Anatomy and

physiology
Zelalem Gizachew
ophthalmology
DEFINITION
! Ophthalmology is a branch of clinical medicine dealing

with the anatomy , physiology and diseases of the eye

and its adnexa.
! It has got different sub-specialities that deal with the

different parts of the eye.

! The eye is one of the vital sensory organs of human

body.
I-Anatomy and physiology
! Deal with the following eye structures

- Orbit, Lids and lacrimal apparatus, Conjunctiva

- Cornea, Sclera, Uveal tract, Lens, Vitreous, Retina and optic nerve

- Extra ocular muscles

- Visual pathways
Orbit
! The eye lies in a closed two bony compartments called the orbit

! The orbit is a pear shaped structure with the optic nerve as the stem

! The medial orbital walls are parallel to each other while the lateral orbital walls form
an angle of 45°with the medial plane.

! The periorbital sinuses surround the orbits =

The maxillary sinus inferiorly

The frontal sinus superiorly

The ethmoid sinuses medially
! Volume of orbit : 35mm x 45mmx 45mm.

! Seven bones make the bony orbit :

- frontal - zygomatic
- maxillary - sphenoidal
- ethmoidal - palatine
- lacrimal
Orbit
! The orbital roof is formed by the orbital plate of the frontal bone and
the lesser wing of the sphenoid bone

! The lacrimal fossa is located in the anterolateral part of the

orbital roof

! 4 bones comprise the medial orbital wall:

-frontal process of the maxillary
-orbital plate of the ethmoid( largest)
-lacrimal bone
-lesser wing of the sphenoid
! Floor of the orbit comprised of three bones, is also the roof of
the maxillary sinus
- maxillary - palatine -orbital plate of zygomatic
bone

• Lateral orbital wall formed by two bones is the strongest

and thickest part of the orbit

• The zygomatic bone and the greater wing of the sphenoid bone.
Lids and Lacrimal apparatus
Anatomy of the Eye lids

! The human eye contains the upper mobile eye lid and the lower lid.

! The exposed area between the two lids is the palpebral fissure.

! It`s about 27-30 mm wide and 8-11mm long.

! The levator palpebrae and the orbicularis occuli are two important
muscles acting on the lids which change it`s dimensions for closure
and opening.
Eye lid margin, contains important structures
- punctum ( upper and lower) located medially at the
lid margin used for tear outflow
- gray line is an important structure separating the eye
lid into anterior / posterior lamella
- anterior to this line are the eye lashes or the cilia
- posterior to the grey line are the meibomian orifices
that are exits of meibomian escretions from the ducts
of the meibomian gland
Orbicularis occuli
these are several concentric rings of muscle around the eye ,
has orbital and palpebral parts .

Orbital septum
thin connective tissue which is an extension of the periosteum
of the upper and the lower orbital margin that is a barrier for
the transmission of orbital infections. Orbital fat lies behind the
septum.
Levator palpebrae superioris

has different tendons inserting into the tarsus, canthus ..

forms the upper eye lid crease
overlies the superior rectus muscle
innervated by the superior division
of third cranial nerve

Mullers muscle

is a thin sympathetically innervated muscle that elevates the upper eye

lid located behind the levator superioris.
Tarsus
- tarsal plate contains dense connective tissue plate

- the length( 29mm) and the thickness( 1mm ) is equal in both the
upper and the lower eye lids, but the upper tarsus is three times as wide
as the lower tarsus( 11mm v 4mm).

- Meibomian glands are modified holocrine subaceous glands located

under the tarsus , oriented vertically , they secret oily material which is
distributed in the tear film by the lid movement.
- A single row of 30-40 meibomian gland orifices are present in the
upper eyelid, while only 20-30 of them are present in the lower lids.
Conjunctiva
! is a transparent membrane of vascularized tissue
which is continouation of the fornix and merges with
the bulbar conjunctiva before it ends up at the limbus.
Vascular supply of lids
-The blood supply of the eyelids are derived from the orbital
system (internal carotid artery) or the facial system ( external
carotid artery).

-The marginal arterial arcade located 3mm from margin behind

the tarsus makes the major supply for the lids.

-The peripheral arterial arcade also supplies the lids.

 The venous drainage follows a superficial and deep part

-Superficial part drains into the internal or external jugular

vein

- deep part drains into cavernous sinus

 Lymphatic drainage follows the venous drainage , into the

submandibular glans medially and into the preauricular glands
laterally.

- NB lids and conjunctiva only contain lymphatic vessels none

of them in the orbit.
Lacrimal gland
! Lacrimalgland is a small exocrinegland located in the
anterolateral aspect of the roof in the lacrimal fossa

! Has an orbital and palpebral part separated by the

levator apponeurosis that inserts into the lateral orbital tubercle

! Has got 12 ducts that empty into the conjunctival fornix 5mm above the
superior margin of the upper tarsus

! The gland has a serous secretion containing two types of cells (acinar
and myoepithelial cells)
 Acinar cells line the lumen of the lobules
whereas myoepithelial cells surround the parenchyma.

 Lacrimal artery , a branch of the ophthalmic artery

supplies the gland.

 Accesory lacrimal glands of Krause and Wolfring located

in the fornices are also contributory to tear secretion (10%)
Tear secretion
 Coordinated neurologic mechanism

 has reflex and basal secretory components

● Basic tear secretion is ascribed to the accessory lacrimal glands;

● reflex tear secretion is by the main lacrimal in response to different

stimulations like mechanical , trauma, thermal , psychogenic or
bright light conditions.

 Sympathetic and parasympathetic mechanism elicit secretion of

tear
! The tear film covers the exposed surfaces of the
cornea and conjunctiva

! The tear film contains three layers

- Superficial oily layer ( meibomian
glands)
- middle aqueous layer ( lacrimal
glands)
- inner mucin layer ( conjunctival goblet cells)
The Functions of the tear film
 provide a smooth optical surface to the eye

 carries away debris from the eye to the punctum

 protects the ocular surface from dessication

 provide oxygen, nutrients and other compounds to the corneal epithelium

 contains a vast amount of antimicrobial agents , lubricates the eye

Tear dysfunction
! A q u a l i tative or quantitative dysfunction of the tear film can occur in a
varietyof conditions

 change in the amount of tear film components

 change in the composition of the constituents

 uneven distribution b/c of surface irregularities

 ineffective distribution because of eyelid globe incongruity

Lacrimal excretory system
 punctum to the cannaliculi then to the lacrimal sac , finally to the nasolacrimal
ducts where it exits to the inferior turbinate of the nose

 There are two puncti, each 0.3 mm in diameter located in the medial aspect of the
upper and lower lids

 Upper and lower canaliculi meet and enter the lacrimal sac which is around 10-
15mm in length that finally drains into the nasolacrimal duct measuring 12mm on
average

 Eye lid movements like blinking help in the excretion of tear from the eye into the
lacrimal drainage

 Any blockage in the path of the tear excretion will result in tearing be it anatomic or
physiologic
conjunctiva
 Lines the globe and the internal aspect of the lids

 divided into three zones as palpebral , forniceal and bulbar part

 Palpebral part lines the internal aspect of the lids which is tightly
adherent to the tarsus

 the forniceal conjunctiva which is loosely adherent

 the delicate bulbar conjunctiva that covers the globe and attaches
at the limbus
 Anterior ciliary arteries supply the bulbar part where as the tarsal
part is supplied by the tarsal arterial arcade

 Conjunctiva is a mucous membrane consisting of stratified

non keratinized squamous epithelium together with goblet cells

 The substantia propria is richly vascularized consisting

 Lymphoid tissue as part of mucosa associated lymphoid

tissue, also called conjunctiva associated lymphoid tissue( CALT)
Tenon`s capsule
 Is a thick layer of collagen tissue behind the conjunctiva

 Attaches anteriorly behind the limbus

 posteriorly makes a sling around the extraocular muscles

perforated by the optic nerve sheath, anterior

ciliary arteries and the vortex veins
Helps in the direction of pull of the extraocular muscles

especially the horizontal recti

Cornea
! a transparent avascular structure lining the anterior pole

! measuring in diameter 11-12mm(H)x10-11mm( v)

! The cornea is an aspheric structure central cap measuring 7.8mm in

diameter

! It has got a refractive index of 1.376, contributes 74% of the average

diopteric power of the eye ( 43.2D v58.6D)

! Cornea has got free nerve endings that make it highly sensitive
Epithelium
 Its thickness is about 50um (5-7cell layers thick)

 it is stratified squamous type epithelium whose basal cell is columnar resting on

basement membrane

 Tight junctions prevent entry of the tear film into the stroma

 It has germinal activity the epithelium has 3 predominant layers

 Basal cells-single layer of columnar cell lying on basement membrane

 Wing cells- 2 to 3 layers of cells.

 Surface cells-2 layers of cells are stratified squamous type with

microvilli in contact with tear film
 Bowman’s membrane

● It ends abruptly at periphery of cornea. it has no power of

regeneration after damage

 Lamina propria or stroma

● It comprises about 90% thickness of cornea. Collagen lamella are made up

of collagen fibrils

● The regular arrangement of the collagen lamellae gives clarity of the

cornea

● There are about 2.4 million keratocytes in the corneal stroma

● Transparency of the cornea depends upon in keeping the hydration to 78%

which is a balance between intactness of the epithelium and barrier
function of the endothelial lining
 Descemet’s membrane

● It is basement membrane of endothelium. It terminates at

periphery as prominent line called schwalbe’s line

 Endothelium

● It is single layer of hexagonal cells

● It plays vital role in detergence (dehydration) of cornea

● T heir number can decrease with age or by

different traumas that will bring about corneal stromal
edema
 BLOOD SUPPLY

● C ornea is avascular, but corneoscleral limbus (1mm) is

supplied by perilimbal plexuses

● C ornea gets oxygen supply from the precorneal tear film by

diffusion and also from the aqueous humor in the anterior chamber

 NERVE SUPPLY

● Long ciliary nerve, branches of ophthalmic division of trigeminal nerve

 FUNCTION

● It acts as a powerful refracting lens in eye for focusing light on retina.

the average refractive power of cornea is+43 dioptres
Sclera
! Covers the posterior 4/5 th of the globe with an opening anteriorly for
the cornea and posterior for the optic nerve.

! The tendons of the extraocular muscles insert into the sclera .

! Covered by the conjunctiva and the tenon`s capsule.

! Thinnest behind the insertions of the extraocular muscles

! Relatively avascular except at the episclera with loose layers
of vessels

! The sclera is primarily composed of type I collagen

and proteoglycans

! Normally dense white tissue, becomes transparent

with thinning as a result of different pathologic conditions
Limbus
 is a transtion zone between the cornea and the sclera

 It`s an important structure where the outflow

aqueous pathway is located

 Also important surgically where incisions are made

 Anterior chamber is the space between the posterior surface of the cornea and
the anterior part of the lens iris complex

 The anterior chamber is filled by fluid called aqueous humor

 The depth of the anterior chamber is around 3mm

 The anterior chamber angle is formed by the following structures

 the cornea ( schwalbe`s line)

 the scleral spur

 the trabecular meshwork and shlemm`s canal

 the ciliary body

 the iris surface

The aqueous humor
 Produced by the ciliary processes of the ciliary body

 This fluid is protein free that helps in clarity of vision and

kept clear by the blood aqueous barrier

 The aqueous humor consists of sodium, HCO3, Cl,

ascorbic acid, lactic acid…

 Has higher amount of ascorbic acid as compared to the plasma

 Intactness of the anterior chamber angle is important for

the drainage of aqueous humor
 The aqueous humor enters the posterior chamber by four mechanisms
 Diffusion
 Ultrafiltration
 Carbonic anhydrase II mechanism
 Active secretion

 This fluid produced passes through the pupil from the posterior chamber and
drains through the anterior chamber angle via the trabecular meshwork
Uveal tract
 Uveal tract is the main vascular component of the eye

 - Consists of three main parts

1. Iris

2. Ciliary body

3. Choroid
IRIS
 The iris is the colored structure surrounding

 anterior extension of the uveal tract

 separates the anterior part of the eye into two compartments of Anterior
chamber and Posterior chamber

 consists of blood vessels and nerves in addition to the pigmented

melanocytes that give it it`s distinctive color

 aperture in the center of the iris makes the pupil that varies in size with
the contraction of the iris dilator muscle ( mydriasis) and contraction of
constrictor muscle ( miosis)
CILIARY BODY
 The ciliary body is a structure containing muscle and is located behind
the iris which focuses the lens

 It`s a triangular structure

 has got two principal functions , aqueous formation and accomodation

 The ciliary body is inside the eye and producesa fluid called aqueous
humor

 Ciliary muscles aid in accommodation, the process of changing the

shape of the lens in the eye to see things at various distances
CHOROID
 The choroid is a layer containing blood vessels

 It line the back of the eye and is located between the inner visually
sensitive layer, called the retina, and the outer white eye wall,
called the sclera

 is the posterior portion of the uvea, nourishes the outer layer of the
retina

 perfusion of the choroid comes from the long and short posterior
ciliary vessels and venous drainage through the vortex veins
Lens
 lens is a biconvex structure located behind the iris and pupils

 It`s the refractive component of the eye next to cornea

 Crystalline lens is avascular and not innervated , relies on the

aqueous humor for it`s metabolism

 Functions of the normal lens are to maintain it`s own clarity,

refract light ( refractive index of 1.4) and for accomodation
 Consists of the lens capsule, epithelium, nucleus and cortex

 Lens capsule is an elastic transparent membrane

consisting of type IV collagen fibrils

 Zonular fibers attach between the equatorial zones of the lens

and the ciliary processes of the ciliary body
 Lens epithelium are found immediately behind the anterior capsule
that contain a single layer of cells which differentiate and migrate
to the equator of the lens to form lens fibers

 Compaction of these lens fibers that migrate to the center of the

lens make up the nucleus

 The cortex is the outer part

 The lens has proteins called crystallins that constitute 33% of the
wet weight of lens

 Aging causes change of water soluble proteins to water insoluble

components as well as decrease in total lens proteins

 glucose entering the lens from the aqueous humor and mainly
metabolised through anerobic glycolysis
Vitreous
 The vitreous cavity occupies 4/5th of the volume of the eye

 Contains a viscous jelly transparent material called vitreous

 Consists of 99% water and hyaluronic acid that renders

it`s viscous property( 2x water)

 Provide a route for the metabolites used by the lens,

ciliary body and retina.

 Consists of fine collagen fibrils mainly of type II

Retina
! Fundus oculi is the part of the eye that is visible on ophthalmoscopy,
including the retina and its vessels and the optic nerve head or optic
disc.

! The macula lies in between the temporal vascular arcades, diameter is

5-6mm.

! The red color of the fundus is due to transmisssion of light

reflected from the posterior sclera through the capillary bed of the
choroid.

! The retina has two different parts grossly as: Neurosensory retina and
Retinal pigment epithelium
Optic Nerve
 The optic nerve consists of more than I million axons that originate in
the ganglion cell layer of the retina

 It is the second intracranial nerve

 It extends from optic disc to optic chiasma

 Itsnerve fibre do not possess schwan cells so it cannot

regenerate after damage

 It is the only cranial nerve which is covered by three

meningeal sheaths therefore it is considered as extension of the brain
 Anatomical classification
1. Intraocular

2. Orbital

3. Intracanalicular

4. Intracranial

 Optic nerve lesion can cause decrease visual acuity and a defect in the visual field

● Central scotoma: involves fixation point

● Centroceacal scotoma : fixation to blind spot

● Altitude field defects : two quardrants of either the superior or inferior visual field

● Arcuate defects : selective damage to the superior or inferior retinal nerve fibres.
Extra ocular muscles
 These are the muscles of eye around the globe that help in the synchronized movement of the eye

 Knowing the location, origin, insertion of these muscles is important in understanding the action of
these muscles on the globe

 There are six extraocular muscles , four of them originate from the annulus of zinn.these are

-Superior rectus( SR)

- Inferior rectus (IR)
- Medial rectus(MR) Annulus of Zinn
- Lateral rectus (LR)

 The rest two have different origin

- Superior oblique( SO) from the periosteum of the sphenoid
- Inferior oblique (IO) from a notch in the maxillry bone of floor of
orbit
 Cranial nerve VI ( Abduscens N ) innervates LR

 Cranial nerve IV ( Trochlear N ) innervates SO

 Cranial nerve III ( Occulomotor N ) innervates the MR, SR , IR ,

IO and the levator palpebralis muscles

 Muscle cone lies posterior to the equator and consists of the

extraocular muscles, muscle sheaths and the intermuscular
membrane
Light reflex
! is simultaneous and equal constriction of the pupils in response to illumination of one or the other
eye

! Afferent visual pathway coincides with the visual pathway, pupillary pathways leave the visual fibers
at the posterior part of the optic tract and reach the pretectal nuclei at the lateral aspect of the
midbrain

! Efferent fibers start then and pass to the Edinger Westphal nucleus and run in the inferior division of
the occulomotor nerve as it enters the orbit

! These fibers synapse in the ciliary ganglion located in the intraconal space and give rise to short
ciliary nerves, about 3-5% of which are pupillomotor and the rest go to the ciliary muscle and
concerned with near reflex

! Near reflex is a synkinesis that occurs when attention is changed from distance to near

! This reflex includes accomodation, pupil constriction and convergence.