ANATOMY OF THE EYE

BY ELIZEL LAGUNZAD-CLAVERIA, MD, DPBO

EXTERNAL EYE DISEASES AND CORNEA
PLM-OSPITAL NG MAYNILA MEDICAL CENTER

ANATOMYOFTHEEYE
Learning Objectives: To be able to identify the different ocular structures
◦ Orbit
◦ The Eyeball
◦ Ocular Adnexae
◦ To clinically correlate basic ocular consults to their anatomy

PART I. THE ORBIT

A. The Bony Orbit
B. Orbital apex
C. Blood Supply
D. Venous Drainage
E. Cranial Nerves
F. Ciliary Ganglion
G. Periorbital Sinus
H. Radiographic correlates
I. CT correlates
◦ Orbital volume ~ 30ml; 1/5 occupied by the eyeball
◦ Shaped like a pear with the optic nerve as the stem
◦ Orbital entrance: H= 35mm, W=45mm
◦ Maximum width is behind the orbital margin
◦ Orbital depth = 40-45mm in
adults from entrance to apex
Orbit = 7 bones + 4 sides + a margin
1. Orbital margin
2. Roof
3. Medial Orbital Wall
4. Orbital floor
5. Lateral wall

1. Orbital margin
◦ Superior: frontal bone
◦ Medial margin: posterior lacrimal crest of the lacrimal bone, anterior lacrimal crest of the maxillary
bone
◦ Inferior margin: maxilla and the zygomatic bones
◦ Lateral: Zygomatic and frontal bones
2. Orbital Roof
◦ Orbital plate of the frontal bone + Lesser wing of the sphenoid
◦ Lacrimal gland is located in the lacrimal fossa in the anterior
lateral aspect of the roof within the orbital roof
Medially: Trochlear fossa 4mm from the orbital margin (pulley of SO
muscle)
3. Medial Orbital Wall
◦ 4 bones:
1. Frontal process of the maxilla
2. Lacrimal bone
3. Orbital plate of ethmoid bone- largest portion/ lamina
papyracea
4. Lesser wing of the sphenoid
◦ Lacrimal fossa continuous with the nasolacrimal canal,
extending into the inferior meatus
4. Orbital Floor – has 3 bones
1. maxilla
2. palatine
3. orbital plate of the zygomatic
floor of the orbit slopes downward approx. 20
degrees from posterior to anterior
5. Lateral Orbital Wall
◦ The thickest and strongest of the walls
◦ 2 bones:
1. Zygomatic bone
2. Greater wing of the sphenoid
Whitnall’s tubercle --- small elevation in the zygomatic
orbital margin
Attachment of the following:
1. Check ligament of the LR muscle
2. Suspensory ligament of the eyeball
(Lockwood suspensory ligament)
3. Lateral palpebral ligament
4. Aponeurosis of the levator palpebrae
superioris muscle
5. Whitnall’s ligament

B. Orbital APEX
◦ entry portal for all nerves and vessels to the
eye
◦ the site of origin of all extraocular muscles except the
inferior oblique
Superior orbital fissure lies between the body and the
greater and lesser wings of the sphenoid bone
◦ superior ophthalmic vein and the lacrimal, frontal,
and trochlear nerves pass through the lateral portion
of the fissure that lies outside the annulus of
Zinn
Within the annulus of Zinn
1. SOV, superior and inferior divisions of CN III,
CN VI and nasociliary nerves pass through the
medial portion of the fissure
2. The optic nerve and ophthalmic artery pass
through the optic canal

o The inferior ophthalmic vein may pass through

any part of the superior orbital fissure, including the
portion adjacent to the body of the sphenoid that lies
inferomedial to the annulus of Zinn.
The inferior ophthalmic vein frequently joins the
superior ophthalmic vein before exiting the orbit.C.
Blood Supply
Ophthalmic artery
◦ principal arterial supply of the orbit and its
structures
◦ 1st major branch of the intracranial portion of the internal carotid artery
◦ passes beneath the optic nerve and accompanies it through the optic canal into the orbit
Ophthalmic Artery Branches:
1. central retinal artery - 1st intraorbital branch, which
enters the optic nerve about 15 mm behind the globe
2. lacrimal artery, supplying the lacrimal gland and
upper eyelid
3. muscular branches to the various muscles of the
orbit
4. Long posterior ciliary arteries
5. Short posterior ciliary arteries supply the choroid
and parts of the optic nerve
6. Medial palpebral arteries to both eyelids
7. Supraorbital and supratrochlear arteries

From the Ophthalmic artery

Branches:
 Long Posterior ciliary arteries supply the
ciliary body and anastomose with each other
and with the anterior ciliary arteries to form
the major arterial circle of the iris
 Anterior ciliary arteries - are derived from
the muscular branches to the rectus muscles
- supply the anterior
sclera, episclera, limbus, and conjunctiva and
contribute to the major arterial circle of the
iris

D. Venous Drainage
primarily through the superior and inferior ophthalmic
veins

drain the vortex veins, the anterior ciliary veins, and

the central retinal vein

ophthalmic veins communicate with the cavernous

sinus via the superior orbital fissure and the pterygoid
venous plexus via the inferior orbital fissure

E. Cranial Nerves
F. Ciliary Ganglion
3 roots:
1. long sensory root:
◦ nasociliary branch of CN V
◦ sensory fibers from the cornea, the iris, and the ciliary
body
2. short motor root
◦ inferior division of CN Ill
◦ supplies the inferior oblique muscle, and iris
sphincter.
3. sympathetic root
◦ plexus around the internal carotid artery.
◦ ocular blood vessels and possibly the dilator
muscle
G. Periorbital Sinuses
◦ Have a close anatomical relationship with the orbits
◦ Medial orbital walls border the nasal cavity
anteriorly, the ethmoid sinus and sphenoid sinus
posteriorly are almost parallel
◦ Lateral walls border the middle cranial, temporal and
pterygopalatine fossae
◦ Superior to the orbit are anterior cranial fossa and the frontal
sinus
◦ Inferior: the maxillary sinus and palatine air cells
◦ These routes offer a route for spread of infection
◦ Mucocoeles occasionally arise from the sinuses and may be
confused as tumors
◦ Damage to the Fovea ehtmoidalis, roof of the ethmoids may
cause CSF leak during lacrimal app sx
H. Radiographic Correlates

I. CT Correlates

PART II. THE EYEBALL

A. The Conjunctiva
B. The Tenon’s Capsule
C. The Episclera/ Sclera
D. The Cornea
E. The Uvea
F. The Lens
G. The Aqueous Humour
H. The Anterior Chamber Angle
I. The Retina

II. The Eyeball

 Normal adult globe - approximately spherical, with an anteroposterior diameter 23-25 mm
 Contains 3 compartments:
3 Compartments of the eyeball:
1. Anterior chamber
• Space bet iris and cornea filled with
aqueous
• Approximately 3mm deep; ave. vol = 200µl
2. Posterior chamber
• Anatomical portion of the eye posterior to
the iris and anterior to the lens and
vitreous face
• Also filled with aqueous; ave vol = 60µl
3. Vitreous cavity
• Largest compartment
• More than 2/3 of the volume of the eye

A. Conjunctiva
 Thin mucous membrane that covers the outer surface of the
eye (sclera)
 Lines inside of the eyelids
 Anteriorly - continuous with the cornea
 Nourished by tiny blood vessels (nearly invisible to the naked
eye)
 Secretes oils and mucous that moisten and lubricate the eye
1. Palpebral conjunctiva
 begins at the mucocutaneous junction of the eyelid
 covers the lid's inner surface
 adheres firmly to the tarsus
2. Forniceal conjunctiva
 enmeshed with fibrous elements of the levator aponeurosis
and Muller muscle in the upper eyelid
 fibrous expansions of the inferior rectus muscle sheath fuse
with the inferior tarsal muscle, the equivalent of the Muller
muscle
3. Bulbar conjunctiva - freely movable but fuses with the Tenon capsule
and inserts into the limbus
 Conjunctival Blood supply: Anterior ciliary arteries
 Innervation: CN V1
 mucous membrane
 numerous goblet cells
B. Tenon's Capsule (Fascia Bulbi)
 fibrous membrane that envelops the globe from the limbus
to the optic nerve
 Adjacent to the limbus, the conjunctiva, Tenon's capsule, and
episclera are fused together
 fuses posteriorly with the optic nerve sheath
 fuses anteriorly with intermuscular septum, 3 mm posterior
to the limbus
 collagen fibers and a few fibroblasts
Check ligaments - tough tubular reflection around each of these
muscles to the point where Tenon's capsule is pierced by tendons
of the EOM’s in their passage to their attachments to the globe
 regulate the direction of the EOM action
 act as their functional mechanical origins
Lockwood's ligament
 suspensory ligament of the eyeball where the lower
segment of Tenon's capsule is thick and fuses with the
fascia of the IR and the IO muscles upon which the globe
rests
C. The Sclera & Episclera
 Fibrous outer protective coating of the eye, consisting
almost entirely of collagen
 dense and white and continuous with the cornea anteriorly
and the dural sheath of the optic nerve posteriorly
 insertion of the rectus muscles, the sclera is about 0.3 mm
thick; elsewhere it is about 0.6 mm thick

 Slightly posterior to the equator, the four vortex veins draining the choroid exit through the sclera,
usually one in each quadrant
 Across the posterior scleral foramen are bands of collagen and
elastic tissue, forming the lamina cribrosa, between which
pass the axon bundles of the optic nerve
D. The Cornea
 transparent avascular tissue
 is inserted into the sclera at the limbus
 average adult size is 550nm thick at the center
 about 12 mm in diameter horizontally and 11 mm vertically
 Function: air-tear film interface -- primary refracting power of the
eye 43D

Sources of nutrition for the cornea

 The vessels of the limbus, the
aqueous, and the tears.
 The superficial cornea also gets most
of its oxygen from the atmosphere.
Sensory nerves of the cornea
 Supplied by the first (ophthalmic)
division of CN V (trigeminal) cranial nerve.
Transparency of the cornea is due to its
uniform structure, avascularity, and
deturgescence
D. The Corneal Clarity
 structural integrity
- trauma, infections, hereditary dystrophies, metabolic
diseases
 functional maintenance of dehydration
- surgical trauma, glaucoma, intraocular infections and
inflammatory diseases

E. The UVEA

1. Iris
◦ Colored part of the eye
◦ Controls light levels inside the eye
◦ Color comes from microscopic pigment cells
(melanin)
◦ The color, texture, and patterns of each
person's iris are as unique as a fingerprint

Muscles acting on Iris:

 Sphincter muscle: In bright light, the sphincter contracts, causing
the pupil to constrict
 Dilator muscle: Dilates the eye in dim lighting

 The two heavily pigmented layers on the posterior surface of the iris
represent anterior extensions of the neuroretina and retinal
pigment epithelium.
 The blood supply to the iris is from the major circle of the iris
 Sensory nerve supply to the iris is via fibers in the ciliary nerves.
2. Ciliary Body
 roughly triangular in cross-section, extends forward from the anterior end of the choroid to the root of
the iris (about 6 mm).
 Consists of :
 Pars plicata (2 mm) - a corrugated anterior zone
 Pars plana (4 mm). and a flattened posterior zone
 The ciliary processes arise from the pars plicata
 Composed mainly of capillaries and veins that drain through
the vortex veins.
 Capillaries are large and fenestrated and hence leak
intravenously injected fluorescein.
 There are two layers of ciliary epithelium:
 Internal nonpigmented layer, representing the anterior
extension of the neuroretina,
 External pigmented layer, representing an extension of the
retinal pigment epithelium.
 The ciliary processes and their covering ciliary epithelium
are responsible for the formation of aqueous.
3. Choroid
 Posterior segment of the uveal tract, between the retina
and the sclera
 Composed of three layers of choroidal blood vessels: large,
medium, and small
  The deeper the vessels are placed in the choroid, the wider their lumens
 Internal portion of the choroid vessels is known as the choriocapillaris
 Blood from the choroidal vessels drains via the four vortex veins, one in each of the four posterior
quadrants
 choroid is bounded internally by Bruch's membrane and externally by the sclera

F. THE LENS
 biconvex, avascular, colorless, and almost completely transparent
structure
 about 4 mm thick and 9 mm in diameter
 It is suspended behind the iris by the zonule, which connects it with the
ciliary body.
 Anterior to the lens is the aqueous; posterior to it, the vitreous
 Lens capsule - semipermeable membrane (slightly more
permeable than a capillary wall) that will admit water and
electrolytes
 Subcapsular epithelium is present anteriorly
 Lens nucleus is harder than the cortex. With age, subepithelial
lamellar fibers are continuously produced, so that the lens
gradually becomes larger and less elastic throughout life.
 Lens is held in place by a suspensory ligament known as the zonule (zonule of Zinn), which is
composed of numerous fibrils that arise from the surface of the ciliary body and insert into the lens
equator.
 There are no pain fibers, blood vessels, or nerves in the lens
 Accommodation- Pupils constrict, Lenses become globular, Convergence

G. The Aqueous
◦ produced by the ciliary body. Entering the

posterior chamber, it passes through

the pupil into the anterior chamber
and then peripherally toward the
anterior chamber angle
 ◦ Anterior chamber angle lies at the junction of the peripheral cornea and the root of the iris
◦ Main anatomic features are Schwalbe's line, the trabecular meshwork (which overlies Schlemm's
canal), and the scleral spur.
I. The Retina
 Thin, semitransparent, multilayered sheet of
neural tissue that lines the inner aspect of the
posterior two-thirds of the wall of the globe.
 The retina is 0.1 mm thick at the ora serrata and
0.56 mm thick at the posterior pole.
Function: Conversion of energy
Color and form sense
 the retina and retinal pigment epithelium are
firmly bound together, thus limiting the spread of
subretinal fluid in retinal detachment.
 Potential spaces for detachments:
1. Subretinal space – bet. the retina and retinal pigment epithelium are easily separated, such as occurs in
retinal detachment, except at the optic disk and the ora serrata
2. The potential suprachoroidal space between the choroid and sclera, which extends to the scleral spur.
Choroidal detachments thus extend beyond the ora serrata, under the pars plana and pars plicata.
3. The epithelial layers of the inner surface of the ciliary body and the posterior surface of the iris
represent anterior extensions of the retina and retinal pigment epithelium.
4. The inner surface of the retina is apposed to the vitreous.
I. The Layers of the Retina
starting from its inner aspect, are as follows:
1) internal limiting membrane;
2) nerve fiber layer, containing the ganglion cell
axons passing to the optic nerve;
(3) ganglion cell layer;
(4) inner plexiform layer, containing the connections of
the ganglion cells with the amacrine and bipolar cells;
(5) inner nuclear layer of bipolar, amacrine, and horizontal
cell bodies;
(6) outer plexiform layer, containing the connections of
the bipolar and horizontal cells with the photoreceptors;
(7) outer nuclear layer of photoreceptor cell nuclei;
(8) external limiting membrane;
(9) photoreceptor layer of rod and cone inner and outer segments; and
(10) retinal pigment epithelium. The inner layer of Bruch's membrane is actually the basement membrane of
the retinal pigment epithelium
Macula
 Center of the posterior retina is the 5.5- to 6.0-mm-diameter
 Defined clinically as the area bounded by the temporal retinal vascular arcades.
 Known to anatomists as the area centralis, being defined histologically as that part of the retina in
which the ganglion cell layer is more than one cell thick.
 The macula lutea is defined anatomically as the 3-mm-diameter area containing the yellow luteal
pigment xanthophyll.
 The 1.5-mm-diameter fovea corresponds to the retinal avascular zone of fluorescein angiography
I. The Retinal Blood Supply
The retina receives its blood supply from two sources:
1. Arterioles of the central retinal artery, which supply the inner two-thirds.
 The retinal blood vessels have a nonfenestrated endothelium, which forms the inner blood-retinal
barrier. The endothelium of choroidal vessels is fenestrated. The outer blood-retinal barrier lies at the
level of the retinal pigment epithelium
. the choriocapillaris
 • immediately outside Bruch's membrane, which supplies the
outer third of the retina, including the outer plexiform and
outer nuclear layers, the photoreceptors, and the retinal
pigment epithelium;
• The fovea is supplied entirely by the choriocapillaris and is
susceptible to irreparable damage when the retina is
detached.
J. The Vitreous
 The outer surface of the vitreous ”the hyaloid
membrane”- normally in contact with the
following structures: the posterior lens capsule,
the zonular fibers, the pars plana epithelium, the
retina, and the optic nerve head.
 Is a clear, avascular, gelatinous body that
comprises two-thirds of the volume and weight of
the eye. It fills the space bounded by the lens,
retina, and optic disk
 The base of the vitreous maintains a firm
attachment throughout life to the pars plana
epithelium and the retina immediately behind the ora serrata. The attachment to the lens capsule and
the optic nerve head is firm in early life but soon disappears.
 Is 99% water.
 1% includes two components, collagen and hyaluronic acid, giving the vitreous a gel-like form and
consistency because of their ability to bind large volumes of water.
K. The Optic Nerve (ON)
 The ON trunk consists of about 1 million axons that arise from the
ganglion cells of the retina (nerve fiber layer).
 ON emerges from the posterior surface of the globe through the
posterior scleral foramen, a short, circular opening in the sclera
about 1 mm below and 3 mm nasal to the posterior pole of the eye
 The nerve fibers become myelinated on leaving the eye, increasing
the diameter from 1.5 mm (within the sclera) to 3 mm (within the
orbit).
 intraocular optic nerve head 1mm
 intraorbital optic nerve 24mm
 intracanalicular ON 9mm
 intracranial ON 16mm

PART III. THE EXTRAOCULAR MUSCLES

A. Different EOM’s
B. Origin and Insertion
C. Muscle Action
D. Innervation
A. The Extraocular Muscles
1. medial rectus
2. lateral rectus
3. superior rectus
4. inferior rectus
5. superior oblique
6. inferior oblique
7. levator palpebrae superioris
 Spiral of Tillaux - imaginary curve drawn through the muscle insertions of the 4 recti muscles starting
at the MR -> IR -> LR -> SR
 Medial rectus tendon is closest to the limbus, and the superior rectus tendon is farthest
  RADSIN
 Recti (except LR)– Adduct
 Superiors - Intort

PART IV. THE OCULAR ADNEXAE

A. The Lacrimal Apparatus
1. Lacrimal Gland and
2. Lacrimal Excretory System
B. The Adnexal Structures
1.Eyebrows
2. The Lids
3. Caruncle
4. Plica Semilunaris

A. The LACRIMAL APPARATUS

Lacrimal complex consists of the:
1. Lacrimal gland,
2. The accessory lacrimal glands,
3. The lacrimal excretory system - canaliculi, the lacrimal sac, and the nasolacrimal duct
Lacrimal Gland
 Lobulated exocrine glands secreting tears (reflex)
 Located in the upper, outer portion of each orbit of the eye
Lacrimal Ducts
 6-12 in number
 They dump tears on the surface of the conjunctiva of the upper lid through the palpebral part of the
gland
Nerve Supply
(1) The lacrimal nerve (sensory), a branch of the CN V
(2) The great superficial petrosal nerve (secretory), which comes from the superior salivary nucleus; and
(3) Sympathetic nerves accompanying the lacrimal artery and the lacrimal nerve
Blood Supply & Lymphatics
 Lacrimal artery.
 The vein that drains the gland joins the ophthalmic vein.
 The lymphatic drainage joins with the conjunctival
lymphatics to drain into the preauricular lymph nodes
Drainage
• Punctum
• Ampulla
• Canaliculus
• Valve of Rosenmuller
 • Lacrimal sac
• Nasolacrimal ducts
• Valve of Hassner
B. The Adnexal Structures
THE Structure of the LIDS
• skin
• subcutaneous
• orbicularis oculi
• orbital septum
• levator palpebrae superioris
• tarsal plates
• conjunctiva
THE EYEBROWS
The eyebrows are folds of thickened skin covered with hair. The skin fold is supported by underlying muscle
fibers. The glabella is the hairless prominence between the eyebrows
THE LIDS
 2 main functions:
1. Protection of the eyeball – mobile modified folds of skin that close to protect the anterior eyeball
2. Secretion. distribution and drainage of the tears
Blinking helps spread the tear film, which protects the cornea and conjunctiva from dehydration. The
upper lid ends at the eyebrows; the lower lid merges into the cheek
ACCESSORY LID STRUCTURES
Caruncle
• small, fleshy, ovoid structure; inferomedial
side of the plica semilunaris
• sebaceous glands and fine, colorless hairs.
• nonkeratinized, stratified squamous
epithelium
Plica semilunaris
• highly vascular, crescent-shaped fold
• resembles histologically rich in goblet cells
• analogous to the nictitating membrane (found in dogs and other animals)