrition and normal
maintenance of the retina.

 A thin (2–4 m) amorphous hyaline sheet known as Bruch's

membrane separates the choriocapillary layer from the retina
 Cont….

 Connective tissue of the

sclera (S) and the loose
 vascular connective tissue of
the choroid (C).

 suprachoroidal lamina (SCL).

 The choroid's inner region,
the choroidocapillary
lamina (CCL)

 Bruch's layer (B)

 Middle vascular coat of the eyeball(Ciliary Body)
Ciliary Body
 Is muscular as well as vascular,
connects the choroid with the
circumference of the iris.
 It is continuous with the choroid
behind and the iris in front.

 It is situated posterior to the

corneoscleral junction
 The ciliary bodies suspend the lens
via suspensory ligaments.
Parts of the Ciliary Body
The ciliary body is
triangular in cross section,
thick in front and thin
behind.
•consists of
Ciliary processes

The ciliary muscle

(smooth muscle
fibers)
 Cont…

• The ciliary processes are

longitudinal ridges projecting
from the inner surface of the
ciliary body.

• Extending from them are

zonular fibers attached to the
lens of the eyeball, which
suspend the lens in its proper
position and collectively form
the suspensory ligament of the
lens.
 Cont….
– Microscopically, it is formed of:

 ciliary muscle, formed of

two bundles of smooth
muscle fibers, concerned
with accommodation.

 loose CT rich in elastic

fibers, vessels &
melanocytes.
 Cont….
– Histology of ciliary processes:
– Are covered by two layers
of cuboidal epithelium:
1. Outer non-
pigmented(NE):

2. Inner heavily
pigmented(PE):
 Iris
 The iris is the most anterior
extension of the uvea (middle
layer) that partially covers the lens,
leaving a round opening in the
center called the pupil.

• The iris is attached at its periphery

to the middle of the anterior
surface of the ciliary body.
• Peripheral to this attachment the
ciliary body and narrow rim of
sclera form the iridocorneal angle.
 Iris cont….
 It consist of two ayer of
smooth muscle consists of
two parts.
 Constrictor pupillae—an
inner (near the margin of
the pupil) part made of
circular fibers.

 Dilator pupillae—a
peripheral part made up
of radial fibers.
 Iris cont….

• The parasympathetically stimulated sphincter pupillae closes

the pupil, and the sympathetically stimulated dilator pupillae
opens it.
 Iris cont…
• The anterior surface of the iris, exposed to the anterior
chamber, is not covered by epithelium, but consists of an
irregular, discontinuous layer of fibroblasts and melanocytes.
 Iris cont….
 The posterior surface of the iris is smooth, with a two-layered
epithelium continuous with that covering the ciliary body and its
processes.

 Deeper in the iris the stroma is more typical loose connective

tissue with microvasculature.
 Iris cont….
 The heavy pigmented epithelium of the iris prevents light from
entering the interior of the eye except through the pupil.
 The underlying epithelial layer is composed of myoepithelial
cells which are also at least partially pigmented.

 The abundant melanocytes in the vascular layer of the eye act

collectively to keep stray light rays from interfering with image
formation.
 Melanocytes of the iris stroma also provide the color of the
eyes.
 Iris cont….
 As the number of melanocytes and
amount of collagen increases in the
stroma, the iris color changes
through various shades of green,
gray, and brown.

 Individuals with albinism have

almost no pigment and the pink
color of their irises is due to the
reflection of incident light from the
blood vessels of the stroma.
 Functions of Iris:

 Control size of pupil, amount of light & depth of focus.

 Share in the formation of aqueous humor from its posterior

surface (minimal), and absorb stray light rays.

 Its level of pigmentation determines the color of the eye.

 Lens
 The lens is a transparent biconvex structure immediately behind
the iris, used to focus light on the retina.

 The lens is a unique avascular tissue.

 It is highly elastic, a feature that is lost with age as lens tissue
hardens.
It consist of
 Lens capsule,
 Subcapsular epithelium,
 Lens fibers .
 Cont…
Capsule:
 It is thick lamina that covers the entire lens.
Subcapsular Epithelium:
Subcapsular lens epithelium consists of a single layer of cuboidal
epithelial cells and is present only on the anterior surface of the
lens.
 Lens fibers
 Lens fibers are highly elongated and appear as thin, flattened
structures.

 Developing from stem cells in the lens epithelium, the

differentiating lens fibers eventually lose their nuclei and
other organelles, fill the cytoplasm with a group of proteins
called crystallins, and become very long.

 Mature lens fibers are typically 7–10 mm long, 8–10 m wide,

and 2 m thick.
 The fibers are densely packed together forming a perfectly
transparent tissue highly specialized for light refraction.
 Differentiating lens fibers (DLF)
still have their nuclei, but are
greatly elongating and filling
their cytoplasm with proteins
called crystallins.

 The mature lens fibers (MLF)

have lost their nuclei and
become densely packed to
produce a unique transparent
structure. The lens is difficult to
process histologically and
sections
usually have cracks or blebs
among the lens fibers. X200.
H&E.
 Clinical correlation
Cataracts
• With increasing age and in certain disease states the lens of
the eye becomes opaque.

• Increasing opacity results in increasing visual impairment.

• A common operation is excision of the 'cloudy' lens and

replacement with a new manmade lens.
 Retina
 It is the innermost layer of the eye
and is responsible for
photoreception.

 Anteriorly, it decreases in thickness

and becomes continuous with the
ciliary body at the region called ora
serrata.

 Posteriorly, it forms the optic disc,

where the nerve fibers merge to
form the optic nerve.
ora serrata.
 Retina
It has a shallow depression
in its posterior wall that
contains only cones; this
avascular region, called the
fovea centralis, whose
central region, the macula,
exhibits the greatest visual
acuity.
 Retina
The retina consists of two major layers.
The neural retina, contains the neurons and photoreceptors.

This layer's visual region extends anterior only as far as the ora
serrata, but it continues as a cuboidal epithelium lining the
surface of the ciliary body and posterior iris.
Pigmented layer is an epithelium resting on bruch's membrane
just inside the choroid.

This pigmented, cuboidal epithelium also lines the ciliary body

and posterior iris, contributing to the double epithelium.
 Rods cells
 About 120 million rods are found in the retina of each eye,
 Extremely sensitive to light, responding to a single photon, and
allow some vision even with light low levels, such as at dusk or
nighttime.

 Are thin, elongated cells (50 µm x 3 µm), composed of two

distinct segments: the outer photosensitive segment and the
inner segment which contains the metabolic machinery for the
cell's biosynthetic and energy-producing processes.
 Cont…..
 Abundant polyribosomes located inside the mitochondrial
region produce proteins that are transported to the outer
segment, where they are incorporated into the membranous
discs.

 These proteins include the visual pigment rhodopsin which is

bleached by light and initiates the visual stimulus.

 The rod vesicles migrate to the outer segment and the apical
vesicles are always sheded and phagocytosed by the pigment
cells.
 Cone cells (day time vision)
 Each human retina contains about 6 million cones
 Each cone is formed of an outer cone shaped segment and an
inner thick segment.

 The outer segment contains stacked membranous discs, which

arise from the plasma membrane.

 cones are only active during day and contain special pigment
known as iodopsin.
 iodopsin pass to the outer segment where it is evenly distributed.
 the inner segment is thick containing the nucleus, organelles and
inclusions
 Histological layers of retina

1. Pigmented epithelium layer (pl):

2. Rods and cones layer
3. Outer limiting membrane/lamina (oll)
4. Outer nuclear layer (onl):
5. Outer plexiform layer (opl):
6. Inner nuclear layer (inl):
7. Inner plexiform layer (ipl):
8. Ganglion cell layer (GL):
9. Optic nerve layer (OL)
10. Inner limiting membrane(IL)
Layers of retina
 Layers of retina
1- Pigmented epithelium layer (PL):
 It is a single layer of melanin-rich columnar cells.
 Their outer (basal) border lies opposite to Bruch's membrane.
 Their inner border sends microvilli, which extend to touch the
tips of rods and cones.
 Layers of retina cont..
2- rods and cones layer (RCL):
contain the photosensitive portions (i.e. the outer
segments of rods and cones.

3 outer limiting membrane/lamina (oll):

Formed by the junctional complexes between the
photoreceptors and the processes of Müller cells.

4 outer nuclear layer (onl):

contains densely packed cell bodies of the photoreceptors
(cones and rods).
 Layers of retina cont..
5- outer plexiform layer (opl):
–The synaptic bodies of the photoreceptors synapse with the
dendrites of the 1st order neurons (bipolar neurons).
–The two types of neurons represented in this layer are:
– Dendrites of Bipolar cells.
– Dendrites of Horizontal cells.
6. inner nuclear layer (inl):
– It contains the cell bodies (nuclei) of
– bipolar cells (1st order neurons)
– association neurons (horizontal cells and Amacrine cells)
and
– supportive neuroglial cells called Müller's cells.
7- The inner plexiform layer (IPL):
 contains the synaptic contacts between the axons of bipolar
cells and amacrine and the dendrites of the ganglion cells.
8-The ganglion cell layer (GL):
– consists of the large cells bodies of ganglionic neurons.
9-Optic nerve fiber layer (NFL):
– contains the axons of ganglion cells.
– the fibers arise from the cell bodies and emerge as the optic
nerve .
– the fibers become myelinated as they pierce the sclera.
10- inner limiting membrane:
–limits the retina from inside separating it from the vitreous body.
–consists of the origin of Müller's fibers lying on a basement
membrane.
 Medical Application (age-related macular
degeneration)
 A leading cause of blindness in elderly individuals of developed
countries is age-related macular degeneration, which causes
blindness in the center of the visual field.

 Degenerative changes in the retina around the macula include

depigmentation of the posterior epithelium, focal thickening of the
adjacent Bruch's membrane, major changes and blood loss in the
capillaries in the choroid and retina, and eventual loss of the
photoreceptorcells producing blind spots.

 There appears to be a genetic predisposition to the disorder, along

with environmental triggers such as excessive exposure to
ultraviolet radiation.
 Extraocular Muscles of the Orbit
• Voluntary (striated) muscles of the orbit are seven, out of which
six muscles (four recti and two obliques) move the eyeball, and
one muscle, levator palpebrae superioris, elevates the upper
eyelid.
1. Four recti muscles
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
2. Two oblique muscles
Superior oblique,
Inferior oblique.
3. One levator palpebrae superioris
Extraocular Muscles of the Orbit
Levator palpebrae superioris
 It is the most superior muscle in the orbit, originating from
the roof, just anterior to the optic canal on the inferior
surface of the lesser wing of the sphenoid.
 Innervation is by the superior branch of the oculomotor
nerve [III].
 Contraction of the levator palpebrae superioris raises the
upper eyelid. 107
 Rectus muscles
• Four rectus muscles occupy medial, lateral, inferior, and
superior positions as they pass from their origins posteriorly
to their points of attachment on the anterior half of the
eyeball.

• They originate as a group from a common tendinous ring at

the apex of the orbit and form a cone of muscles as they pass
forward to their attachment on the eyeball .
Rectus muscles
 Superior and inferior rectus muscles

• The superior rectus originates from the superior part of the

common tendinous ring above the optic canal.

• The inferior rectus originates from the inferior part of the

common tendinous ring below the optic canal.
 Superior and
inferior rectus
muscles

 superior rectus
elevates, adducts,
and internally
rotates the eyeball.

 Inferior rectus
depresses, adducts,
and externally
rotates the eyeball.
 Medial and lateral rectus muscles
• The medial rectus originates from the medial part of the
common tendinous ring medial to and below the optic canal,
whereas the lateral rectus originates from the lateral part of
the common tendinous ring as the common tendinous ring
bridges the superior orbital fissure.

• The medial and lateral rectus muscles pass forward and attach
to the anterior half of the eyeball.

• To isolate the function of and test the medial and lateral

rectus muscles, a patient is asked to track a physician's finger
medially and laterally, respectively, in the horizontal plane.
 Medial rectus
adducts the
eyeball

 Lateral rectus
abducts the
eyeball.
 Oblique muscles

• The oblique muscles are in the superior and inferior parts of

the orbit, do not originate from the common tendinous ring,
are angular in their approaches to the eyeball, and, unlike the
rectus muscles, attach to the posterior half of the eyeball.

– Contraction of the superior oblique directs the pupil down

and out.

– Contraction of the inferior oblique directs the pupil up and

out.
Oblique muscles
 Nerve supply of extraocular muscle of the eye
• In addition to the optic nerve (CN II), the nerves of the orbit
include those that enter through the superior orbital fissure and
supply the ocular muscles:
• Oculomotor (CN III)
• Trochlear (CN IV)
• Abducent (CN VI) nerves.

• A memory device for the innervation of the extraocular muscles

moving the eyeball is similar to a chemical formula: LR6SO4AO3
(lateral rectus, CN VI; superior oblique, CN IV; all others, CN III)

117
Nerve supply of extraocular muscle of the eye
 Arterial supply of eyeball
• The blood supply of the orbit is
 Mainly from the ophthalmic artery, a branch of the
internal carotid artery.

 Infraorbital artery

 External carotid artery, also contributes blood to structures

related to the orbital floor.
 Arterial supply of eyeball

• The central artery of the retina, a branch of the ophthalmic

artery arising inferior to the optic nerve, runs within the dural
sheath of the optic nerve until it approaches the eyeball.

• The central artery pierces the optic nerve and runs within it,
emerging at the optic disc.

• Its branches spread over the internal surface of the retina.

• The terminal branches are end arteries, which provide the
only blood supply to the internal aspect of the retina.
Branches of ophthalmic
artery
 Veins drainage
• There are two venous channels in the orbit, the superior and
inferior ophthalmic veins .

• The superior ophthalmic vein begins in the anterior area of

the orbit as connecting veins from the supra-orbital vein and
the angular vein join together.
 superior ophthalmic vein
 Receive tributaries
from the companion
veins to the branches
of the ophthalmic
artery and veins
draining the posterior
part of the eyeball.

 Posteriorly, it leaves
the orbit through the
superior orbital
fissure and enters the
cavernous sinus.
Inferior ophthalmic vein:

 It runs below the optic

nerve and ends either by
joining the superior
ophthalmic vein or drain
directly into the cavernous
sinus.

 It communicates with
pterygoid venous plexus by
small veins passing through
the inferior orbital fissure.
 Clinical correlation
• Blockage of the central Artery of
the retina.

• Because terminal branches of the

central artery of the retina are end
arteries, obstruction of them by an
embolus results in instant and total
blindness.
Gross & microscopic anatomy of Ear
 Ear

 The ear is the organ of hearing and plays an important role in

maintaining the balance (equilibrium) of the body. The ear is
divided into three parts.

1. External ear.
2. Middle ear.
3. Internal ear

 The external and middle parts are mainly concerned with the
transference of sound to the internal ear

 The internal ear contains the organ for equilibrium (the

condition of being evenly balanced) as well as for hearing
 Auricle
 The external ear is composed of the
shell-like auricle (pinna), which collects
sound
 The entire pinna except its lobule is
made up of a single piece of crumpled
yellow elastic cartilage covered with skin.

 The lobule of pinna is made of fibrofatty

tissue covered with skin.
 The auricular cartilage is continuous with
the cartilage of the external auditory
meatus.

129
 Blood and nerve supply

• The arterial supply to the auricle

is derived mainly from the
posterior auricular and
superficial temporal arteries.

• The main nerves to the skin of

the auricle are the great
auricular and auriculotemporal
nerves.
 The lymphatic drainage of the auricle
• The lateral surface of the
superior half of the auricle drains
to the superficial parotid lymph
nodes
• The cranial surface of the
superior half of the auricle drains
to the mastoid nodes and deep
cervical lymph nodes
• The remainder of the auricle,
including the lobule, drains into
the superficial cervical lymph
nodes

131
 Clinical correlation
• Pinna is a source of several graft materials for the surgeons.

• The lobule of ear is commonly pierced for wearing earrings.

 The external ear
1- The auricle (pinna):
 It is formed mainly of coiled
elastic cartilage plate, which
is covered on both sides by
skin.

 It contains fine hairs at the

orifice of the external
auditory meatus that
protects the orifice from
being invaded by foreign
particles.
 The external auditory meatus
 It is oval in transverse section
 It starts from the external orifice
till the tympanic membrane.

 Its length is divided into:

 The outer third has elastic
cartilaginous

 The inner two thirds has a

bony wall
 External acoustic meatus

It consists of:
 Hair follicles
 Ceruminous glands:
 Modified apocrine sweat glands formed histologically of
coiled tubular glands which produce a brownish semisolid
secretion (mixture of fats and waxes) known as CERUMEN
or EAR WAX.
 The cerumen and the hair follicles have an important
protective function to the external ear canal.
 External Acoustic Meatus

• “S” shaped canal that leads

inward through the tympanic
part of the temporal bone
from the auricle to the
tympanic membrane

• Measures about 2-3 cm in

adults

136
 External Acoustic Meatus

• The lateral 1/3rd is

cartilaginous and lined with
skin that is continuous with
the auricular skin.

• Its medial 2/3rd is bony and

lined with thin skin that is
continuous with the external
layer of the tympanic
membrane.

137
 External Acoustic meatus

• The ceruminous and sebaceous glands in the subcutaneous tissue

of the cartilaginous part of the meatus produce cerumen (earwax)
• Has some protection against entering foreign objects, insects and
bacteria.

138
 The tympanic membrane

• Approximately 1 cm in diameter, is a thin, oval semitransparent

membrane at the medial end of the external acoustic meatus
• Forms a partition between the meatus and the tympanic cavity of
the middle ear.
• The tympanic membrane moves in response to air vibrations that
pass to it through the external acoustic meatus. 139
 The Tympanic Membrane (Ear Drum).
– Formed of three layers:
1. An External layer:
 Lined by a thin layer of skin
epidermis (hairless) with
out dermis
 Only about 10 cells thick

2. The Intermediate fibrous layer:

 It is fibrous CT core in the space
between inner & outer layers.
 It is filled with collagen and
elastic fibers as well as
fibroblasts.
3.The inner surface:
Is covered with simple cuboidal epithelium continuous with
the lining of the tympanic cavity

The tympanic membrane transmits sound waves to the

middle ear bony ossicles.
 Nerve supply of tympanic membrane

• The external surface of the tympanic membrane is supplied

mainly by the auriculotemporal nerve, a branch of CN V3

• Some innervation is supplied by a small auricular branch of

the vagus (CN X)

• The internal surface of the tympanic membrane is supplied by

the glossopharyngeal nerve (CN IX)

142
Nerve supply of tympanic membrane
 Otoscopic Examination
• Examination of tympanic membrane: Inspection of the
tympanic membrane with an otoscope provides significant
information about the condition of the middle ear.
• The color, curvature, presence of lesions, and position of
malleus are features of special importance.
 Middle Ear

• The middle ear is an air-

filled, mucous membrane-
lined space in the temporal
bone between the
tympanic membrane
laterally and the lateral
wall of the internal ear
medially.
 Middle Ear

• Its basic function is to transmit vibrations of the tympanic

membrane across the cavity of the middle ear to the internal
ear.

• It accomplishes this through three interconnected but movable

bones that bridge the space between the tympanic membrane
and the internal ear.

• These bones are the malleus (connected to the tympanic

membrane), the incus (connected to the malleus), and the
stapes (connected to the incus and the lateral wall of the
internal ear at the oval window).
Middle Ear
 Middle Ear

• It consists of two parts

– the tympanic cavity proper immediately adjacent to the
tympanic membrane
– the epitympanic recess superiorly.
The tympanic cavity is
connected
anteromedially with the
nasopharynx by the
pharyngotympanic tube
and posterosuperiorly
with the mastoid cells
through the mastoid
antrum
 Contents of the middle ear
• The contents of the
middle ear are the:
– Auditory ossicles
(malleus, incus, and
stapes).
– Stapedius and tensor
tympani muscles.
– Chorda tympani
nerve, a branch of CN
VII
– Tympanic plexus of
nerves.
 Histology of the Middle Ear:

1- The Epithelial lining:

 The middle ear cavity is lined mainly with simple cuboidal

epithelium resting on a thin lamina propria that is
strongly adherent to the underlining periosteum.

 Near the auditory tube, this simple epithelium is gradually

replaced by the ciliated simple columnar epithelium.
 Histology of the Middle Ear:

• In the medial bony wall of the

middle ear are two membrane-
covered regions devoid of bone:
the oval and round windows a
layer of simple squamous or
low cuboidal epithelium.
 Auditory (pharyngotymphanic or Eustachian tube)

 Connects middle ear to

nasopharynx, where it
opens posterior to the
inferior nasal meatus

 The posterolateral third of

the tube is bony and the
remainder is cartilaginous
 Eustachian tube
 its posterior 1/3 is bony, while its
anterior 2/3 is cartilaginous with
collapsed lumen lined by simple
columnar ciliated epithelium.

 Near the nasopharynx it is lined by

pseudostratified columnar ciliated
epithelium with goblet cells.

 Its lamina propria contains

seromucous glands.
 Auditory (pharyngotymphanic or Eustachian tube)

• Equalize pressure in the middle ear with the atmospheric

pressure, thereby allowing free movement of the tympanic
membrane.

• Because the walls of the cartilaginous part of the tube are

normally in apposition, the tube must be actively opened.
• levator veli palatini and tensor veli palatini pulls

• Because these are muscles of the soft palate, equalizing

pressure is commonly associated with activities such as yawning
and swallowing.
 Clinical correlation( Otitis Media)
• An earache and a bulging red tympanic membrane may indicate
pus or fluid in the middle ear, a sign of otitis media . Infection of
the middle ear is often secondary to upper respiratory infections

156
 Auditory Ossicles
• They form a mobile chain of small bones across the tympanic
cavity from the tympanic membrane to the oval window
• They are the first bones to be fully ossified during development
and are essentially mature at birth.

• Connect tympanic membrane to receptor complexes of inner ear

• The bone from which they are formed is exceptionally dense
(hard)
• The ossicles are covered with the mucous membrane lining the
tympanic cavity; but unlike other bones, they lack a surrounding
layer of osteogenic periosteum.

157
Auditory Ossicles
 Types auditory Ossicles
• Malles (hammer)

• Incus (anvil)

• Stapes (bound to
oval window of
cochlea)(stirrup)
 Malleus
• It resembles a hammer and, therefore, known as malleus.
• It has head, neck, handle (manubrium), a lateral process, and
an anterior process.

• The head and neck lie in the epitympanum, whereas the

handle is embedded in the fibrous layer of tympanic
membrane.

• The head of malleus articulates with the body of the incus

forming the incudomalleolar joint (saddle type of synovial
joint).
Malleus

161
 Incus
• It resembles an anvil or a
premolar tooth in shape.

• It consists of a relatively large

body and two slender
processes: a short process and
a long process

• Forms the incudostapedial

joint (ball and socket type of
synovial joint)

162
 Stapes
• It resembles a stirrup.

• It consists of head, neck,

anterior and posterior
crura, and footplate.

• The footplate closes the

oval window and is
attached to its margin by
annular ligament
 Muscles
Associated with
Ossicles

•The tensor tympani

•The tensor tympani pulls the handle of malleus medially, tensing the
tympanic membrane and reducing the amplitude of its oscillations.
•This action tends to prevent damage to the internal ear when one is
exposed to loud sounds.
•The tensor tympani is supplied by the mandibular nerve (CN V3).
 Muscles Associated with Ossicles

Stapedius muscle
 Contraction, usually in response to loud noises, pulls the
stapes posteriorly and prevents excessive oscillation
 Supplied by nerve to the stapedius which arises from the
facial nerve (CN VII)
 Internal Ear
• The internal ear contains the vestibulocochlear organ
concerned with the reception of sound and the
maintenance of balance.

• Buried in the petrous part of the temporal bone

• The internal ear consists of two components
The inner ear

Bony Labyrinth:
1 Bony vestibule
2 Bony cochlea
3 Three bony semicircular canals
Bony labyrinth
Internal Ear

Membranous labyrinth.
 a closed system of fluid filled intercommunicating membranous
sacs and ducts.
 The fluid filled in the membranous labyrinth is called endolymph
 Bony Labyrinth
• The bony labyrinth, composed of the semicircular canals,
vestibule, and cochlea are filled with perilymph, and house the
membranous labyrinth filled with endolymph.
 Semicircular canals house the semicircular ducts of the
membranous labyrinth.
 The vestibule houses the saccule and utricle.
 Cochlea
Bony labyrinth.

 The membranous labyrinth lies within the complex

intercommunicating bony cavities and canals in the petrous
part of the temporal bone.
 Cochlea

•The cochlea resembles the shell of a common snail.

•The spiral canal of the cochlea begins at the vestibule and makes 2.5
turns around a bony core, the modiolus.

•The base of cochlea faces posteromedially and an apex that faces

anterolaterally.
 Vestibule of the Bony Labyrinth
• The vestibule of the bony labyrinth is a small oval chamber
(approximately 5 mm long) that contains the utricle and
saccule , and parts of the balancing apparatus (vestibular
labyrinth).
• The vestibule features the oval window on its lateral wall,
occupied by the base of the stapes.

• The vestibule is continuous with the bony cochlea anteriorly,

the semicircular canals posteriorly, and the posterior cranial
fossa by the aqueduct of the vestibule
Vestibule of the Bony Labyrinth
 Semicircular
canals

 The semicircular canals (anterior, posterior, and lateral)

communicate with the vestibule of the bony labyrinth.
 Each of these canals forms two-thirds of a circle connected at
both ends to the vestibule and with one end dilated to form
the ampulla.
 Membranous Labyrinth
1 Utricle and saccule
(in the bony
vestibule)

2 Membranous
cochlea (cochlea
duct)

3 Membranous
semicircular canals
(semicircular
ducts)
 Membranous labyrinth
• The membranous labyrinth consists of a series of
communicating sacs and ducts that are suspended in the bony
labyrinth
• It contains endolymph, a watery fluid similar in composition to
intracellular fluid.

177
 Utricle and saccule

 The utricle is the larger of the two sacs.

 It is oval, elongated and irregular in shape and is in the
posterosuperior part of the vestibule of the bony labyrinth.
 The saccule is a smaller, rounded sac lying in the
anteroinferior part of the vestibule of the bony labyrinth.

 The saccule is continuous with the cochlear duct through the

ductus reuniens, a uniting duct
 The utricle and saccule have specialized areas of sensory
epithelium called maculae.

 The hair cells in the maculae are innervated by fibers of the

vestibular division of the vestibulocochlear nerve.
 Histological structure of macula

– Both maculae are basically similar to each other

– They are formed of thin sheet of connective tissue overlied
by neuroepithelial elements:

1- Neuroepithelial cells
2 Supporting cells are columnar in between the receptor cells
3 Otolithic membrane: thick gelatinous glycoprotein layer
(otolithic layer) which contains a surface deposits of crystal
bodies of calcium carbonate (otoliths or Otoconia)
Histological structure of macula
Types of hair cells
–Type I hair cells (bulbar), which are
almost completely surrounded by a
cup-shaped afferent nerve ending.

–Type II hair cells (columnar), which

make contact with small afferent
terminals containing synaptic
vesicles
–Both cell types are also
associated with efferent fibers.
 The apical end of each hair cell has a single kinocilium with a
basal body and a bundle of 60–100 long, rigid, unbranched
stereocilia.
 Cont…
– The tips of the stereocilia and kinocilium are embedded in a
thick, gelatinous layer of proteoglycans called the otolithic
membrane, the outer part of which is filled with calcified
structures called otoliths (or otoconia).

– The hair cells in the maculae of the saccule and the utricles
respond to linear acceleration, gravity, and tilt of the head.
 Semicircular Ducts

• Three ducts continues

with utricle and filed
with endolymph

• Superior

• Posterior

• Horizontal

186
 Semicircular Ducts
•The crests are sensors for
recording movements of the
endolymph in the ampulla
resulting from rotation of the
head in the plane of the duct.

•The hair cells of the crests

stimulate primary sensory
neurons, whose cell bodies are
in the vestibular ganglia.
Internal acoustic meatus
 Crista ampullaris

 Cristae ampullaris (ampullary

crests) located in the membranous
ampullae of the semicircular ducts.
Contains
 Neuroepithelial cells (hair cells or
receptor cells)
 Supporting columnar cells
 Gelatinous glycoprotein layer called
cupola.
 Cochlea duct

 The cochlear duct, a part of the membranous labyrinth connected

to the saccule, is highly specialized as a sound receptor.

 When observed in sections, the cochlea appears to contain three

spaces: the scala vestibuli, the middle cochlear duct (or scala
media), and the scala tympani.
 Cochlea duct

 The cochlear duct contains endolymph and ends at the apex of

the cochlea.

 The other two spaces contain perilymph and are in reality one
long tube, beginning at the oval window and ending at the
round window.
 Cochlear Duct (Scala Media)
• Scala vestibuli and the scala tympani are continuous with each
other at the apex through a narrow slit called helicotrema
 Cochlear Duct (Scala Media)

• The cochlear duct has a central position in the cochlea of the

bony labyrinth dividing it into two canals (the scala vestibuli
and the scala tympani).

• It is maintained in this position by being attached centrally to

the lamina of modiolus, which is a thin lamina of bone
extending from the modiolus and peripherally to the outer
wall of the cochlea (spiral ligament)
The spiral organ is the organ of hearing, rests on the basilar
membrane, and projects into the enclosed, endolymph-filled
cochlear duct
 Cochlea duct
 Along its length, the cochlear duct is separated from the scala
vestibuli by the vestibular membrane.

 This very thin structure consists of a basement membrane with

simple squamous epithelium on each side one mesothelium
facing the scala vestibuli and the other part of the cochlear
duct's lining.

 Cells of both layers have extensive tight junctions that help

preserve the very high ionic gradients across this membrane
between endolymph and perilymph.
 Cochlea duct
 In the lateral wall of the cochlear duct is the stria vascularis , a
unique epithelium responsible for production and
maintenance of the endolymph for the entire membranous
labyrinth.

 The stria vascularis encloses a network of capillaries and

consists of cells with many deep basal infoldings of their
plasma membranes, where numerous mitochondria are
located.

 Fluid and K+ ions pumped from the capillaries by these

epithelial cells are released in the cochlear duct as endolymph.
The spiral organ (SO) is located on the
basal wall of the cochlear duct (CD).
This duct is filled with endolymph
produced in the stria vascularis (STV),
an unusual association between the
columnar epithelial cells which have
numerous basal infoldings and the
capillaries in the periosteum of the
bone
(B). On either side of the
cochlear duct are the scala vestibuli
(SV) and scala tympani (ST), which are
filled with perilymph and are
continuous at the apex of the cochlea.
Cell bodies of bipolar neurons in the
spiral ganglion (SG) send dendrites to
the hair cells of the spiral organ and
axons to the cochlear nuclei of the CNS.
X25. H&E
 In the wall that separates the cochlear duct from the scala
tympani is the complex structure called the spiral organ
(organ of Corti) which contains special auditory receptors in
the form of hair cells that respond to different sound
frequencies.
 The spiral organ rests on a thick basal lamina—the basilar
membrane.
Types of hair cells:
Outer hair cells (OHC):
 Occur in three rows near the
oval window, increasing to
five rows near the apex of the
cochlea.
 Have a curved row of longer
Stereocilia
 Cochlea duct

– IHC(inner hair cells)

 There is a single row of inner hair cells (IHC).
 Have one linear array of short stereocilia
 No kinocilium is present on cochlear hair cells, allowing
symmetry on the cells that is important for their role in
sensory transduction.
Stereocilia of cochlear hair cells
With the tectorial membrane removed, SEM
shows the morphology of the three rows of
outer hair cells (a), and the single row of inner
hair cells (b) in the middle turn of a cochlea.
X2700.
 Cochlea duct
 The tips of the tallest stereocilia of the OHC are embedded in
the tectorial membrane, an acellular layer extending over the
spiral organ from the modiolus.

 The tectorial membrane consists of fine bundles of collagen

(types II, V, IX, and XI), associated proteoglycans and other
proteins.

 Both outer and inner hair cells have afferent and efferent
nerve endings, with IHC much more heavily innervated.
 The cell bodies of the afferent bipolar neurons are located in a
bony core of the modiolus and constitute the spiral ganglion
 Cochlea duct
 Supporting columnar cells are associated with the hair cells of
the spiral organ.
 Pillar cells
 Are stiffened by bundles of keratin and outline a triangular,
tunnel-like space between the outer and inner hair cells
another structure important in sound transduction.

 Phalangeal cells
 Intimately surround and directly support both inner and
outer hair cells, almost completely enclosing each IHC but
only the basal ends of the OHC.
 Cochlea duct
 Stereocilia of cochlear hair cells detect movements of the
spiral organ.

 Sound waves collected by the auricle of the external ear cause

the tympanic membrane to vibrate, which causes movement
of the ossicles in the middle ear.

 The large size of the tympanic membrane compared to the

oval window and the mechanical properties of the ossicle
chain connecting these two membranes allow for optimal
transfer of energy between air and perilymph, from sound
waves to vibrations of tissues and fluid-filled chambers.
Cochlea and cochlear duct (labeled)
 Clinical correlation
• Conductive hearing loss: resulting from anything in the
external or middle ear that interferes with movement of the
oval or round windows.
• People with this type of hearing loss often speak with a soft
voice because, to them, their own voices sound louder than
background sounds.

• Sensorineural hearing loss: resulting from defects in the

cochlea, cochlear nerve, brainstem, or cortical connections