ANATOMY &

PHYSIOLOGY of
THE EYES
AGUS SETYAWAN.
Dept. of Ophthalmology
Faculty of Medicine Diponegoro University
 Outline
• ANATOMI:
– ORBIT
– BOLA MATA & OTOT EKSTERNAL
– ADNEKSA
– SYARAF
• FISIOLOGI
 PENDAHULUAN
• Anatomi !!! pemahaman peny dg
manifest pd mata
• Surgical & postmortem  + MRI,
OCT, USG, dsb
• Fisiologi  fungsi struktur2 terkait
 ORBIT
• Outline:
– Dinding Orbita
– Apeks Orbita
– Pendarahan
• Orbit:
– Piramid, 4 ddg, ddg medial paralel
– Ø Rim < Ø lingkaran di dlmnya  proteksi
– Volume (dws) 30 ml  1/5 bl mata, 4/5 jar periokuler
(lemak, otot, syaraf)
– Bts anterior: Septum Orbita
– Bts sinus: s. frontalis (atas), s. maxillaris (bwh), s.
ethmoidalis & s. sphenoidalis (med)
– Ddg med & dsr orbita  tipis  ruptur  herniasi
 Dinding Orbita
• Atap (roof) Orbita:
– Tlg Frontal (utama)  klj lakrimal di
fossa lacrimalis
– Tlg Sphenoid (lesser wing)
• Ddg lateral:
– Bts dg roof  fissura orbital superior
– Bag antor  tlg Zygomatic (Malar) 
strongest
 … Dinding Orbita
• Dasar Orbita:
– Bts dg lateral  fissura orbitalis infor
– Lempeng orbital tlg Maxilla (utama, sentral) 
blowout fractures
– Antor (Rim orbita infor)  tlg Maxilla (medial) +
tlg Zygomatic (lateral)
– Postor  processus orbital tlg Palatina
(triangular)
• Ddg Medial:
– Tlg ethmoid  paper thin  ke antor menebal
– Tlg sphenoid (body)  postor aspect
Apex & Annulus of Zinn
 Blood Supply
• Arteries:
– Intracranial Internal Carotid a.  1st
branch: Ophthalmic a.  passes
beneath & accompanies N II, branches
as:
• Central Retinal a. enters the N II, 8 – 15
mm behind the globe
• Lacrimal a.  lacrimal glds
• Long & Short postor Ciliary a.
• Muscular branches  antor Ciliary a.
 …Blood Supply
• …Arteries:
– Short postor Ciliary a.  N II + choroid
– Long postor Ciliary a.  ciliary body +
major arterial circle* of the iris
(anastomose w/ antor Ciliary a.)
– Antor Ciliary a.  antor sclera, episclera,
limbus, conjunctiva, *
– Most antor branches of Ophth a.
arterial arcade of the eyelids
 …Blood Supply
• Veins:
– Supor & Infor Ophthalmic v.
•  Vortex v.
• Communicate w/ Cavernous sinus &
Pterygoid venous
• Drain the skin of the periorbital skin
lethal cavernous sinus thrombosis
(in cellulitis periorbital)
– Antor Ciliary v.
– Central Retinal v.
 The Eyeball
• AP Ø 24,2 mm
• Components:
– The Conjunctiva
– Tenon’s Capsule (Fascia Bulbi)
– The Sclera & Episclera
– The Cornea
– The Uveal Tract
– The Lens
– The Anterior Chamber Angle
– The Aqueous
– The Retina
– The Vitreous
 …The Eyeball
• The Conjunctiva:
– Transparent
– Covers postor palp & antor surface of
sclera
– Continuous w/:
• The lid margin (mucocutaneous junc) 
Palpebral conj
• Fornices (supor & infor)
• The limbus (corneal epithelium)  Bulbar
conj
 …The Eyeball
• …The Conjunctiva:
– Palpebral Conj  firmly adherent to the
tarsus
– Bulbar Conj  loosely attached to
Tenon’s capsule
– Plica / semilunar
fold & caruncle
 …The Eyeball
• ...The Conjunctiva:
– Epithelium:
• Stratified columnar: basal & superficial
(goblet cells)
• Stratified squamous: limbus, caruncle,
mucocutaneous junc
– Stroma:
• Adenoid (superficial): lymphoid tissue &
“follicle-like”  NOT develop 2 – 3 mo of life
• Fibrous (deep): attaches to the tarsal plate
• “Krause (fornix) & Wolfring (supor tarsus)
accessory lacr glds”
 …The Eyeball
• ...The Conjunctiva:
– Blood, lymphatic, Nerve Supply:
• Blood supply: Conjunctival arteries (from a.
Ciliaris & Palpebralis). Veins ~ arteries
• Lymphatic: join w/ lymphatic of the eyelid
(preauricular & parotid nodes, submandibular
l.n.)
• Nerve supply: 1st div (Ophthalmic) of N V
 …The Eyeball
• Tenon's Capsule (Fascia Bulbi):
– Fibrous membrane, envelopes from
limbus to N II
– Limbus  Conj, Tenon's, Episclera fixed
together
– Posteriorly  lies the sclera, contact w/
orbital structure & muscle cone
 …The Eyeball
• ...Tenon's Capsule (Fascia Bulbi):
– Pierced by extraocular tendons  reflected
 surrounding structure  orbital bone  limit
extr.oc muscle  Check ligaments
– Inferiorly:
• thicker
• fuses w/ fascia of the IR m & IO m  form
the suspensory ligaments of the eyeball
(Lockwood ligament)
 …The Eyeball
• The Sclera & Episclera:
– Fibrous (collagen)
– Antor  cornea; postor  scleral foramen
(lamina cribrosa)  pass the axon
bundle of the N II
– Antor sclera  episclera (thin, elastic,
blood vessels)
– Inner surface  lamina fusca (pigment,
outer layer of suprachoroidal space)
 …The Eyeball
• …The Sclera & Episclera:
– Thickness: 0,3 mm (at insertion of muscle) –
0,6 mm
– Penetrated around the N II:
• Short & long postor ciliary arteries
• Short & long ciliary nerve
– Long postor ciliary a. & long ciliary n.  pass in
shallow groove at 3 & 9 o’clock meridians
– Vortex veins  postor equator, 1 each quadrant
– 4 antor ciliary a. & v.  penetrate 4 mm from
limbus
– Nerve supply: ciliary nerve
…The Eyeball
• The Cornea:
– 550m thick in center, ±11,75mm Ø
horizontally & ±10,6mm Ø vertically
– Nutrition: Aqueous,
tears, limbus vessel
– Transparency:
• Uniform structure
• Avascular
• Deturgescence
 …The Eyeball
• The Cornea’s layers:
– Epithelium  5-6 layers of cells
– Bowman’s membrane  modf of stroma
– Stroma  90% of corneal thickness, collagen
fibers, proteoglicans
– Descemet’s membrane  basal lamina of
endothelium
– Endothelium  one layer, maintain
deturgescence, loss w/ aging
• Nerve supply: 1st div of N V
 …The Eyeball
• The Uveal Tract:
– Iris:
• Pigmented, Extension of ciliary body
• Dividing the COA & COP
• Central round aperture  Pupil  balance of
parasympathetic (m. Sphincter pupillae, N
III) & sympathetic (m. Dilator pupillae)
activity
• Blood supply: Major circle of the iris
• Nerve supply (sensory): Ciliary nerve
 …The Eyeball
• …The Uveal Tract:
– The Ciliary body:
• Pars plicata (2 mm, anteriorly)  ciliary process 
aqueous formation
• Pars plana (4 mm, posteriorly)
• Epithelium: nonpigmented (internal, cont’d of
neuroretina), pigmented (external, cont’d of RPE)
• Ciliary muscle:
– Circular & radial fibers  contract & relax zonular fibers
– Longitudinal fibers  open pore of TM
• Blood & nerve supply:
– = Iris, through Vortex veins
 …The Eyeball
• …The Uveal Tract:
– The Choroid:
• Postor segment of Uveal tract  between
retina & sclera
• Internally: Bruch’s membrane; Externally:
Sclera
• Choroidal blood vessels:
– Chorio-capillaris  fenestrated, nourishes the
outer neuroretina
– Drainage: Vortex veins
…The Eyeball
• The Lens:
– 4 mm thick, 9 mm Ø, Biconvex,
avascular, colorless, almost completely
transparent
– 65% water, 35% protein + trace
minerals
– Supported by zonule of Zinn at equator
– corpus ciliaris
– Capsule: semipermeable membrane
 …The Eyeball
• …The Lens:
– Subcapsular epithelium  anterior 
concentric lamella fibers
– The “Y” suture lines:
• End to end joining of the lamellas
• Upright anteriorly, inverted posteriorly
– Potassium >> in the lens
– Ascorbic, Glutathione
…The Eyeball
• The Anterior
Chamber Angle:
– Junc of peripheral
cornea & iris root
– Schwalbe’s line (SL)
– trabecular
meshwork (TM)–
scleral spur (SS)
 …The Eyeball
• SL  end (peripheral) of corneal
endothel
• TM  Uveal meshwork (internal
portion) & Corneoscleral meshwork
(external portion)  Schlemm’s
canal  ±30 collector channels +
±12 aqueous veins  episcleral
venous system
• SS  inward extension of sclera
 …The Eyeball
• The Aqueous:
– Produced by ciliary
body
– Entering postor
chamber  pupil 
antor chamber 
antor chamber angle
 …The Eyeball
• The Retina:
– Semitransparent, multilayered, 2/3
postor inner aspect of globe
– Ora serrata (OS):
• anterior edge of retina (ragged edge)
• 6,5 mm behind SL (temporal), 5,7 mm
(nasal)
– Subretinal space  retinal detachment
– At the PN II & OS  ret & RPE firmly
bound  limiting ret detachment
 …The Eyeball
• …The Retina:
– Suprachoroidal space  choroidal detachment
 extend to anterior (SS)
– Thickness: 0,1 mm at OS, 0,56 mm at postor
pole
– Macula:
• Postor pole, 5,5 – 6,0 mm Ø
• > 1 layers of ganglion cells
• 3 mm Ø center  macula lutea w/ fovea centralis 
Xanthophyll >>>, photoreceptors >>>
• 1,5 mm Ø center  retinal avascular zone
• 0,25 mm Ø center  foveola (thinnest part of retina)
 …The Eyeball
• …The Retina:
– Blood supply:
• Choriocapillaris:
– 1/3 outer + fovea  irreparable damage when
RD
– Fenestrated
– Blood barrier  RPE
• Central retinal artery
– 2/3 inner
– Nonfenestrated  blood retinal barrier
 …The Eyeball
• The Vitreous:
– Clear, avascular, gelatinous body (99%
water, 1% collagen + hyaluronic acid),
2/3 volume & weight of the eyeball
– Outer surface  hyaloid membrane 
contact w/ postor lens capsule, zonular
fibers, pars plana epithelium, retina, N
II head
– Vitreous base (attachment): pars plana
epithelium & retina just behind the ora
serrata
 The Extraocular Muscles
• Insertions of
Rectus Muscles:
 spiral of Tillaux
 …The Extraocular Muscles
• Blood Supply:
– Ophthalmic artery (muscular branch)
– Also:
• Lateral rectus m.  Lacrimal artery
• Inferior Oblique m.  Infraorbital artery

• Nerve Supply:
– N III  SR, MR, IR, IO
– N IV  SO
– N VI  LR
 The Ocular Adnexa
• Eyebrows:
– The folds of thickened skin
– Covered w/ hair
– The Glabella  hairless between 2 eyebrows
• Eyelids:
1. Skin Layer
2. Orbicularis Oculi Muscle (OOM)
3. Areolar Tissue
4. Tarsal Plate
5. Palpebral Conjunctiva
 …The Ocular Adnexa
• …Eyelids:
1. Skin Layer:
– Thin, loose, elastic
– Few hair follicles
– NO subcutaneous fat
2. OOM:
– Concentric  close the lids
– Inside the lid: Pretarsal & Preseptal portion
– Outside the lid: Spread around the orbital
margin (orbital portion)
– Supplied by N VII
 …The Ocular Adnexa
• …Eyelids:
3. Areolar Tissue:
– Submuscular  communicates w/
aponeurotic layers
4. Tarsal Plate:
– Main supporting structure of the lids
 dense fibrous & elastic tissue
– Lateral & medial  attached to orbital
margins by palpebral ligaments
– Upper & Lower  thin fascia (Orbital
Septum)
 …The Ocular Adnexa
• …Eyelids:
5. Palpebral Conjunctiva:
– Adhere firmly to the tarsal plate

GRAY LINE  splits the lids into:

– Anterior Lamella (Skin + OOM)
– Posterior Lamella (Tarsal Plate + Palp
Conjunctiva)
 …The Ocular Adnexa
• The Lid Margins:
– GRAY LINE  mucocutaneous junction
– Anterior Margin:
• Eyelashes  upper, upward; lower,
downward
• Glands of Zeis  sebaceous glds at base of
• Glands of Moll  sweat glds eyelashes
– Posterior Margin:
• Small orifices of meibomian / tarsal glds
– Lacrimal Punctum:
• Medial end of the postor margins
 …The Ocular Adnexa
• Palpebral Fissure:
– Lateral canthus  ±0,5 cm from orb rim
– Medial canthus  more elliptic, surround
lacrimal lake:
• Lacr caruncle  modf. sweat & sebaceous
glds
• Plica semilunaris  3rd eyelid of lower
animal sp
– Epicanthus:
• Normal in Asian population & Young infants
• Hiding caruncle
 …The Ocular Adnexa
• Orbital Septum:
– Lies between Orb rim & tarsus
– Serves as barrier
– Pierced by:
• the several vessels & nerves (lacrimal,
supra/infratrochlear, supraorbital)
• Levator palp superior muscle (LPSM)
– Blends w/:
• Supor: Tendon of LPSM & supor tarsus
• Infor: infor tarsus
 …The Ocular Adnexa
• Lid Retractors:
– Musculofacial complex (striated & smooth
muscles)  Opening the eyelids
– Upper lid  m. Levator Palp Supor, divided
into:
• Aponeurosis (antor)  elevate antor lamella
• Muller’s muscle (smooth m. fibers)  elevating postor
lamella
 inserting supor eyelid into postor surface of OOM 
upper lid skin crease
– Lower lid  m. Rectus Infor
– Smooth muscle  innervated by sympathetic
nerves
– Striated muscle  innervated by N III
 …The Ocular Adnexa
• Sensory Nerve Supply to eyelids:
– 1st (ophthalmic):
• Lacrimal, Supraorbital, Supra/Infratrochlear,
External Nasal nerves
– 2nd (maxillary) divisions of N V:
• Infraorbital, Zygomaticofacialis,
Zygomaticotemporal nerves
 …The Ocular Adnexa
• Blood Supply & Lymphatics:
– Arteries:
• Lacrimal & Ophthalmic arteries (lat & med
branches)  anastomoses: submusc.
Areolar tissue
– Veins:
• Arranged in pre & post tarsal plexuses
• Into Ophthalmic veins
– Lymphatics:
• Lateral side  preauricular & parotid nodes
• Medial side  submandibular l.n.
 …The Ocular Adnexa
• The Lacrimal Apparatus:
– The lacrimal complex:
• The Main Lacrimal glds
• The Accessory Lacrimal glds
• The Canaliculi
• The Lacrimal sac
• The Nasolacrimal duct
 …The Ocular Adnexa
• The Main Lacrimal Glands:
– Orbital portion:
• In the lacrimal fossa
• Separated from palp. portion by lateral horn
of m. Levator Palp
– Palpebral portion:
• Just above the temporal segment of the
supor conj fornix
• Secretory ducts w/ 10 orificies connects orb
& palp portion to the supor conj fornix
 …The Ocular Adnexa
• The Accessory Lacrimal Glands:
– Krause & Wolfring glds  subs propria
palp conj
• Drainage of tear:
– Lacr lake  upper/lower puncta 
canaliculi  lacr sac  nasolacr duct 
meatus nasal cavity
– Mechanism: capillary attraction, gravity,
blinking & pumping action by Horner’s
muscle
 …The Ocular Adnexa
• Blood & Lymphatic supply:
– Arteries: Lacrimal artery
– Veins: joins w/ Ophthalmic vein
– Lymph drainage: joins w/ conj lymphatic 
preauricular l.n.
• Nerve supply:
– Sensory: Lacrimal nerve (1st div of N V)
– Secretory: Great Petrosal nerve (from supor
salivary nucl)
– Sympathetic nerve: accompanying the
Lacrimal artery & nerve
 …The Ocular Adnexa
• Related Structure:
– The medial palpebral ligament 
connects the upper & lower tarsal plate
to Frontal process at medial canthus
antor to lacr. Sac
– Below the ligaments  lacr. Sac covered
by few fibers of OOM  little resistance
 swollen in acute dacryocystitis
– The angular vein & artery  8 mm from
medial canthus  incision should be 2-3
mm
 The Optic Nerve
• The Intra ocular:
– 1,5 mm Ø
• The Intra orbital:
– 25 – 30 mm; 3 mm Ø
• The Optic Chiasm:
– Near the top of sella
tursica
– Decussation
• The Retrochiasmatic
…The Optic
Nerve
The pupillary
reflex arc