Anatomy & Physiology of Eye

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Khmer-Soviet Friendship Hospital, Eye Department
Phnom Penh Eye Center
How Does the Eye Work?
Think of the Eye as a Camera

Lens cover = Cornea**

Camera aperture = Iris & Pupil
Lens = Lens
Film = Retina
Photo Shop & Film Processing = Brain
 Film

Lens

Light

Retina

Fovea Lens
&
Macula Light

The Eye
 How does the eye work ?
focus light. > like a camera.
==================
Light rays enter eye through > cornea,
Light then travels through > lens
focus properly on > retina.
> Optic nerver > THE BRAIN.
________________________
The retina acts like film in the camera.
Light is changed by the retina into electric
impulses carried by the optic nerve to the
brain.
How Does the Eye Work?

Occipital Lobe / Visual Cortex

 Anatomy of the Eyes

I. External of the eye ball

1. Orbital bone

2. Lacrimal system (lacrimal apperatus)

3. Eyelids

4. Conjunctiva

5. External ocular muscles

 1. Orbital Bone
1. Frontal

2. Zygomatic

3. Maxillary

4. Ethmoidal

5. Sphenoid

6. Lacrimal

7. Palatine

7 bones : Bony Orbit

2. Lacrimal System

Decretory system:
- Lacrimal gland
- Accessory lacrimal
glands
2. Lacrimal System

Excretory system:
Puntum
Canaliculus
Common canaliculus
Lacrimal sac
Nasolacrimal duct
2. Lacrimal System
 Blinking
3. Eyelid Protection
Tear Function

Eyelids
Anterior lamellar

1. Skin
2. Orbicularis muscle

Posterior lamellar

1. Tarsus + Meibomian Glands

2. Conjunctiva
Palpebral conjunctiva
Fornix conjunctiva
Bulbar conjunctiva
4. Conjunctiva
1. Conjunctiva is
transparency outer surface
of the eye under the eye
lid and cover sclera.
Palpebral Conjunctiva
Fornix Conjunctiva
Bulbar Conjunctiva
2. Sclera is the collagenous
outer wall of the eyeball.
 4. Conjunctiva
(4) palpebral conjunctiva

(3)Conjunctival fornix

(2)Bulbar conjunctiva
 5. Extra-ocular muscle
6 Extraocular Muscles
4 rectus Muscles
1. Medial Rectus
2. Lateral Rectus
3. Superior Rectus
4. Inferior Rectus

2 Oblique Muscles
5. Superior oblique
6. Inferior oblique
Control Eye Movement & Alignment
5. Extraocular Muscle Insertion
5. Extraocular Muscle Origins

Rectus Muscles:

MR, IR, LR, SR

Annulus of Zinn at Orbital Apex

Oblique Muscle
SO
Medial to optic foramen
IO
Orbital floor near orbital rim
 II. The eye ball
1. anterior segment
- cornea
- sclera
- anterior / posterior chamber
- uvea tract (iris, ciliary body, choroid)
- lens
2. posterior segment
- vitreous, retina and optic nerve head
 Eyeball

Anterior
Segment
Posterior
Segment
1. Cornea
 1. Cornea
Cornea : have 5 layer
(Sensory nerve CN5th)
Epithelium
Bowman's layer
Stroma
Descemet's membrane
Endothelium
Corneal Transplant
 2. Sclera
Sclera

The white, opaque cover of the eye.

Covers 80% of the eyes outer layer.
Contains thick elastic collagen.
 3. Anterior Chamber
between cornea and iris = angle irido-cornea

> READ MORE ON

INCREASING INTER-
OCULAR PRESSURE
> GLAUCOMA
3. Aqueous Flow

Aqueous Humus
is produced by
Ciliary Body
Entering from the
posterior chamber, it
passes through the
pupil into the
anterior chamber
and filtrates through
the angle into the
blood stream.
Glaucoma
4. Uvea tract (iris, ciliary body, choroid)
Iris
Ciliary body
Choroid
4. Uvea tract (iris, ciliary body, choroid)
Iris = pupil = aperture
for light / image pass
through
Ciliary body = secretion
of aqueous humus for
maintain sharp of the
eye ball
Choroid = blood supply
O2 to 1/3 in outer part
of the retina
Lens
Anterior
Lens Anatomy
Capsule
Cortex

Epithelium

Nucleus

Posterior
Capsule
Lens and Cataract Surgery
Nuclear
sclerosis
Cortical
cataract
Mature cataract Morgagnian cataract
 Posterior
subcapsular
cataract
 II. The eye ball
1. anterior segment
- cornea, sclera ,anterior / posterior chamber
- uvea tract (iris, ciliary body, choroid), lens
2. posterior segment
- vitreous
- retina
- optic nerve head
1. Vitreous & Vitreous Cavity

Vitreous

vitreous humor, a
transparent gel that
maintains the structure
of the globe.
2. Retina
 Macula Fovea

Optic disc
10 Layer of Retina
1.Inner limiting membrane
2.Nerve fibers
3.Ganglion cells
4.Inner plexiform layer
5.Inner nuclear layer
6. Outer plexiform layer
7. Outer nuclear layer
8.Outer limiting membrane
9.Photo receptor
(Rods and cones cells)
10. Retina pigment epithelium
( RPE )
3. Optic Nerve & Visual Pathway
Visual Pathway
For Left Eye
It have 2 way to transit the
signal / image from retina to
THE BRAIN.
Nasal Retina
In-direct way
Temporal Retina
Direct way
 Nasal Retina
For Left Eye
It have 2 way to transit the
signal / image from retina to
THE BRAIN.
Nasal Retina
In-direct way
Temporal Retina
Direct way
Temporal retina
For Left Eye
It have 2 way to transit the
signal / image from retina to
THE BRAIN.
Nasal Retina
In-direct way
Temporal Retina
Direct way
Left Hemifield
Path
Right Hemifield
Path
Read and listen it more than one time
You will understand.

BLOOD SUPPLY

marginal arterial arcades
superior arterial arcade

Post tarsal which drains into
ophthalmic veins and a pre-
tarsal opening into
subcutaneous veins.

preauricular lymph nodes
submandibular lymph nodes

INNERVATION OF EYELIDS
oculi orbicularis
superioris palpebrae levator.
levator
palpebrae superiotis , tarsal plate, and forniceal
conjunctiva.
 The palpebral conjunctiva
It lines the lids and can be
subdivided
marginal
About 2 mm from the lid margin
transitional zone between skin and
the conjunctiva.
tarsal
thin, transparent and highly
vascular.
adherent to the whole tarsal plate
in the upper lid.
In the lower lid, it is adherent only
to half width of the tarsus.
orbital conjunctiva
lies loose between the tarsal plate
and fornix.
 The bulbar conjunctiva
It is thin, transparent and lies
loose over the underlying
structures and thus can be moved
easily

It is separated from the anterior

sclera by episcleral tissue and
Tenon's capsule.

A 3-mm ridge of bulbar

conjunctiva around the cornea is
called limbal conjunctiva.
 The conjunctiva fornix
It is a continuous circular cul-de-
sac which is broken only on the
medial side by caruncle and the
plica semilunaris.

Conjunctival fornix joins the

bulbar conjunctiva with the
palpebral conjunctiva.

It can be subdivided into

superior, inferior, medial and
lateral fornices.
 ANTERIOR SEGMENT
Structure of the wall of the eye

1. Sclera
2. Choroid
3. Large choroidal vessels
4. Medium choroidal vessels
3

4
5. Small choroidal vessels
6. Suprachoroid lamina of
sclera
5 7. Long ciliary nerve
8. Retina

84
 lens zonules run from ciliary body fuse into
lens capsule around equatoral zone
Not elastic
 Pupil
Circular hole in the middle of the iris.
Acts like the shutter of a camera:
In darkness the iris dilator muscle causes the pupil to
dilate and allowing more light to reach the retina.
In brightness, the iris sphincter muscle (which encircles the
pupil) constricts, causing the pupil to constrict and
allowing less light to reach the retina.
Constriction also occurs during accommodation - the
near reflex.
 Ciliary body

Pars plana flat area

continuous with the retina
Pars plicata contains the
ciliary processes that
secretes the aqueous
humor
Ciliary muscle runs
circularly around the eye
and controlles
accommodation
 Lens

Biconvex, avascular,
transparent structure.
Suspends behind the
iris by the zonules
which are connected
to the ciliary body.
Serves to converge
light onto the retina.
 Accommodation

Ciliary muscle
constrict > zonular
tension decreases >
lens becomes more
spherical > more
dioptric power that
converge light from
a near target onto
the retina.
 Presbyopia
With age, lens is less
elastic > muscle
constriction achieves less
accommodation.
 Cataract
With age, lens fibers are
less transparent
cataract
Lens is removed and a
plastic lens is inserted
instead
 Retinal gross anatomy
Fovea: area with the highest concentration of
photoreceptors.
Central retina: A circular field of approximately 6
mm around the fovea.
Peripheral retina: stretching to the ora serrata.
 Optic nerve
Consists of 1 million axons that arise from the
retina.
Leaves the eye through the sclera optic canal
into the cranium.
 Trochlear nerve
Dorsal surface of the brain stem decussates
cavernous sinus orbit supplies the
superior oblique.
 Abducens nerve
Originates between the pons and medulla
cavernous sinus orbit lateral rectus
 Vestibulo-ocular reflex
Primitive reflex which aims to keep the eyes
on a target when the head moves
The extra-ocular muscles receive
information from the otolit organs and
move the eyes in the opposite direction
Layers : "EBSDEin"
Blood supply of the orbit

Arterial supply
of the orbit
 Blood supply of the orbit
Venous drainage
Cavernous sinus
Cavernous sinus
 Orbit
Bony orbit
Soft tissue of the orbit
Blood vessels arteries
veins
Lymphatic vessels
Nerves : CN II, III, IV
CN V, VI
Ciliary ganglion
 Ocular adnexa
Eyelid
Lacrimal apparatus
Covering of the eyeball
: Tenons capsule
: Conjunctiva
 Eyeball
Eye topography Uveal tract :
Cornea Iris
Sclera Ciliary body
Anterior chamber Choroid
Limbus Lens
Aqueous outflow app. Vitreous
Retina
Orbital bone
 orbit

Orbital bones
Relationship of orbit & periorbital
CN.V and its distribution
 Mechanism of fracture floor of or

20 degree
Anterior orbital floor is in horizontal
alignment, but posterior floor is 20
degree angle. The fracture site is at
the posterior floor
Eyelid surface anatomy
Anatomy & Physiology of the eye
Surgical landmark for lid margin
 Surgery for lid margin

Excision /repair lid

Pentagonal excision

A= meibomian opening
B= grey line
C= lash line
Anatomy & Physiology of the eye

Sensory nerve
CN V1 upper lid
CN V2 lower lid
Anatomy & Physiology of the eye

Blood supply
facial system ( external -
carotid artery)
orbital system ( internal -
carotid artery)
Anatomy & Physiology of the eye
Venous drainage of the orbit
Orbital circulation

Arterial system
Internal carotid artery

Venous
system
cavernous
sinus
Anatomy & Physiology of the eye

Lymphatic drainage
1) medial & inferior
submanibular node
2) medial & superior
superficial parotid node
deep parotid ( preauricular)
node
Anatomy & Physiology of the eye
Tear & Lacrimal apparatus
3 layers of precorneal tear
lipid layer
aqueous layer
mucous layer
function
Tear flow
lubricant/refractive surface
oxygen/nutrient supply
host defence mechanism
nasolacrimal duct obstruction

Dacryocystogram (DCG)by injection

of contrast media into both punctum then
take bone substraction image to evaluate
lacrimal drainage system
 Aqueous dynamic

A = ciliary epithelium
B = trabecular meshwrk
C = Schlemms canal

is conventional outflow
(trabecular meshwork)
is uveoscleral outflow
 Retina

10 Retinal pigmented epithelium( RPE)

9 Rod and cone inner and outer segment
8 External limiting membrane
7 Outer nuclear layer
6 Outer plexiform layer
5 Inner nuclear layer
4 Inner plexiform layer
3 Ganglion cell layer
2 Nerve fiber layer
1 Inner limiting membrane
 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
occlusion
138
 RIGHT
SR
SO EYE CN III
CN IV

LR MR CN VI CN III

IO CN III
IR CN III

Position of Cranial Nerve

muscle supply
Orbicularis Oculi
Conjunctiva
Optic Nerve
ganglion cell layer
nasal to macula
4 parts
Intraocular
Intraorbital
Intracanalicular
intracranial
Optic Nerve

Optic disc
Optic nerve
Optic chiasm
Optic tract
Optic radiation
 Optics of
the human eye
 The human eye as an optical
system
Total optical power
= 60 diopters(D)
Average cornea
power = 42 D
Anterior surface
power = +48.21 D
Posterior surface
power = -5.88 D
Average lens power
= 18-19 D
Anterior subcapsular
cataract
 Trauma
Contusion
Penetrating & perforating injury
Radiation-induced cataract
Chemical injuries
Electrical injury
ANTERIOR SEGMENT
UVEAL TRACT

148
 ANTERIOR SEGMENT
Structure of the wall of the eye

1. Sclera
2. Choroid
3. Large choroidal vessels
4. Medium choroidal vessels
3

4
5. Small choroidal vessels
6. Suprachoroid lamina of
sclera
5 7. Long ciliary nerve
8. Retina

149
ANTERIOR SEGMENT
UVEAL TRACT

150