Anatomy & Physiology

of the eye
Department of Ophthalmology
Ramathibodi hospital

Extraocular muscle
1. Extraocular muscle of the eyeball
1.1 rectus muscle ( superior, inferior,
medial and lateral)

1.2 oblique muscle ( superior and inferior)

2. Muscle of the eyelid
2.1 levator muscle
2.2 Mullers muscle
3. Plain muscle of the orbit

Eyelid

Extraocular muscle of the eyeball

Rectus muscle
origin at the orbital apex ( annulus of
Zinn)
insertion at sclera posteriorly to limbus in
spiral of Tillaux (anterior to center of
rotation)
medial rectus
5.5 mm
inferior rectus 6.6 mm
lateral rectus
6.9 mm
superior rectus 7.7 mm

Extraocular muscle of the eyeball

Oblique muscle
Superior oblique

origin medial to optic foramen near Annulus of

Zinn
pass through Trochlea
return to posterior under superior rectus
insertion postero-superior quadrant lateral to
center of rotation

Inferior oblique

origin anterior medial of floor of orbit

lie under inferior rectus
insertion postero-lateral quadrant below
horizontal meridian

Extraocular muscle of the eyeball

A= superior view
B= lateral view
C= medial view
D=inferior view
Left eye

Eye movement
Monocular eye movement (duction)
adduct = nasal move
move
elevation = upward
downward
intorsion =nasal rotate
rotate

abduct = temporal
depression =

extorsion = temporal

Binocular eye movement

version = conjugate eye movement ( the eyes

move in the same direction)
vergence = disconjugate eye movement ( the eyes
move in the opposite direction)

Vergence
Convergence
= movement of both eyes nasally
Divergence
= movement of both eyes
temporally

Action of extra ocular muscle of

the eyeball
muscle
MR
LR
IR
SR
IO
SO

primary
adduction
abduction
depression
elevation
extorsion
intorsion

secondary
extorsion

tertiary
adduction

intorsion
adduction
elevation
abduction
depression abduction

Test of extraocular muscle

Principle
1. evaluate only one action of
each muscle
2. limit other action by align the
muscle pararel to distal muscle
alignment

6 cardinal position
RSR
LIO
RLR
LMR
RIR
LSO

RIO
LSR
RMR
LLR
RSO
LIR

Physiology of binocular vision

Normal
1) Fovea is the central fixation.

2) Visual axis is the visual direction of the

fovea.
3) Corresponding retinal area in the two eyes are
in identical relationship to the fovea in each
eye.
4) Simultaneous stimulus at correspondence
retinal area will be percepted as same position of
vision.

single vision with normal retinal

correspondence

temporal

tempor
fovea nasal

nasalfovea

physiologic diplopia

temporal

fovea

fovea

temporal

pathologic diplopia

fovea

esotropia

fovea

fovea

fovea

exotropia

haropter
focal plain

diplopia

diplopia
single vision
and stereopsis

Dimension of the eyeball

sagittal diameter
24.15
mm
transverse diameter
mm
vertical diameter
23.48
mm
circumference
78
mm
weight
7.5
gram
volume
6.5
cc.

24.13

axis, equator
anterior pole = center of cornea
posterior pole = center of sclera
geometrical axis = line from anterior to posterior
pole
visual axis = line from fixation point to fovea
geometrical equator - equatorial line perpendicular
to center of geometrical axis
anatomical equator - equatorial line that line in the
middle of the arc of anterior to posterior pole

axis and equator of the eye

A

anterior pole

P F fovea

posterior pole

D
E

if AC = CP
AE = EP, AH
=HP
1. Which is
geometrical
/anatomical
equator?
2. What is
AF?
3. Describe

Potential space of the eye

1. subconjunctival space

between conjunctiva and

tenon
may be accumulated by fluid ( chemosis) or blood
(subconjunctival hemorrhage)
2. subtenonian space between tenon and sclera
use for landmark in surgical plain and lacal drug injection
3. suprachoroidal space between choroid and sclera
may be accumulated by fluid ( effusion) or blood
(hemorrhage)
4. subretinal space between pigmented epithelium and
retina
may be accumulated by fluid (retinal detachment)

Chamber of the eye

1. Anterior chamber
aqueous
2. Posterior chamber
3. Vitreous chamber
vitreous humor

humor
1
3

tonic of the eyeball

3 layer of eyeball (outer to inner layer)
1. fibrous tonic anterior - cornea (1/6
circumference)
posterior - sclera
2. uveal ( vascular) tonic 3 component- iris,
ciliary body and choroid
3. nervous tonic - epithelium of iris and ciliary
body , retinal pigment epithelium and retina

Cornea
General appearance
1. anterior horizontal oval , posterior
circle

horizontal diameter = 1
vertical diameter =10.6

2. surface area =1.3 cm2 (1/14 total surface

area of eyeball)

general appearance of the cornea

3. radius of curvature anterior =7.8 mm ,posterior=
6.5mm

refractive index /radius curvature

diopters
curvature < horizontal
astigmatism (with the rule)

power of lens =
convex lens of 48
vertical radius
physiologic

4. thickness central =0.52mm limbus = 0.67 mm

5 layer of the cornea

1.
2.
3.
4.
5.

1
Epithelium
2
Bowmans layer
Corneal stroma
3
Descemets membrane
Endothelium
4
5

epithelium of cornea
1. stratified, non-keratinized, nonsecretory epithelium
2. 5-7 cell thick ( 50 -100 micron)
3. innermost cell are basal cell with
mitosis activity
4. turnover time = 7 days

Bowmans layer
Bowmans layer is not the true
membrane but condensation of corneal
stroma.
Any lesion in or deeper than this layer
heal with scar
Unmyelinated axon penetrate this layer
across the corneal surface to provide
layer
epithelial bowmans
innervation.

Corneal stroma
dense connective tissue
2 micron thick, flattened,
collagen lamella (200-250 layer)
no blood and lymphatic vessel
but sensory nerve fiber
transparency is highly dependent
on the regularity of collagen
fiber

Descemets membrane
true membrane ( modified
basement membrane)
8-12 micron in thickness
may be detached and tends to
inwards towards A/C

Descemets membra

Corneal endothelium
single squamous epithelium on the
posterior cornea
pumping mechanism to maintain corneal
hydration and transparency
low regenerative activity
350000 cells/cornea (3-4000 at birth,
2500 in middle age, 2000 in old age)
density below 800 cells/mm2 lead to
corneal edema (corneal decompensate)

corneal transplantation
Cornea was the first successfully
transplanted solid tissue.
Corneas were rejected less frequently than
other transplanted tissue. (80-90% success
rate)
No need for HLA typing
relative isolation from blood/lymphatic
channel

Criteria Contraindicating donor

cornea
Death of unknown cause
unknown/infectious C.N.S disease
systemic infection
Evidence suggestive of HIV,syphilis,viral
hepatitis
active Leukemia
intrinsic eye disease
congenital or acquired eye disorder
prior intraocular or anterior segment
surgery

Eye Banking
Tissue removal
consent and medical record review
application of ice pack on the closed lids
storage of the body at refrigerator temperature
abnormal
enucleation as soon as possible
Gross examination
Slitlamp examination
Specular microscopy
Tissue decontamination and infectious normal
work up
Tissue storage

Specular

Prognosis of graft clarity

Group 1 excellent prognosis (> 90%)
avascular central corneal thinning,scar or edema
Dx keratoconus, central corneal scar

Group 2 very good prognosis ( 80 - 90%)

lesion that extends to periphery with mild- mod vascularity

Dx corneal decompensate, inactive herpetic keratitis

Group 3 fair prognosis ( 50 - 80%)

extremes of corneal thinning, perforation, active disease

Dx active keratitis/ulcer, mild chemical burn, moderate keratitis
sicca

Group 4 poor prognosis ( 0 - 50%)

severe fibrovascular change, conjunctival ischemia

Dx severe chemical burn, Steven-Johnson syndrome, mutiple
graft failure

Contraindication for keratoplasty

Ocular condition

1. Corneal anesthesia CN5 dysfunction

2. Exposure keratitis CN7 dysfunction,
uncorrected lid deformity
3. Severe dry eye

Systemic condition

1. Healing difficulty
Malnourished, DM,
2. Highly susceptibility to infection
3. Poor compliance senility, mental
retardation, drug addiction

tonic of the eyeball

3 layer of eyeball (outer to inner layer)
1. fibrous tonic anterior - cornea (1/6
circumference)
posterior - sclera
2. uveal ( vascular) tonic 3 component- iris,
ciliary body and choroid
3. nervous tonic - epithelium of iris and ciliary
body , retinal pigment epithelium and retina

sclera
Boundary
Anterior limbus ( transitional zone from cornea to sclera)
posterior optic nerve
external
tenon capsule
internal
suprachoroidal space
General appearance
fibrous tonic 5/6 of eye circumferential and 94%
surface area
relatively avascular except episclera and intrascleral plexus at
limbus
Elasticity will be vary( depended on ocular condition and
aging ) and has an effect on intraocular pressure. (ocular
rigidity)

sclera
Ocular rigidity

young age sclera will be thick but low

rigidity , that cause
more displacement
with application of pressure.
in Schioz tonometry, measurement of IOP
will be higher with more ocular rigidity
Scleral thickness
limbus
0.8 mm
posterior
0.6 mm
muscle insertion 0.3 mm
optic
nerve
1.0 mm

tonic of the eyeball

3 layer of eyeball (outer to inner layer)
1. fibrous tonic anterior - cornea (1/6
circumference)
posterior - sclera
2. uveal ( vascular) tonic 3 component- iris,
ciliary body and choroid
3. nervous tonic - epithelium of iris and ciliary
body , retinal pigment epithelium and retina

Iris
Anterior part of uveal tract
free border ( pupillary border)
attached border (ciliary border)
Dome shape
estimate anterior
chamber depth
Anterior surface
iris stroma
ruff excess pigment epithelium at pupillary
border

collarette circular line 1.5 mm from pupillary

border

crypts irregular incomplete atrophy

Iris
4 layers
1. Anterior border layer
Melanocyte pigment
2. Stroma & sphincter muscle
3. Anterior epithelium & dilator muscle
4. Posterior pigment epithelium

Iris
Blood supply

major circle of iris from 2 long

posterior ciliary arteries
and 7 anterior ciliary arteries
form minor circle of iris at collarette

Nerve supply

sensory from nasociliary N. (CN 5)

sympathetic from carotid plexus to dilator m.
parasym from CN 3 to spinctor m.

Color of iris
3 factors

1. Pigment in anterior border

2. Pigment in stroma
3. Posterior pigment epithelium
Pigment
stroma
Anterior
epithelium
border layer
absent
absent
absent
present
absent
absent
present
few
few

Color of
iris
Albino
blue
Grey or
dark grey

Ciliary body
Circular band with cross section of
triangular shape

posterior apex
anterior base
outer surface spraciliary
inner surface
posterior smooth surface par plana
anterior truncated surface par plicata

Histology of ciliary body

5 layer
innermost nonpigment epithelium
pigment epithelium
stroma
ciliary muscle
supraciliaris

Aqueous production
is formed by blood plasma and secreted by nonpigmented
epithelium
diffusion movement of ion
ultrafiltration depend on IOP. BP and blood osmotic
pressure
carbonic anhydrase II activity control Na and HCO3
active secretion membrane associated Na K ATPase
Tight junction of NPE
blood- aqueous barrier
fluid&electrolyte similar to plasma, glucose 70% of plasma
very high Ascorbic acid ( 10-50 times)
no protein secretion from ciliary body but some leakage
from iris root (except some protein may be secreted ciliary
body)

Aqueous dynamic
Aqueous production

by ultrafiltration & secretion from ciliary

epithelium in posterior chamber pass trough
pupil into anterior chamber

Aqueous outflow
1) trabecular meshwork (80%) into

Schlemms canal and then into venous

circulation
2) uveoscleral pathway (20%) into
suprachoroidal space and drain into venous
circulation in ciliary body, choroid and,
sclera

Aqueous dynamic
A = ciliary
epithelium
B = trabecular
meshwrk
C = Schlemms
canal
is conventional
outflow
(trabecular
meshwork)

anterior chamber angle & depth

A = closed

angle &
shallow
anterior
chamber
B = narrow
angle &
shallow A/C

C&D =

Choroid

Choroid
Posterior portion of uveal tract ,nourishes
outer retina
Perfusion comes from long and short
posterior ciliary arteries and anterior
ciliary arteries
Venous drainage drain to Vortex system
very high blood flow
2-3%
difference in arterial/venous O2

Vitreous

4 cc
Viscocity > water 2-4
Water 99%,hyaluronic acid,collagen
Contact lens
Anterior hyaloid membrane

tonic of the eyeball

3 layer of eyeball (outer to inner layer)
1. fibrous tonic anterior - cornea (1/6
circumference)
posterior - sclera
2. uveal ( vascular) tonic 3 component- iris,
ciliary body and choroid
3. nervous tonic - epithelium of iris and ciliary
body , retinal pigment epithelium and retina

Retina
1
0
9
8
7
6
5
4
3
2

Retinal pigmented epithelium( RPE)

Rod and cone inner and outer segment
External limiting membrane
Outer nuclear layer
Outer plexiform layer
Inner nuclear layer
Inner plexiform layer
Ganglion cell layer
Nerve fiber layer
Inner limiting membrane

Retinal pigmented epithelium

Monolayer of hexagonol cells
Intercellular junctional complex
outer blood retinal barrier
Function
Vitamin A metabolism
outer blood retinal barrier
phagocytosis of photoreceptor outer segment
absorption of light
heat
exchange
formation of basal laminar production of
mucopolysaccharide
active transport of material in and out of the
RPE

RPE
-

no regeneration

- high metabolism
- fluid pump
- support
photoreceptor

Photoreceptor
Specialize neuro-epithelial cell ,
photosensitive
Rod photoreceptor
Only one type
peak absorption 510 nm
sensitive in dim light
long adaptation time
periphery > central
poor visual acuity

Cone
photoreceptor
3 type (R/G/B)
peak absorption
555 nm
sensitive in
bright light
short adaptation

Distribution of Rod and Cone

Cone high density at fovea represent visual
acuity 20/20
Rod
high density at 20 degree from fovea
and absent at fovea
Note no photorecepter at optic disc
blind
spot at 15 degree from center

Other retinal neuronal elements

Inner nuclear layer
vertical arrangement Bipolar cell
horizontal arrangement
near photoreceptor
Horizontal cell
near ganglion cell
Amacrine cell
Ganglion cell layer
ganglion cell
Receptive field = surface area that
all retinal neuronal element synapse
same ganglion cell

Other layer of retina

External limiting membrane

attachment site of photoreceptor and Muller cell

Outer plexiform layer

interconnection between photoreceptor and bipolar/horizontal cell

Inner plexiform layer

axon of bipolar/amacrine cell synapse with dendrite of ganglion

cell

Nerve fiber layer

axon of ganglion cell passing through optic nerve to lateral

geniculate body

Internal limiting membrane

footplate of Muller cell

Ophthalmoscopic view of the retina

M = macular
F = fovea
Fv = foveolar
E =equator

Retina

Blood supply of the retina

Choroidal circulation
RPE & photoreceptor
Central retinal artery
inner nuclear layer & ganglion cell
Note Cherry
red spot is seen in
central retinal
artery

Blood supply of the retina

Color vision

Good luck