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ANATOMI

PALPEBRA
Fungsi Palpebra

Pelindung mekanik bola mata.


Menghasilkan komponen lipid untuk
tear film
Membantu membasahi kornea.
THE LIDS

THE LIDS ARE COVERED


ANTERIORLY BY SKIN AND
POSTERIORLY BY MUCOUS
MEMBRANE - THE CON-
JUNGTIVA TARSI. THEY
CONTAIN MUSCLES,
GLANDS, BLOOD VESSELS,
AND NERVES. ALL BOUND
TOGETHER BY CONNECTIVE
TISSUE WHICH IS PARTI-
CULARY DENSE AT THE
POSTERIOR PART WHERE IT
FORMS A STIFF PLATE -
THE TARSUS
THE SKIN OF THE LIDS
IS PECULIAR IN
ITS THINNES AND ITS
LOOSE ATTACH-MENT

THE CILIA OR
EYELASHES ARE
STRONG SHORT
CURVED HAIRS,
ARRANGED IN TWO OR
MORE CLOSELY SET
ROWS

THE SEBACEOUS
GLANDS ARE CALLED
ZEISSS GLANDS AND
THE SWEAT GLANDS
ARE KNOWN AS MOLLS
GLANDS
THE TARSUS
CONSISTS OF
DENSE
FIBROUS
TISSUE; IT
CONTAINS NO
CARTILAGE,
EMBEDDED IN
IT ARE SOME
ENORMOUSLY
DEVELOPED
SEBACEOUS
GLAND : THE
MEIBOMIAN
GLANDS
THE ORBICULARIS
PALPEBARUM OCCUPIES
THE SPACE BETWEEN THE
TARSUS AND THE SKIN

THE MAIN CENTRAL BOND


OF THE LEVATOR
PALPEBRAE SUPERIORIS
IS INSERTED INTO THE
UPPER BORDER OF THE
TARSUS

THE THIRD NERVE


SUPPLIES THE LEVATOR
PALPEBRAE

THE SEVENTH SUPPLIES


THE ORBICULARIS
Batas-Batas Palpebra

Batas superior : daerah alis


dan rima orbita superior.
Batas inferior : dari rima
orbita inferior sampai ke kulit
nasojugal dan lipatan malar.
Lebar horizontal fisura =30
mm vertikal 8-10 mm.
Lipatan Palpebra Superior

(Lid crease) :terbentuk dari perlekatan


serabut aponeurosis levator di lapisan
subkutan.
Lokasi: 7-11 mm di atas margo palpebra.
Posisi Primer Palpebra

Margo palpebra superior, 1-2 mm di


bawah limbus superior.
Margo palpebra inferior pada limbus
inferior.
Margo Palpebra (1/2)
Panjang 25-30 mm dan lebar 2 mm.
Papila lakrimal: 6 mm lateral dari sudut
kantus medial
Gray Line :Pertemuan
antara
epitel berlapis gepeng
berkeratin di anterior,
epitel berlapis gepeng
tak berkeratin dan
epitel berlapis silindris
di posterior.
Margo Palpebra (2/2)

Bagian anterior margo palpebra terdapat


otot Riolan.
Palpebra superior:cilia uk.8-12 mm jumlah
100-150.
Palpebra inferior:silia ku.6-8 mm, jumlah
50-75.
Kel sebasea Zeiss dan kel Apokrin Moll.
7 Lapisan Palpebra
Kulit & jaringan
subkutan.
Otot protraktor.
Septum orbita.
Lemak orbita.
Otot retraktor.
Tarsus.
Konjungtiva.
Lipatan Palpebra :
Occidental vs Oriental
Kulit & Jaringan Subkutan
Sangat tipis dan elastis.
Tidak mempunyai lapisan lemak subkutan
Lapisan dermis:
jaringan ikat longgar yang mengandung serat
elastin,pemb darah,limfe dan saraf.
Lapisan subkutan: folikel rambut & kelenjar
sebacea.
Otot Palpebra
Otot Protraktor.
Otot Retraktor.
Otot Protraktor Palpebra
M.Orbikularis okuli, melingkari fisura orbit.
Dipersyarafi saraf otak VII.
Tiga bagian :
Orbikularis orbital,

Orbikularis preseptal,

Orbikularis pretarsal.
Otot Orbicularis Orbital

Terbesar dan tertebal, melapisi rima


orbita.
Berbatasan dengan
otot frontalis,
proserus,
korugator superfisialis
temporalis.
Otot Orbikularis Preseptal
Terletak di atas septum orbita.
Fungsi: menutup palpebra & berperan dalam
pompa lakrimalis.
Serabut otot preseptal atas dan bawah
membentuk tendon di raphe palpebra lateral.
Otot Orbikularis Pretarsal

Bagian terkecil.
Fungsi: saat refleks mengedip dan
berperan pada pompa lakrimal.
Dibagi 4 bagian: bagian atas dan
bagian bawah @superfisial dan dalam
Otot tensor tarsi Horner.
Dilateral bersatu membentuk tendon
kantus lateral.
Septum orbita

Jaringan ikat berlapis berasal dari


periosteum pada rima orbita superior-
inferior di daerah arkus marginalis.
Fungsi:sebagai barier antara orbita dan
palpebra.
Lemak Orbita
Normal: letak di posterior septum orbita
dan anterior dari aponeurosis levator.
Dapat mengalami herniasi ke palpebra.
Bantalan lemak sentral penting untuk
operasi palpebra elektif dan repair laserasi
palpebra.
Otot Retraktor Palpebra

Otot rektraktor palpebra superior: m.


levator dan aponeurosisnya dan
m.tarsalis superior (muller).
Otot retraktor palpebra inferior: fasia
kampsulopalpebral dan m.tarsalis
inferior.
Dipersarafi: saraf simpatis.
Otot Retraktor Palpebra Superior
(1/2)

M.Levator palpebra : otot utama dan


berfungsi mengangkat palpebra superior
sekitar 15 mm.
M.Muller : fungsi memberi tambahan tonus
dan hilang bila kelelahan atau paralisis
dan palpebra turun 2 mm.
Bila mengalami overstimulasi : terjadi
retraksi 2-3 mm di atas normal.
Otot Retraktor Palpebra Superior
(2/2)

Origo m Levator: di atas anulus Zinn.


Komponen otot 20mm dan komponen
aponeurosis 14-20 mm.
Lig.Whitmall: letak di daerah transisi
m.levator dan aponeurosis levator.
Fungsi lig.Whitmall:pendukung palpebra
superior dan jaringan orbita superior.
Otot Retraktor Palpebra Inferior
(1/2)

Palpebra inferior membuka secara pasif


karena tarikan m.rektus inferior.
Fasia kapsulopalpebral analog dengan
aponeurosis levator.
Dua bagian kepala kapsulopalpebra
membentuk lig.Lockwood.
Otot Retraktor Palpebra Inferior (2/2)

M.Tarsalis inferior analog dengan m


Muller.
Ligamentum suspensorium forniks.
Tarsus (1/2)

Terdiri dari jaringan padat.


Berfungsi sebagai rangka palpebra.
Ukuran tarsus superior: lebar 10 mm di
sentral,panjang 25-29mm dan tebal 1
mm.
Ukuran tarsus inferior: lebar 3.5-4 mm
di sentral,panjang 25-29 mm dan tebal
1 mm.
Tarsus (2/2)

Mengandung kelenjar
Meibom: 30-40 di
palpebra superior ,20-
30 di palpebra
inferior.
Konjungtiva
Konjungtiva palpebra.
Konjungtiva forniks.
Konjungtiva bulbi.
Plika semilunaris.
Vaskularisasi
Suplai vaskular padat dan banyak sirkulasi
kolateral.
Mempercepat penyembuhan.
Mudah terjadi perdarahan saat prosedur
operasi.
Vaskularisasi Arteri

Dari a.karotis Interna melalui


a.oftalmika dan a.infraorbita.
A.karotis eksterna melalui
a.fasialis dan a.temporalis
superfisialis.
Membentuk sirkulasi kolateral
yang besar.
Vaskularisasi Vena
Terdiri dari arkade palpebra
superior dan arkade palpebra
inferior.
Vena palpebra superior dan
inferior menuju v.angularis di
kantus medial.
Vena angularis membentuk
anastomosis dengan sinus
kavernosus.
Sistim Limfatik

Menuju nodus limfatikus


preaurikular dan submandibular.
Menerima drainase dari sistem
superfisial dan profunda.
Pleksus superfisial : menerima
aliran limfa dari kulit dan otot
orbikularis.
Pleksus profunda : dari tarsus dan
konjungtiva.
Sistem Limfatik

Aspek medial palpebra superior


inferior,sentral palpebra inferior dan
konjungtiva menuju nodus limfatikus
submandibularis.
Palpebra superior,aspek lateral
palpebra inferior dan konjungtiva
menuju nodus imfatikus preaurikular
Persarafan (1/2)

2 saraf motorik untuk gerakan palpebra.


N.III: mempersarafi m.levator palpebra
untuk mengangkat palpebra superior
dan m.rektus inferior.
N.VII mempersarafi m.orbikularis okuli.
Persarafan (2/2)

N.V :untuk sensasi palpebra


Palpebra superior dipersarafi
oleh cab.1 n.oftalmikus
Cabang utama n. oftalmikus:
n.lakrimalis, n.supraorbita,
n.supratroklearis, dan
n.infratroklearis.
THE EXTRA OCULAR MUSCLES
A TEAM OF SIX MUSCLES
CONTROLS THE MOVE-
MENT OF EACH EYE
THE RECTUS MUSCLE
- THE MEDIAL RECTUS
- THE LATERAL RECTUS
- THE SUPERIOR RECTUS
- THE INFERIOR RECTUS
THE OBLIQUE MUSCLE
- THE SUPERIOR
OBLIQUE
- THE INFERIOR
OBLIQUE
Gambar extraocular muscle
THE RECTUS
MUSCLES HAVE THE
GENERAL ACTION
OF ROTATING THE
EYE IN FOUR
CARDINAL
DIRECTIONS : UP,
DOWN, OUT AND IN

THE OBLIQUE
MUSCLES HAVE THE
PRIMARY FUNCTION
OF ROTATION OF
THE GLOBE
THE MEDIAL
RECTUS IS
INSERTED INTO
THE SCLERA,
ABOUT 5 MM TO
THE NASAL SIDE
OF THE CORNEO-
SCLERAL MARGIN.

THE INFERIOR
RECTUS 6 MM
BELOW

THE LATERAL
RECTUS 7 MM TO
THE TEMPORAL
SIDE

THE SUPERIOR
RECTUS 8 MM
ABOVE
THE LACRIMAL APPARATUS

THE LACRIMAL APPARATUS CONSISTS OF


THE LACRIMAL GLANDS
THE LACRIMAL PASSAGES
THE LACRIMAL GLAND OF EACH EYE
CONSISTS OF :
THE SUPERIOR OR ORBITAL GLAND
THE INFERIOR OR PALPEBRAE GLAND
THE ACCESSORY LACRIMAL
GLANDS OR KRAUSES GLANDS
THE LACRIMAL PASSAGES CONSISTS OF :
THE LACRIMAL PUNCTA
THE CANALICULI
THE LACRIMAL SAC
THE NASAL DUCT
ANATOMY OF THE GLOBE
ANTERIOR
SEGMEN

IRIS PLANE

POSTERIOR
SEGMEN
ANATOMY OF THE EYE BALL

THE WALL OF THE EYE BALL IS COMPOSED OF A


DENSE, IMPER-FECTLY ELASTIC SUPPORTING
MEMBRANE
THE ANTERIOR PART OF THE MEM-BRANE IS
TRANSPARENT THE CORNEA
THE ANTERIOR PART OF THE SCLERA IS COVERED
BY MUCOUS MEMBRANE THE CONJUNGTIVA
THE CORNEA CONSIST OF FIVE
LAYERS :
- EPITHELIUM
- BOWMANS MEMBRANE
- STROMA OR SUBSTANTIA PROPIA
- DESCEMETS MEMBRANE
- ENDOTHELIUM
THE EPITHELIUM REGARDED AS THE CONTINUATION
OF THE CONJUNGTIVA OVER THE CORNEA

THE SUBSTANTIA PROPIA REGARDED AS THE


CONTINUATION FORWARD OF THE SCLERA

THE STROMA FORMING 90 % OF THE TOTAL CORNEAL


THICKNESS
DESCEMETS MEMBRANE IS A THIN ELASTIC MEMBRANE,
COVERED ON ITS POSTERIOR BY ENDOTHELIUM

THE PRIMARY MECHANISME CONTROLLING STROMAL


HYDRATION IS A FUNCTION OF THE CORNEAL ENDOTHELIUM

ENDOTHELIAL CELLS BECOME LESS IN NUMBER WITH AGE


AND INDIVIDUAL CELL ENLARGE TO COMPENSATE
THE CORNEA IS SET INTO THE SCLERA LIKE A
WATCH GLASS SO THAT THE LATTER OVER-
LAPS THE CORNEA ALL AROUND THE PERI-
PHERY; THE JUNCTION OF THE TWO TISSUES
IS KNOWN AS THE LIMBUS
THE CORNEA IS VERY RICHLY SUPPLIED WITH
NERVE FIBERS DERIVED FROM THE
TRIGEMINAL AND IT HAD NO BLOOD VESSEL
LINING THE INNER
ASPECT OF THE
SCLERA ARE TWO
STRUCTURES :

THE HIGHLY
VASCULAR UVEAL
TRACT
CONCERNED
CHIEFLY IN
NUTRITION OF THE
EYE

A NERVOUS
LAYER, THE TRUE
VISUAL NERVE
ENDING ONCERNED
IN THE RECEPTION
AND
TRANSFORMING OF
LIGHT STIMULL
CALLED THE
RETINA
THE UVEAL TRACT CONSIST OF THREE PARTS, WHICH
THE TWO POSTERIOR, THE CHOROID, AND CILIARY
BODY, WHILE THE ANTERIOR FORMS A FREE CIRCULAR
DIAPHRAGM : THE IRIS

THE APERTURE OF THE DIAPHRAGM IS THE PUPIL

SITUATED BEHIND THE IRIS AND IN CONTACT WITH THE


PUPILLARY MARGIN IS THE CRYSTALLINE LENS
THE ANTERIOR CHAMBER IS A SPACE FILLED
WITH FLUID, THE AQUEOUS HUMOR; IT IS
BOUNDED IN FRONT BY THE CORNEA, BEHIND BY
THE IRIS AND THE PART OF THE ANTERIOR
SURFACE OF THE LENS WHICH IS EXPOSED IN THE
PUPIL
ITS PERIPHERAL RECESS IS KNOWN AS
THE ANGLE OF THE ANTERIOR
CHAMBER, BOUNDED POSTERIORLY BY
THE ROOT OF THE IRIS AND THE
CILIARY BODY AND ANTERIORLY BY
THE CORNEOSCLERA
IN THE INNER LAYER OF THE SCLERA AT
THIS PART THERE IS A CIRCULAR VENOUS
SINUS, CALLED THE CANALIS SCHLEMM -
GREAT IMPORTANT - IN THE DRAINAGE OF
THE AQUEOUS HUMOR
AT THE PERIPHERY OF
THE ANGLE BETWEEN
THE CANAL SCHLEMM
AND THE RECESS OF THE
ANTERIOR CHAMBER
THERE LIES A LOOSELY
CONSTRUCTED
MESHWORK OF TISSUES,
THE TRABECULAR
MESHWORK
THERE ARE TWO UNSTRIPED MUSCLE WHICH
CONTROL THE MOVEMENTS OF THE PUPIL

THE SPHINCTER PUPILAE


A CIRCULAR BUNDLE RUNNING ROUND THE PUPILLARY
MARGIN; IS SUPPLIED BY MOTOR NERVE FIBERS DERIVED
FROM THE OCULOMOTOR NERVE

THE DILATATOR PUPILLAE


ARRANGED RADIALLY NEAR THE ROOT OF THE IRIS. THE
MOTOR NERVE FIBRES ARE DERIVED FROM THE CERVICAL
SIMPHATHETIC CHAIN
THE INNER SURFACE OF THE CILLIARY BODY
IS DIVIDED INTO TWO REGION

THE PARS PLICATA


THE ANTERIOR PART WHICH IS CORRUGATED WITH A
NUMBER OF FOLDS

THE PARS PLANA


THE POSTERIOR PART WHICH IS SMOOTH
THE CHIEF MASS OF THE CILLIARY BODY IS
COMPOSED OF THE UN-STRIPED MUSCLE FIBERS -
CALLED - THE CILLIARY MUSCLE

THE CILLIARY BODY EXTENDS BACK WARD AS FAR


AS THE ORA SERRATA, AT WHICH POINT THE
RETINA BEGINS ABRUPTLY
THE CHOROID IS EXTREMELY VASCULAR MEMBRANE IN
CONTACT EVERY WHERE WITH THE SCLERA. THERE IS A
POTENTIAL SPACE BETWEEN THE TWO STRUCTURE -
CALLED - THE EPICHOROIDAL SPACE
THE INNER SIDE THE CHOROID IS COVERED BY A THIN
ELASTIC MEMBRANE - CALLED- THE LAMINA VITERA OR
MEMBRANA OF BRUCH
THE RETINA CONSISTS OF 10 LAYERS
1. PIGMEN EPITHELIUM
2. LAYER OF ROD AND CONES
3. EXTERNAL LIMITING
MEMBRANE
4. OUTER NUCLEAR LAYER
5. OUTER PLEXIFORM LAYER
6. INNER NUCLEAR LAYER
7. INNER PLEXIFORM LAYER
8. GANGLION CELL LAYER
9. OPTIC NERVE FIBER
LAYER
10. INTERNAL LIMITING
MEMBRANE
AT THE POSTERIOR
POLE OF THE EYE
WHICH IS SITUATED
ABOUT 3 MM TO THE
TEMPORAL SIDE OF
THE OPTIC DISC, A
SPECIALLY
DIFFEREN-TIATED
SPOT IS FOUND IN
THE RETINA, THE
FOVEA CENTRALIS, A
DEPRESSION OR PIT,
AND IN HERE ONLY
CONES ARE PRESENT
IN THE NEURO
EPITHELIAL LAYER
THE FOVEA IS THE
MOST SENSITIVE PART
OF THE RETINA, AND IT
IS SURROUNDED BY A
SMALL AREAS, THE
MACULA LUTEA OR
YELLOW SPOT.
WHICH ALTHOUGH NOT
SO SENSITIVE, ITS
MORE SENSITIVE THAN
OTHER PARTS OF THE
RETINA

AT THE OPTIC DISC THE


FIBERS OF THE NERVE-
FIBER LAYER PASS INTO
THE OPTIC NERVE
THE LENS IS A BICONVEX MASS OF PECULIARLY
DIFFERENTIATED EPITHELIUM, IT IS SURROUNDED BY A
HYALINE MEMBRANE, THE LENS CAPSULE, IT IS HELD IN
PLACE BY THE SUSPENSORY LIGAMENT OR ZONULES OF
ZINNI CONSISTS BUNDLE OF STRANDS WHICH PASS FROM
THE SURFACE OF THE CILLIARY BODY TO THE CAPSULE
THERE IS A TRIANGULAR SPACE BETWEEN THE BACK OF
THE IRIS AND THE ANTERIOR SURFACE OF THE LENS AND
ITS BOUNDED ON THE OUTER SIDE BY THE CILLIARY BODY
- CALLED - THE POSTERIOR CHAMBER AND CONTAINS
AQUEOUS HUMOR
BEHIND THE
LENS THERE IS
LARGE VITREUS
CHAMBER
CONTAINING THE
VITREUS
HUMOR, A JELLY
LIKE MATERIAL,
CHEMICALLY OF
THE NATURE OF
INNERT GEL
CONTAINING A
FEW CELLS AND
WANDERING
LEUCOCYTES
DURING ACCOMODATION

THE CILIARY MUSCLES CONTRACTS

DRAWING TOWARD THE CHOROID

RELAXING THE SUSPENSORY LIGAMENT

DIMINISHES THE TENSION OF LENS


CAPSULE

INCREASE THE CONVEXITY OF THE LENS


PHYSIOLOGY OF THE EYE

MECHANISM OF ACCOMODATION.

THE LENS IS AN ELASTIC


STRUCTURE WHEN RELASE FROM
THE FLATTENING INFLUENCE OF ITS
SUSPENSORY LIGAMENT TENDS TO
ASSUME A SPHERICAL SHAPE
CIRCULATION OF THE
AQUEOUS HUMOR
AS THE GREATER
PART OF FLUIDS IS
FORMED IN THE
CILLIARY REGION,
IT IS SECRETED
INTO POSTERIOR
CHAMBER, IT FLOWS
FROM THE
POSTERIOR
CHAMBER THROUGH
THE PUPIL INTO
THE ANTERIOR
CHAMBER AND
ESCAPES THROUGH
THE DARINAGE
CHANNELS AT THE
ANGLE, AND THEN
INTO THE
EPISCLERAL VEIN
THE INTRA OCULAR PRESSURE
(IOP)

PROLONGED CHANGES ARE ESSENTIALLY


CAUSED BY TWO FACTORS :
AN ALTERATION IN THE FORCES
DETERMINING THE FORMATION OF THE
AQUEOUS
ALTERATIONS IN THE RESISTANCE TO ITS
OUTFLOW
FROM THE CLINICAL POINT OF VIEW, THE
LATTER IS THE MORE IMPORTANT
A RISE IN THE IOP MAY BE CAUSED BY AN
INCREASE IN THE PRESSURE IN THE
EPISCLERAL VEIN OR BY ANY PROCESS
WHICH BLOCKS THE SEEPAGE OF AQUEOUS
INTO THE CANAL OF SCHLEMM, SUCH AS
SCLEROSIS OF THE TRABECULAE OR THEIR
OBSTRUCTION BY EXUDATES OR ORGANIZED
TISSUE GLAUCOMA
THE IOP PRESSURE

THE IOP NORMALLY


VARIES FROM 10 TO 20
MM HG

IT IS ACCURATELY
MEASURED BY A
MANOMETER
CLINICALLY BY
TONOMETRY