Orbital and Ocular Anatomy

Ass.Prof. Dr. Saif Ali Ahmed Ghabisha

 Components of the Visual System
I. Accessory structures (the adnexa of the eye)
II. Eyes: is the organ of vision.
III. Optic nerve, tract, and pathway.
Components of the Visual System
 I. Accessory structures of the Eyes
1. Eyebrows: protects eyes - to prevent sweat, water, and other
damaging particles from falling down into the eye.
2. Eyelid (Superior and Inferior Palpebra): for blinking “average blinking
= 25B/min”.
Function:
• Protects the eye from foreign objects, sun, bright light and
from sweat.
• Help spread tears over surface of eye (moist & comfort).
• They keep the eyes from drying during sleep.
 I. Accessory structures of the Eyes
3. Eyelash:
• Protects the eye from foreign objects.
• Lubricates lids and restrains tears from flowing over
the margin of the eyelids.
4. Medial and lateral commissure: angels where the eyelids join at the
medial and lateral margins of the eye.
I. Accessory structures of the Eyes
I. Accessory structures of the Eyes
 I. Accessory structures of the Eyes

Lateral angle lacus lacrimalis

Conjunctiva

Medial angle

Palpebral fissure
 I. Accessory structures of the Eyes
Structure of the Eyelid

Each eyelid consists of five layers:

•Skin.

•Superficial fascia.

•Orbicularis oculi (palpebral fibres).

•Tarsal plate and palpebral fascia.

•Conjunctiva.
 I. Accessory structures of the Eyes
Structure of the Eyelid
 I. Accessory structures of the Eyes
Structure of the Eyelid

Skin:
•It is thin and continues with the conjunctiva at the margin of the eyelid.

It consists of:

•Large sebaceous glands (Zies glands) which open at the lid margin closely
associated with cilia.
•Modified sweat glands (Moll glands) which lie along the lid margin closely
associated with Zies glands.
•Skin of upper eyelid receives the insertion of levator palpebral superioris.

Superficial fascia:
•The subcutaneous tissue is thin and devoid of fat and contains the palpebral part
of orbicularis oculi muscle.
 I. Accessory structures of the Eyes
Structure of the Eyelid
 I. Accessory structures of the Eyes
Structure of the Eyelid

Tarsal plate
•The tarsi are dense fibrous plates connected to the orbital margin by fibrous
orbital septum.
• The lateral ends of the tarsal plates are attached by the lateral palpebral ligament
to a bonny tubercle just within the orbital margin.
• The medial ends of the tarsal plates are attached by the medial palpebral
ligament to the anterior lacrimal crest (frontal process of the maxilla).
• The tarsal glands are embedded in the posterior surface of the tarsal plates.
• The outer surface of the orbital septum and tarsal plates are covered by the
palpebral fibers of the orbicularis occuli muscle.
• The aponeurosis of the levator palpebrae superioris pierces the orbital septum
to reach the anterior surface of the superior tarsal plate.
 I. Accessory structures of the Eyes
The eyelids tarsi and palpebral ligaments
 I. Accessory structures of the Eyes
The eyelids tarsi and palpebral ligaments
 I. Accessory structures of the Eyes
The eyelids tarsi and palpebral ligaments
 I. Accessory structures of the Eyes
Structure of the Eyelid Glands

• The large modified sebaceous glands (Meibomian or 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 oily fluid that reduces evaporation of tears and
prevent them from overflowing onto the cheek.
• The ciliary glands are arranged in several rows immediately behind the root of
eyelashes.
• Their ducts open on the lid margin close to the lashes.

The ciliary glands are of two types:

•Glands of Zeis, which are modified sebaceous glands and open into the follicles
of eyelashes.
•Glands of Moll, which are modified sweat glands.
 I. Accessory structures of the Eyes
Structure of the Eyelid Glands
 I. Accessory structures of the Eyes
Structure of the Eyelid Glands
 I. Accessory structures of the Eyes
Structure of the Eyelid Glands

Dr. Bahgat
 I. Accessory structures of the Eyes
Structure of the Eyelid

Palpebral fascia (orbital septum):

•It is a sheet of fascia which connects the anterior surface of each tarsal
plate with the corresponding periosteum of the bony orbital margin.

Conjunctiva (palpebral part):

•It is the inner most layer which lines the posterior surface of the tarsal
plate and continues over the sclera at the fornices.
•Upper palpebral conjunctiva receives the insertion of levator palpebrae
superioris.
 I. Accessory structures of the Eyes
The eyelids tarsi and palpebral ligaments
 I. Accessory structures of the Eyes
Conjunctiva

• It is a transparent mucus membrane lining the external anterior surface of eyeball

(except cornea) and inner aspect of eyelids.
• Palpebral conjunctiva: It is the conjunctiva which lines the inner aspect of eyelids and
continues with the skin of eyelids, lacrimal canaliculi and lacrimal sac at the lid
margins. It is highly vascular.
• Bulbar conjunctiva: It covers the anterior aspect of the outer most coat or sclera of the
eyeball. It is thin and has minimal vascularity. It continues with the epithelium of cornea
in front. The junction of cornea and conjunctiva is known as limbus. The bulbar
conjunctiva reflects onto the inner aspect of eyelids along the superior and inferior
fornices. Ducts of lacrimal gland open into the lateral part of superior fornix. Glands of
Krusae and Wolfring are also present in relation to superior fornix.
• Conjunctival Fluid: Watery from lacrimal fluids, Mucus from conjunctiva, Oily from
tarsal glands.
 I. Accessory structures of the Eyes
Conjunctiva
 I. Accessory structures of the Eyes
Lacrimal apparatus

Components of Lacrimal Apparatus

•Lacrimal gland and its ducts.

•Accessory lacrimal glands. Glands of Krusae and

Wolfring

•Conjunctival sac.

•Lacrimal puncta and canaliculi, common

canaliculus.
•Lacrimal sac

•Nasolacrimal duct

•Tears
 Lacrimal Apparatus
Lacrimal gland:

•The lacrimal gland is a (J-shaped) serous gland.

•It consists of upper large orbital part and lower small palpebral part.

•The two parts are continuous with each other around the lateral margin of the
levator palpebrae superioris.
•The orbital part is almond shaped and situated in the lacrimal fossa in the
anterolateral part of the roof of the bony orbit.
•The palpebral part is one-third of the size of the orbital part and is situated in the
lateral part of the upper eyelid below the levator palpebrae superioris and extends
up to the superior fornix of conjunctiva.
Lacrimal Apparatus
Lacrimal Apparatus
Lacrimal Apparatus
Lacrimal Apparatus
 Lacrimal Apparatus

Lacrimal apparatus (flow of tears)

 Bony Orbit
Seven bones make up the
bony orbit:
• Frontal

• Zygomatic

• Maxillary

• Ethmoidal

• Sphenoid

• Lacrimal

• Palatine
Bony Orbit
 Bony Orbit
Boundaries of the orbit
 Bony Orbit
Boundaries of the orbit

Medial wall (thinnest):

•Frontal process of maxilla.
•Lacrimal process of maxilla.
•Orbital plate of ethmoid.
•Body of sphenoid.
Lateral wall (strongest):
•Orbital surface of the zygomatic bone in front.
•Orbital surface of greater wing of sphenoid behind.
 Bony Orbit
Boundaries of the orbit

Floor:
•Orbital surface of the body of maxilla.
•Orbital surface of the zygomatic bone, anterolaterally.
•Orbital process of the palatine bone, posteromedially.
Roof:
•Orbital plate of the frontal bone in front.
•Lesser wing of the sphenoid behind.
 Bony Orbit
Boundaries of the orbit
Bony Orbit
 Lateral Orbital Wall
Relations

• Above: Anterior cranial fossa and frontal air sinus.

• Lateral: Temporal fossa in front and middle cranial fossa behind.
• Below: Maxillary air sinus.
• Medial: Ethmoidal air sinuses.
 Lateral Orbital Wall
Orbital fascia or periorbita Contents

• Eyeball (most important content).

• Muscles.
• Fascia bulbi.
• Nerves: (Optic, Oculomotor, Trochlear, Abducent, Ophthalmic, Ciliary
ganglion.
• Ophthalmic artery.
• Ophthalmic veins.
• Lacrimal gland.
• Orbital fat.
 Extrinsic eye muscles
Extraocular muscles
The extraocular muscles are classified into two groups:
•Voluntary
•Involuntary
 Extrinsic eye muscles
Voluntary muscles
•There are seven voluntary muscles in the orbit.

•Six muscles move the eyeball and one muscle moves the upper eyelid.

Four recti muscles

•Superior rectus,

•Inferior rectus,

•Medial rectus,

•Lateral rectus.

Two oblique muscles

•Superior oblique,

•Inferior oblique.

One levator palpebrae superioris.

Extrinsic eye muscles
Extrinsic eye muscles
Extrinsic eye muscles
Extrinsic eye muscles
Extrinsic eye muscles
 Extrinsic eye muscles
Involuntary muscles
There are three involuntary/smooth muscles
•Superior tarsal or Muller's muscle,
•Inferior tarsal
•Orbitalis
Eye movement stimulated by cranial nerves
Muscle Action Origin Insertion Innervation

Inferior Depression, From a tendinous Middle of the Oculomotor

Rectus Downward ring on posterior inferior aspect of
Rotation aspect of orbit anterior globe
Superior Elevation, Upward From a tendinous Middle of the Oculomotor
Rectus Rotation ring on posterior superior aspect of
aspect of orbit anterior globe
Medial Medial Rotation From a tendinous Middle of the Oculomotor
Rectus (Adduction) ring on posterior superior aspect of
aspect of orbit anterior globe
Lateral Lateral Rotation From a tendinous Middle of the Abducens
Rectus (Abduction) ring on posterior superior aspect of
aspect of orbit anterior globe
Inferior Adduction, From the Inferolateral Oculomotor
Oblique Elevation of globe, periosteum of the quadrant of the
Rotation of globe maxilla globe
when abducted
Superior Abduction, Greater wing of the Superolateral Trochlear
Oblique Depression of sphenoid quadrant of the
globe, Rotation of globe
globe when
adducted
Eye movement stimulated by cranial nerves
• III Oculomotor

• IV Trochlear

• VI Abducens
Eye movement stimulated by cranial nerves
Eye movement stimulated by cranial nerves
Eye movement stimulated by Cranial Nerves
Eye movement stimulated by Cranial Nerves
 Extrinsic Eye Muscles
Orbital fat

• It fills up the space between the eyeball, optic nerve, and cone of four rectus
muscles.
• It serves as a cushion to stabilize the eyeball during its movements.
 Extrinsic Eye Muscles
Orbital fat
 II. The eyeball (Bulbus oculi)
The eyeball (L. oculus; Gk. ophthalmos)
•Eyeball is the organ of sight.

•It functions like a camera and has a lens

system for focussing images.

Location:
•The eyeball occupies anterior half of the
orbital cavity.
•Optic nerve emerges from it, a little medial
to its posterior pole.

Shape and size:

•It is almost spherical in shape and has a

diameter of about 24 mm.
 II. The eyeball (Bulbus oculi)
The eyeball consists of three tunics (layers):
•External (fibrous) tunic: consists of the
cornea (anterior) and the sclera (posterior).
•Middle tunic-Uvea (vascular and smooth
muscle layer): consists of the ciliary body,
iris (anterior) and the choroid coat
(posterior).
•Internal tunic (nervous layer): nervous coat
consists of the retina.
II. The eyeball (Bulbus oculi)
 External (fibrous) tunic
Sclera
•Sclera forms the posterior five-sixths of the outer coat.
•It is opaque and consists of dens fibrous tissue.
•A small portion of it is visible as the ‘white of the eye’ in the palpebral fissure.
•It is continuous anteriorly with the cornea.
Structures piercing the sclera
•Optic nerve pierces the sclera a little inferomedial to the posterior pole of the eyeball.
•Long and short ciliary nerves.
•Long and short ciliary arteries pierce the sclera around the emergence of the optic nerve.
•4 choroidal veins (also called venae vorticosae) pierce the sclera just behind the equator.
•Anterior ciliary arteries enter the eyeball around limbus.
Functions of sclera:
•Helps to maintain the shape of the eyeball.
•Protects internal structures.
•Provides attachment to muscles that move the eyeball.
External (fibrous) tunic
External (fibrous) tunic
External (fibrous) tunic
 External (fibrous) tunic
Cornea
•The cornea forms the anterior one-sixths of the outer coat.
•It is transparent and more convex than the sclera.
•It is avascular and is nourished primarily by permeation from the periphery.
•It not only permits the light to enter the eye but also refracts the entering light.
•It is highly sensitive and is supplied by the ophthalmic division of trigeminal nerve.
•These nerves form the afferent limb of the corneal reflex.
Structure of Cornea
•Corneal epithelium: It consists of five layers of cells. It is made up of stratified squamous
epithelium. Middle cells are polyhedral with peripheral processes. These cells are known as wing
cells.
•Anterior limiting membrane (Bowman’s membrane): It is made up of a structureless homogenous
mass without any elastic fibers.
•Substantia propria: It is made up of lamellae of dense connective tissue which cross each other
at right angles to form corneal spaces.
•Posterior elastic lamina (Descemet’s membrane): It consists of a structureless homogenous
mass containing elastic fibers.
•Mesothelium of anterior chamber (Corneal endothelium): It is formed by squamous epithelium.
External (fibrous) tunic
Middle (vascular) tunic
 Middle (vascular) tunic
• The middle coat is often called as the vascular coat because it contains most
of the blood vessels of the eyeball.
• It is divided into three parts: From behind forwards these are, choroid, cillary
body and iris. These three parts together form the uvea or uveal tract.
 Middle (vascular) tunic
Choroid
•Choroid is the larger posterior part of the vascular coat of eyeball.

•It is a brown, thin and highly vascular membrane lining the inner surface of the
sclera.

•Anteriorly, it is connected to iris by the ciliary body and posteriorly, it is pierced

by the optic nerve.

Structure of choroid:
•Supra-choroid lamina

•Vascular lamina

•Capillary lamina

•Basal lamina or membrane of Bruch

Middle (vascular) tunic
Middle (vascular) tunic
 Middle (vascular) tunic
Ciliary Body
•Ciliary body is present in the form of a circular thickening in the vascular tunic.

•It extends from the choroid posteriorly at the level of ora-serrata of retina to the
iris anteriorly, at the level of corneo-scleral junction.

•The iris is attached along its lateral margin.

•The ciliary body suspends the lens via suspensory ligaments or zonules.
 Middle (vascular) tunic
Parts of the ciliary body
•The ciliary body is triangular in cross section, thick in front and thin behind.

•Its outer surface lines the inner aspect of the sclera.

•The inner surface consists of following features: Ciliary ring or pars plana, Ciliary
processes or pars plicata.

Structure of ciliary body:

•Stroma

•Ciliary muscle

•Bilaminar ciliary epithelium

Middle (vascular) tunic
Middle (vascular) tunic
 Middle (vascular) tunic
Iris:
• Iris is a pigmented contractile diaphragm present between the cornea and the
lens.
• It is attached along periphery to the choroid by the ciliary body.

• In the centre it presents with an opening called the pupil.

Structure of iris:
• Anterior mesothelial lining.

• Connective tissue stroma containing pigment cells and blood vessels.

• Layer of smooth muscle which consists of two parts: Constrictor pupillae,

Dilator pupillae.

• Posterior layer of pigmented cells which is continuous with the ciliary part of
retina.
Middle (vascular) tunic
Middle (vascular) tunic
Middle (Vascular) Tunic
 Inner (nervous) tunic
Retina:
•Retina is the innermost coat of the eyeball.
•The thickness of retina decreases gradually from behind forwards.
•It consists of two layers: An outer pigment layer, An inner sensory layer.
Structure
•The outer layer of the retina is insensitive to light and made up of pigmented
cuboidal epithelium.
•The inner sensory layer of the retina is sensitive to light and is made up of
photoreceptors cells called rods and cones; as well as numerous relay neurons
(bipolar neurons and ganglion cells).
Inner (nervous) tunic
 Retina through Opthalmascope

Blind spot Optimal vision

 Compartments of the eyeball
• By the lens the interior of the eyeball
is divided into two compartments: a
small anterior compartment in front
of the lens and a large posterior
compartment behind the lens.
Compartments of the eyeball
 Compartments of the eyeball
Anterior compartment:
•It is divided into two chambers: a smaller anterior chamber and a larger posterior
chamber.
•The anterior chamber lies between the iris and cornea and posterior chamber
between iris and lens.

•The two compartments communicate with each other through pupil.

•The two chambers are filled with an aqueous humour, which helps in maintaining
the intraocular pressure.
•The aqueous humour is rich in ascorbic acid, glucose, and amino acids.

•It nourishes the cornea and the lens which are otherwise avascular.
Middle (vascular) tunic
 Compartments of the eyeball
Posterior compartment:
•It is behind the lens (comprising four-fifth of the eyeball).

•It is surrounded almost completely by the retina and is filled with colorless,
transparent jelly-like substance called vitreous body.

•The vitreous humour is enclosed in a delicate hyaloid membrane.

•Anteriorly, the hyaloid membrane forms a depression the hyaloid fossa in which
rests the lens.
•The vitreous humour helps in maintaining intraocular pressure and therefore the
shape of the eyeball.
•Further, it holds the lens and the retina in place.

•The hyaloid canal extends from optic disc to the lens.

Compartments of the eyeball
 Compartments of the eyeball
The lens
•is an unusual biological structure.

•It is a transparent, biconvex body, 1 cm in diameter and 4 mm thick.

External Features
•The lens presents the following external features:

•Anterior and posterior surfaces.

•Anterior and posterior poles.

•A circumference-the equator.

•The line connecting the anterior and posterior poles is called the axis of the lens.
 Compartments of the eyeball
The lens

Structure of lens:
•Lens capsule: It is a transparent, elastic membrane that envelops the lens all
around.

•Anterior epithelium: Under the anterior surface of capsule the lens is lined by a
single layer of cuboidal cells in the centre. These cells elongate as they approach
the equator of lens and give rise to lens fibers.
•Lens fibers: They are arranged concentrically and form the substance of the lens.
Compartments of the eyeball
 Blood and lymph vessels
• A rich network of ophthalmic blood vessels supplies and drains the orbit.
• However, no lymph vessels or nodes are present in the orbital cavity.
 Blood and lymph vessels
Ophthalmic artery

• The ophthalmic artery is a branch of the internal carotid artery after that
• vessel emerges from the cavernous sinus.
• It enters the orbit through the optic canal with the optic nerve.
• It runs forward and crosses the optic nerve to reach the medial wall of the orbit.
• It gives off numerous branches that accompany the nerves in the orbital cavity.
• The ophthalmic artery forms a notable facial anastomosis with the angular
artery (the terminal end of the facial artery) and the frontal branch of the
superficial temporal artery.
 Blood and lymph vessels
Ophthalmic artery
 Blood and lymph vessels
Ophthalmic artery

Branches
•The central artery of the retina is a small branch that pierces the meningeal
sheaths of the optic nerve to gain entrance to the nerve.
•It runs in the substance of the optic nerve and enters the eyeball at the center of
the optic disc.
•The central artery is the end artery to the retina.
•The muscular branches.
•The ciliary arteries supply the eyeball; they are divided into anterior and posterior
groups. The former group enters the eyeball near the corneoscleral junction; the
latter group enters near the optic nerve.
•The lacrimal artery to the lacrimal gland.
•The supratrochlear and supraorbital arteries are distributed to the skin of the
forehead.
 Blood and lymph vessels
Ophthalmic artery
 Blood and lymph vessels
Ophthalmic artery
 Blood and lymph vessels
Ophthalmic artery
 Blood and lymph vessels
Ophthalmic veins

• Two main ophthalmic veins, superior and inferior, pass through the orbit.
• The superior ophthalmic vein forms from the union of the supraorbital and
supratrochlear veins draining the forehead.
• It communicates with the facial vein at the medial angle of the eye.
• The inferior ophthalmic vein communicates through the inferior orbital fissure
with the pterygoid venous plexus.
• Both ophthalmic veins pass posteriorly through the superior orbital fissure and
drain into the cavernous sinus.
 Blood and lymph vessels
Ophthalmic veins
 Blood and lymph vessels
Ophthalmic veins
 III. Optic nerve, tract, and pathway
• Six cranial nerves (optic, oculomotor, trochlear, trigeminal, abducens, facial)
plus additional autonomic components supply the orbit.
III. Optic nerve, tract, and pathway
III. Optic nerve, tract, and pathway