Anatomy of the Eye and Orbit

The Eyeball
A spherical globe with a diameter of 24.5mm.

The conjunctiva
A transparent mucous membrane that lines the inner surfaces of the eyelids and the front surface of the eyeball.

The conjunctiva is composed of 3 sections

Palpebral conjunctiva (covers the posterior surface of the eyelids). Bulbar conjunctiva (coats the anterior portion of the eyeball). Fornix (the transition portion forming the junction between the posterior eyelid and the eyeball).

Cornea
The transparent dome which serves as the window of the eye. The primary (most powerful) structure focusing light entering the eye.

Cornea
Composed of 5 layers, from the front to the back: Epithelium. Bowmans (anterior limiting) membrane Stroma (substantia propria) Descemets (posterior limiting) membrane Endothelium (posterior epithelium)

How does the cornea stay transparent?

No blood vessels Transparent stroma with low level of fluids
Endothelium cells serves as a pump that supply oxygen and remove fluids

Tear film also supplies oxygen and keep corneal surface smooth and clean

Sclera

The white, opaque cover of the eye Covers 80% of the eyes outer layer Contains thick elastic collagen It provides protection Serves as an attachment for the extra-ocular muscles which move the eye

Uveal tract
Iris Ciliary body Choroid

Iris & anterior compartment

A thin diaphragm composed mostly of connective tissue and smooth muscle fibers, than lies between the cornea and the lens

Iris anatomy
The iris is composed of 3 layers, from the front to the back:
Endothelium Stroma Epithelium

Stroma muscles
Dilator - sympathetic innervation Constrictor parasympathetic innervation

Eye color (iris color)

Determined by the amount of pigment present in iris No pigment - pink iris (albino), some pigment blue iris, increasing amounts of pigment- green>hazel> brown irides The pigments: melanin (chromosome 15) and lipochrome (chromosome 19) Heterochromia irides: when one iris has a different color than the other iris

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

Aqueous humor

Produced by the 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 Serves to nourish ocular structures

Anterior chamber angle

Iris-cornea junc. Contains the trabecular meshwork which acts like a filter for the aqueous humor. From the TM the humor drains to schlems canal and then to blood stream.

Glaucoma

Choroid
The posterior segment of the uvea, between the sclera and the retina. Rich in blood supply, supplies oxygen and nutrition to the outer two thirds of the retina.

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

The retina
The innermost layer of the eye, comparable to the film inside of a camera. It is composed of nerve tissue which senses the light entering the eye.

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.

Rods and cones

Cones
Concentrated in the fovea Most active in daylight Central vision

Rods
Mostly in the peripheral retina Most active in night vision Peripheral vision

Optic nerve
Consists of 1 million axons that arise from the retina. Leaves the eye through the sclera optic canal into the cranium.

Optic pathways

Visual field

Hemianopia

The extra-ocular muscles

Oculomotor nerve
Originates from the brainstem cavernous sinus divides into superior and inferior divisions. Superior division: supply the superior rectus and levator palpebrae. Inferior division supplies the inferior and medial rectus and inferior oblique muscle. In addition the oculomotor supplies the pupillary muscles.

Oculomotor palsy
Exotropia Hypotropia Pupil dilation Ptosis

Trochlear nerve
Dorsal surface of the brain stem decussates cavernous sinus orbit supplies the superior oblique.

Trochlear palsy
Hypertropia Head tilt

Abducens nerve
Originates between the pons and medulla cavernous sinus orbit lateral rectus

Abducens palsy
Esotropia

Nystagmus
Involuntary movement of the eyes May seriously reduces vision Etiology:
Congenital Vestibular Neurologic

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