Choroid

Post part of vascular coat of the eyeball.

Prime function : nutrition.
Extends from optic disc to ora serrata
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Choroid
Inner surface smooth, brown and lies in
contact with pigment epithelium of retina.
Outer surface: rough and lies in contact with
the sclera.
Avg. about .25mm in thickness
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Choroid
Consist of 3 layers.
- Choriocapillaries the inner most layer.
- Stroma.
- Supra choroidal lamina outer layer
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Supra choroidal lamina

Thin 10-34 micron
Contains of collagen fibers , melanocytes and
fibroblast.
Continuous with supra ciliary lamina of ciliary body.
Space between this membrane and sclera is called
supra choroidal space
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Stroma
Consist of loose collagenous tissue, pigment
cells, macrophages, mast cells, plasma cells
and lymphocytes.
Main bulk is by vessels in 2 layers
- Outer layer of larger vessels: Hallers layer.
- inner layer of medium vessels: Sattlers layer

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Choriocapillaris
Sattlers layer connect with the
choriocapillaries.
Lying in the single plane beneath RPE.

Rich in capillary network.

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Choriocapillaries
Vessels walls thin with fenestration esp. the
surface facing the retina.
Fenestrated capillaries contain endothelial
cells joint by Zonular occludents.
Endothelial cells lined by basement
membrane containing pericytes.
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Bruch's Membrane
Innermost layer of the choroid.
Lies between Choriocapillaries and RPE.
Defects occur spontaneously in myopes ,in
trauma.

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Blood supply of Uveal tract

Supplied by 3 sets of arteries
a. Short post ciliary artery
b. Long post ciliary arteries
c. Ant ciliary arteries.

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Short post ciliary artery

Aries as two trunks.

Each from ophthalmic artery.
Pierce through sclera around the optic
nerve and then to the Choroid

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Long post ciliary arteries

Two in no. Nasal and temporal
Pierce the sclera obliquely on medial and
lateral side of optic nerve and to supra
choroidal space
And to ciliary body
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Ant ciliary arteries

Derived from muscular branch of ophthalmic artery.
7 in no. 2 each from artery of SR, IR,and MR muscles.
Pass ant to sclera, limbus and conjunctiva and then
enter ciliary muscle where they anastomose with 2
long post ciliary arteries

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Venous Drainage
Ant ciliary veins.
Smaller veins from sclera.
Vortex veins or post ciliary veins

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Smaller veins from sclera

Correspond to the sclera branches of short
ciliary arteries.
Carry blood only from sclera and not from
Choroid.

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Ant ciliary veins.

Tributaries of muscular veins.

Carry blood only from ciliary muscle.
Smaller from corresponding arteries.
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Vortex veins or post ciliary veins

4 in no. sup. Inf, Nasal and Termporal.
Pierce sclera obliquely on each side of SR and IR
6mm behind
Sup temporal vein more post about 8mm
Inf temporal most ant 5.5 mm behind the equator
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Vortex veins or post ciliary veins

Drains blood from:
- whole Choroid.
- Receive small veins from the optic nerve
- Sometimes small veins from retina also join it
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Anterior Chamber

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Anterior Chamber
Bounded antly by cornea and postly by ant
surface of iris and part of ciliary body
About 3m deep in adults.

Shallow in young an old people.

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Anterior Chamber
Shallow in hyperopes.
Deep in myopes and aphakics.
Contains about 0.25ml of AH

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Angle structures
Ciliary body band
Scleral spur
Trabaecular meshwork

Schlemns canal.
Schwalbes line
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Ciliary body band

Most post landmark of the angle
Formed by ant most part of ciliary body.
Grey or dark brown
Wider in myopes.

Narrow in hyperopes

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Scleral spur
Post portion of scleral sulcus
Usually white line on goniocopy
Attached at Ciliary body postly and corneo
Scleral meshwork

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Trabaecular meshwork
Function is for drainage of AH.
Roughly triangular in shape.
Apex: Schwalbes line.
Base: scleral spur
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Trabaecular meshwork
Divided into 3 parts:
- Uveal portion.
- Corneo scleral meshwork.
- Juxta canalicular tissue.
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Trabaecular meshwork
Uveal portion and corneo scleral meshwork
divided by Schwalbes line to scleral spur..
Uveal portion Lies internal to this line.

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Trabaecular meshwork

Pigmentation is variable.
Greater in brown iris than blue iris.

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Corneo scleral meshwork

Series of thin perforated connective tissue.
Arranged in lamellar pattern.
Extends from scleral spur to lateral wall of
sclera.
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Uveal Trabaecular meshwork

Cord like, with fewer elastic fibrils.
Extends from iris root and CB to Schwalbe's
line

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Juxtacanalicular meshwork
Outer most portion of the TM.
Loosely arranged connective tissue lined on
either side by endothelium.

Part of it connects corneo scleral meshwork

with Schlemn's canal (large venous channel)
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Juxtacanalicular meshwork
Gives normal resistance to aqueous outflow.
Lined on either side by endothelium

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Schlemms canal
Lined by endothelium.
Contains numerous opening of collector
channels.

Help to keep canal open.

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Collector channel
Called intrascleral aqueous vessels.
Leave SC obliquely to terminate ultimately
into episcleral veins.

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Schwalbes line
Fine ridge in front of TM.
End of Descemets membrane.
Forms ant structure of angle.
Lies in post corneal surface.
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Embryology.

Introduction
Three primary layers:
- Outer collagenous layer. (Sclera, cornea)
- Middle Vascular layer. (Uvea)
- Inner Sensory layer. ( retina , optic nerve)

Introduction
Embryology is important to know:
- Structure and its anatomic characteristics.
- Diseases of the eye.
- Pathogenesis of various congenital anomalies

Early development. (During and after 3rd week)

Before 3rd week : trilaminar str.

Consist of:
Ectoderm.
Mesoderm.
Endoderm.

Early development. (During and after 3rd week)

Anterior Ectoderm cells proliferate and
thicken to from Neural plate.( curved line).
On either side of groove Ectoderm thickens
to form neural folds which meet to for
Neural tube.

Early development (During and after 3rd week)

At end of third week of gestation Neural tube
closes.
Formation of small depression called optic pit.

Optic pit enlarge to form Optic Vesicles.

Early development. (During and after 3rd week)

Surrounding Optic vesicle is Mesoderm.

Helps in development of vascular system and

mesodermal str. of eye.

Proximal part of Optic vesicle forms Optic

stalk.

Fourth week of gestation

Invaginaiton of Optic vesicle distally and
inferiorly to form Optic cup.
Inferior invaginaiton to this optic vesicle forms
embryonic fissure.
Extends from Peripheral rim of optic cup to
Lateral wall of Forebrain.

Fourth week of gestation

Embryonic fissure helps in development of ON
and Vascular elements of an eye.
Complete closure of Fissure at 6th week of
gestation.

Sixth to seventh of gestation.

Incomplete closure of embryonic fissure leads
to coloboma or incomplete formation of an
eye str.
Complete closure of fissure is present most
structures are formed.

Orbit
4th week : Optic axes of two orbits are 1800
2nd month: 720
3rd month: 450

Lens
Derived for surface ectoderm.
3rd week of gestation.
Formation triggered by forward growth of
optic vesicle with surface ectoderm.

Stages of lens development.

First: thickening of surface ectoderm at site of optic
vesicle called as lens plate.
Second: cells of lens plate arc postly forming
outward concave depression called lens pit. By 22 to
23 days of gestation.
Remaining surface ectoderm forms corneal
epithelium

Stages of lens development.

Third: Lens vesicle entirely formed.
Fourth: lens vesicle consist of cuboidal
epithelium. Anterior cells do not increase in
length as in case of posterior cells to project
into lumen of vesicle.

Stages of lens development.

Fifth: Fibers grow till embryonic lens nucleus
completely formed by end of 4th week of
gestation.

Lens
Lens capsule is thicker anteriorly than
posteriorly.
Formed by 5th week of gestation.

Lens suture begins at 2nd month of gestation.

Lens
Development of primary lens nucleus.
Fibers extend form ant to post pole.
Each time new fibers formation.
Finally formation of Y sutures.

Lens
Linear junction where fibers terminate at ant
and post surface of lens forms Lens Sutures.
All fibers meet at single point leads to pit
formation leading to bad optical quality

Lens
Later in gestation and following birth
formation of these y sutures are irregular.

Progressive addition of lens fibers

results in appearance of Zones.
-

Primary lens nucleus.

Fetal Nucleus.
Infantile Nucleus.
Adult Nucleus.
Cortex.

Retina
Sensory retina and RPE develop from two
layers of original Optic cup.
Ant rim of Optic cup: Epithelial layers of iris
and ciliary body.

Retina
Distal part of Optic vesicle forming Sensory
retina divides into 2 Zones:
- Outer Zones: 8 -9 rows of Nuclei.
- Inner zone: Devoid of nuclei called marginal
zone.

Retina
Five and half months of gestation all layers of
retina are developed.
Macula: 3rd month to 8th month of gestation.

Fovea: last several months after birth.

Uvea
Stroma of 3 layers of Uvea are Mesodermally
derived.
Melanocytes: fifth month of gestation.
Iris: developd from 2 grem layers
- Ant stroma: Mesoderm
- Post pigment epithelium and sphincter:
neuroectoderm.

Sclera
Originates around seventh week of gestation.
Starts a limbus progress until it reaches
posterior pole at fifth month.

Crystalline lens

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Introduction
Biconvex.
Located in posterior chamber.
Behind pupil.
Held in position by zonules.
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Introduction
Transparent crystalline structure.
Power of about 20 D.
Avascular.
Posteriorly in contact with vitreous in circular area
called Weigers ligament.
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Introduction
Between the hyaloid face and lens capsule
small cavity called retrolental space or
Berger's space.
Its nourishment primarily by hyaloid artery
during fetal life.
Later by aqueous and vitreous.
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Introduction
Continuous to grow throughout life.
Color changes with age.

Transparent : infants and young

Adults: colorless.
Definite yellow tinge : about 30 yrs or more.
Amber : old age

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Dimensons
At Birth:
EQ :
6.4mm
AP: 3.5
mm
WT: 90gm
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Dimensons
At Adult life.
EQ: 9-10mm.
AP: 5mm
WT: 255gm

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Other parameters
RI: 1.39
Anterior surface: 10mm
Posterior surface: 6mm.

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Structure
Three layers.
- lens capsule.
- Epithelium.
- Nucleus and cortex.
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Capsule
Thin transparent membrane.
Surrounds the lens.
Highly elastic.
Composed of type IV collagen fibers.
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Capsule
Anterior twice thicker than posterior.
Increases in thickness throughout.
Function : accommodation.

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Epithelium
Single layer of cuboidal nucleated epithelial
cells.
Beneath anterior and equatorial capsule.

Not present in post capsule

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Epithelium
No attachment sites between lens epithelium
and basal lamina.
Cells undergo mitosis in pre equatorial zone.
Cell become elongated and descends to the
deeper layers.

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Epithelium
Absence of division at post capsule, leaves
post capsule clear.
Biosynthesis of DNA, RNA and Proteins takes
place.

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Lens substance or fibers

Cortex and nuclear fibers derived from
migrating epithelial cells.
Cortical cells: hexagonal. Numerous
interlocking projections present.
Lens sutures : due to inter-digitation of apical
processes.
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Lens substance or fibers

Appear as erect Y which is seen ant surface of
nucleus and inverted Y in post nucleus.
Within this nucleus are different zones of diff
optical densities.which are laid down
throughout life.

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Lens substance or fibers

Embryonic nucleus: innermost part (1-3
months of gestation).
Fetal nucleus: ( 3 months of gestation).
Infantile nucleus: ( birth to puberty)
Adult nucleus:( adult life)

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zonules
Supports lens.
Originate from basal lamina of non-pigmented
layer of ciliary body.

Attach to ant lens capsule and post to equator.

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Zonules
Made up of multiple filaments of collagen .
Insert lens capsule
- 1.5 mm ant capsule.
- 1.25 mm post capsule.

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Zonules
Diameter of each Zonule: 0.35-1 microns.
Function in accommodation.

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Vitreous

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General Features
Inert, transparent, colorless, jelly like,
hydrophilic gel acts as supporting str to the
eyeball.
Occupies 4/5th of the volume of the globe.

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Location
Bounded Antly by lens and ciliary body and
Postly by retina.
Adherence: 2mm ant and 4mm post to ora
serrata

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Attachments
Disc margin (outer rim area of Martigiane).
Perifoveal region.
Posterior lens capsule (hyaloidocapsular
ligament of Weiger)

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Composition
Largest, simplest, single piece connective
tissue.
- H2O content: 99%
- Weight: 40 gms.
- Volume: 4ml
- Viscosity : twice of water

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Structure
Divided into three parts
- hyaloid layer
- Cortical vitreous
- Medullary Vitreous
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Hyaloid Vitreous
Not a true membrane.
Str of connective tissue.
Fibrils run parallel to the surface

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Ant hyaloid layer

Covers Antly. Approx.: 1.5mm from ora
serrata.
Lies in contact with pars plana , ciliary
processes, ciliary zonules ,post lens capsule.

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Ant hyaloid layer

Firm adhered in younger individuals called as
Weiger's Ligament.
Within this a potential space is called as
Bergers space or retrolental space.
Middle of Bergers space hyaloid turns
backwards to form Cloquets canal
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Post hyaloid membrane

Extends back from the vitreous to optic disc.
In contact with ILM of retina.

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Cortical vitreous
Refers to entire peripheral vitreous.
Approx.100 microns in width.
Condensed fibrillar vitreous.

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Cortical vitreous
Consist of type II collagen fibrils.
Interspersed with sodium mucopolysaccharide
molecules.
Represents 2% of total vitreous.
Product of neuro-ectoderm.
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Cortical vitreous

Contain vitreous cells called Hyalocytes.

Found in cortical vitreous except in
retrolental part.

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Medullary vitreous
Forms vitreous body.
Similar to cortical vitreous.except for fibrils.
Centre to it is cloquets canal. Absent in
adults.

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Medullary vitreous
Represents remnants of hyaloid artery.
Mittendorf's dot represents remnants of the
ant end of hyaloid artery may be seen in
adults.

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Embryology: 3 stages
Ist stage: 1st month of gestation: Space- lens
and retina filled with primary vitreous.
IInd Stage: 2nd month of gestation: collagen
like fibrils and hyaluronic acid forms secondary
vitreous. represents adult vitreous.

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Embryology: 3 stages
14th week: secondary vitreous begins to fill the
vitreous cavity, by 7th month entire cavity.
Remnants of primary vitreous:SShaped called
Cloquets canal.

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Embryology: 3 stages
IIIrd Stage: tertiary or zonular fibrils develop.
Remants of foetal vasculature seen in adults
called as Mittendorf's dot.

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Function
Occupying major volume of the globe.
To absorb and redistribute forces applied to
surrounding ocular tissue.

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RETINA

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Introduction
Innermost ,delicate layer of the eye.
Post pole thickness: 0.56mm
At EQ: 0.18to 0.2mm.
At Ora Serrata:approx. 0.1mm

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Introduction
Highly developed tissue.
Appears purplish red.
After death: white opaque.

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Gross Anatomy
Extends from optic disc to ora serrata.

OPTIC DISC:
pale disc. About 1.5 mm dia.
All retinal layers terminate at optic disc.
Except NFL (lamina Cribrosa).
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Gross Anatomy
Macula:
- yellow spot.
- 5.5 mm dia.
- Temporal to optic disc.
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Gross Anatomy
Fovea: sensitive part
- depressed part of macula.
- 1.85 mm dia.
- Corresponds 50 of visual
field.
- Surrounding to it is
parafoveal and perifoveal
areas.
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Gross Anatomy
Foveola:
- central floor of fovea.
- 2 disc dia (3mm) away to temporal edge of
optic disc .
- 0.35 mm dia
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Gross Anatomy
Umbo:
- tiny depression in centre of foveola.
- Corresponds as foveolar reflex during
ophthalmoscopy

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Gross Anatomy

FAZ:
- located inside fovea but outside foveola

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Microscopic structures
RPE.

INL

Layers of rods and cones.

IPL

ELM.

Ganglion layer

ONL

NFL

OPL

ILM
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Retinal pigment Epithelium

Outermost layer.
Consist of hexagonal shaped cells
Firmly adherent to Bruchs membrane and loosely to
rods and cones.
Space between RPE and sensory retina : Subretinal
space
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Retinal pigment Epithelium

RPE cells at fovea are taller and contain more
pigment.
pigmentation is not equal ,gives granular
appearance to retina.

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Retinal pigment Epithelium

Function:
- photoreceptors renewal.
- Recycling of vit A.
- Integrity of subretinal space forming blood
retinal barrier
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Retinal pigment Epithelium

Function:
- transport of nutrients
- Phagocytic action.
- Support to photoreceptors.
- Absorption of light
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Layers of rods and cones

Are photoreceptors.
Transform light energy
to visual energy.

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Layers of rods and cones

ROD:
- Subserves peripheral
vision and helps in
scotopic vision.
- Absent at fovea in area
of 0.35mm which
corresponds to 1.250 of
visual field.
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Layers of rods and cones

ROD CELL:
- about 40 60 micron
long.
- Outer segment is
cylindrical.
- Contain visual purple.
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Layers of rods and cones

ROD CELL:
- contain proteins lamellar
disc.
- Disc contains 90% visual
pigment.
- Inner segment:thicker.
Contains mitochondria Golgi
bodies, usual organelles
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Layers of rods and cones

ROD CELL:
- outer rod fiber layer: arise
from inner end of rod,
passes through ELM and
then terminates as inner
rod fiber which lies in OPL,
which end at rod spherules
in contact with cone foot.

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Layers of rods and cones

CONE:
- helps in photopic vision
and for color vision.
- About 6.5 million cones.
- More at fovea

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Layers of rods and cones

Cones:
- about 40 80 microns long
- Largest at fovea and
shortest at periphery.
- Cone outer segment:
conical, shorter than rod,
contains iodopsin, disc
smaller than rod
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Layers of rods and cones

Cones :
- cone inner segment:
similar to the rod.
- Inner segment: directly
continuous with the
nucleus and lies in ONL.
And ends at cone foot
which lies at OPL
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External Limiting Membrane

Is not a true basement membrane.
Extends form ora serrata to edge of optic
disc.
Is formed by junctions between
photoreceptors and mullers cells
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Outer nuclear layer

Formed by nuclei of
rods and cones.
Cone nuclei larger than
rod.
Lies in single layer next
to ELM.
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Outer plexiform layer

Contains synapses between
rod spherules and cone
pedicles with dendrites of
Bipolar cells
Thickest at the macula.
Also known as Henle's layer.

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Inner Nuclear layer

Resembles outer nuclear
layer .
It is thin.

Consist of
bipolar cells (INL)
Horizontal cells( OPL)
Amacrine cells (within OPL)
Mullers cell (within INL)
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Inner plexiform layer

Absent at foveola.
Consist of synapses
between axons of
bipolar cells(1st order
neurons), dendrites of
ganglion cells (2nd order
neurons) and process of
amacrine cells
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Ganglion cell layer

Throughout of the retina this layer is of single
layer except at macula which is multi layered.
Absent at region of fovea.

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Nerve fiber layer

Consist of unmyelinated axons of the ganglion
cells.
Vessels lies in this layer

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Internal limiting membrane

Consist of PAS +ve true Basement membrane.
Interface between retina and vitreous.

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Blood supply
Outer four layers:from RPE to ONL by
choriocapillaries.
Six inner layers: from OPL to ILM by central
retinal artery.
OPL supplied partly by CRA and
choriocapillaries
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Blood supply
Fovea an avascular zone supplied by
choriocapillaries.
Macula by CRA and cilioretinal artery

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Extra Ocular Muscles

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EOM
For eye movements
4: rectii ( SR, MR, IR, LR)
2 oblique: (SO, IO)
1 levator palpebral superiors.
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 All except IO originates at orbital apex.

4 rectii from: annulus of Zinn.

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Annulus of Zinn
Is a fibrous ring.
Common origin of rectus muscles.
Orbital apex surrounded by annulus of Zinn called
occulomotor foramen.
Serves opening for CN III, IV, V, VI.
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Spiral of Tiallux

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Action of a muscle in primary

position
Eye directed in straight head position.
Primary action : Muscle contracts when eye is
in primary Position.

Subsidiary action: Additional effects in

primary position
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Horizontal rectus muscles

Medial Rectus:
- Action : Adduction.
- Origination: Annulus of Zinn.
Lateral Rectus:
- Action: Abduction.
- Origination: Annulus of Zinn
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Vertical Rectus Muscle

Superior Rectus Muscle:
Origination: Annulus of
Zinn.
Course: anteriorly
upwards and laterally
forming 230 with Visual
axis
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Vertical Rectus Muscle

-Action:
Primary: Elevation when
Abducted 230.
Muscle Axis & optic axis
coincide.
Secondary &Tertiary:
Intorsion when adducted
670

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Vertical Rectus muscle

Inferior Rectus:
Origination: Annulus of
Zinn.
Course: Anteriorly
Downwards and laterally
forming 230 With Visual
Axis
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Inferior Rectus Muscle

Action:
Primary action: Depression
when globe abducted 230
Secondary and tertiary
Action: Extorsion when
Adducted 670
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Oblique Muscle
Superior Oblique:
Origination: orbital Apex
above Annulus of Zinn.
Course: Medially upwards
towards Trochlea.
Thereafter runs postly
below SR form an angle of
510

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Superior Oblique
Action:
Primary Action: Intorsion
when globe abducted 390
Optical axis and Pulley of
SO make 900 Angle.
Secondary and tertiary
Action: Depression when
Adducted 510 Muscle axis
and Optical axis Coincide

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Inferior Oblique
Origination: from
Maxillary Bone posterior to
Orbital rim and lateral to
the orifice to Lacrimal
Fossa.

Course : passes laterally

,Superior and posteriorly
going inferior to inferior
rectus forming an angle of
510 with visual axis

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Inferior Oblique
Action:
Primary action: extorsion
when globe abducted
390
Secondary and tertiary
action: elevation when
globe adducted 510
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Hiral Korani

Blood supply
Medial Rectus: Inferior muscular branch of
ophthalmic artery.
Inferior Rectus: Inferior muscular branch of
ophthalmic artery and infraorbital artery.
Lateral Rectus: Lacrimal artery.

Blood supply ctd..

Superior Rectus: superior muscular branch of
ophthalmic artery.
Superior Oblique: superior muscular branch of
ophthalmic artery
Inferior Oblique: Inferior muscular branch of
ophthalmic artery and infraorbital artery.

Definitions
Muscle Cone: lies post to equator of EOM,
EOM sheath, Intermuscular membrane extends
postly to annulus of Zinn.
Muscle Capsule: extend form its origin to its
insertion. Near equator they thicken.

Definitions
Check ligaments: limit excursion of EOM. Act
as support structure to globe. Neither check
movements nor they are ligaments.
Inter muscular membrane: connects all rectii
with thin layer of tissue that underlies
conjunctiva