CHAPTER 1

THE ANATOMY OF THE EYE GLOBE AND ITS ANNEXES

I. GENERALITIES

Vision is the perception of the organ of sight, which is the eye. Its function is to
transform light information into nerve impulses transmitted to the brain.
To 'see' an object, light from that object must enter the eye,
this transforms it into a nerve impulse transmitted to the brain and that it interprets as
his all the information received.

Fig. 1 Perception of an object

The anatomy of the eye is divided into two:

- that of the eyeball
- that of its annexes (the extra-ocular muscles, the nerves, the eyelid, the system
lacrimal and the orbit.
Fig. 2 Schematic representation of the eyeballUnable to access the specified URL for translation.)

The anatomy of the eyeball:

It is roughly spherical.
Dimensions and weight:
Sagittal or anteroposterior diameter: 25 mm (emmetropic); shorter in the
farsighted, Longer for nearsighted people
Transverse diameter 23.5 mm.
Vertical diameter 23 mm.
Weight 7 grams.
Volume 6.5cm

The dioptric apparatus of the eye

the cornea 40 Diopters, the lens 20 D
anterior-posterior axis 22-24 mm
horn diameter 11-12 mm
 - visual axis - line that joins the center of the fovea with the fixation point (object of
regard) and optical axis - line that passes through the center of the cornea towards the nasal portion of
the fovea
II. THE EYE GLOBE

The eyeball - four main parts:

the protective layer: cornea and sclera
the vascular layer (also called uvea): iris, ciliary body, and choroid
the neural layer: retina and optic nerve
the contents of the internal cavity: aqueous humor, lens, and vitreous body.

Fig. 3. Schema of the ocular tunics (tpeillusiondoptique/i-structure-and-functioning-

of the eye

The division of the eyeball

anterior segment - between the cornea and the anterior face of the vitreous - anterior hyaloid:
the cornea, the anterior chamber, the iris, and the lens
- posterior segment - the vitreous, the retina
 The anterior segment – anterior chamber – between the cornea and the anterior capsule of the
crystalline
Posterior chamber - between the posterior face of the iris and posterior

crystalline and the anterior hyaloid

II. 1. The protective layer

a. The cornea:
The cornea represents the first diopter of the ocular optical system. It is avascular.
Generalities and reports:
1- Shape: from the front, the cornea appears slightly elliptical with a large horizontal axis (11 to
12.5 mm
2- Radius of curvature: the radius of curvature of the anterior surface is on average 7.8
mm, the posterior face is more curved (R=6.5 mm). It is measured using a keratometer.
3- Thickness: the thickness of the cornea increases from the center (0.45 mm) towards the periphery

to reach 0.7 at the rim

4- Refractive power: the refractive power is approximately 42 diopters and represents 2/3.
of the total optical power of the eye.
5- Surface: it represents only 7% of the surface of the eyeball.
6- Reports :
The anterior surface is covered by the tear film.
The posterior face, concave, constitutes the external limit of the anterior chamber and the
ceiling of the iridocorneal angle.
The circumference of the cornea is related to the conjunctiva, Tenon's capsule, the episclera and
the sclera.
Fig. 4. The [Link]/pathologies/corneal-pathologies)

Innervation of the cornea:

The cornea is very richly innervated; it receives sensory innervation from the
branches of the ciliary nerves.
Histologically, the cornea is composed of:
The epithelium is the outermost layer made up of five to six layers of cells.
regenerable.
The stroma constitutes almost 90% of the thickness of the cornea, which measures about 500.
µm.
It also consists of three layers:
the Bowman membrane
the stroma proper
Descemet's membrane is a transparent basal membrane.
The endothelium is made up of a single layer of cells consisting of about 500,000
flat, hexagonal cells, without the possibility of direct renewal by mitosis. In
In addition to synthesis functions, the endothelium serves as a barrier by regulating the
exchanges between the stroma and the aqueous humor, and a transport role
active.
1. Fig. 5. The anatomy of the cornea (Kanski J., Bowling B., Clinical Ophthalmology. A systematic
Approach, Edition VIII, Elsevier 2015

b. The sclera:
The sclera, or scleral layer, is the outermost layer of the eyeball.
It surrounds the posterior 4/5 of the globe. Fibrous and inextensible, it is the strongest and
the most resistant of the membranes of the eye, it thus ensures its protection.
It provides insertion to the extraocular muscles and continues forward with the cornea.
1- Shape: It has the shape of a hollow sphere, pierced at the back by the optic nerve and
the cornea is fitted in front.
2- Color: Appears bluish at birth, pearly white in adults and yellowish
at the old man’s house.

3- Thickness: Its thickness varies by region but averages 0.5.

Note that the sclera is thinner and more extensible in children.
 Fig. 6. The insertion of the muscles at the level of the sclera (COUF, Ophthalmology 5th edition)
Elsevier 2020)

- Vascularization - supplied by imbibition via the deep episcleral plexus and via the
choroid
- Innervation - superficially by the short ciliary nerves and deeply by the nerves
long cilia.

The conjunctive

The conjunctiva is a mucous membrane that lines the posterior surface of the eyelids and...
reflecting on the anterior surface of the globe (bulbar). The conjunctiva continues with the
skin at the level of the free edge, with the cornea at the level of the limbus

sclerocorneal and with the epithelium of the tear ducts. The bulbar part and the
Palpebral parts converge at the level of the conjunctival sacs.
Descriptive anatomy:
1- Conjonctive palpébrale :
Marginal conjunctive
Tarsal conjunctiva
Orbital conjunctiva
2- Conjunctival cul-de-sacs
3- Bulbar conjunctiva

Fig. 7. The conjunctiva (Marie Caroline Trone, Liem Trinh, Ophthalmology - Summary Sheets)
Illustrations for the IECN, VG, 2016

II. 2. The vascular layer

It is also called 'the uvea', and consists of three parts.

the iris
the ciliary body
the choroid.
It is the most vascularized part of the eyeball.
Fig. 8. The 3 parts of the uvea Fig. 9. The iris - anterior view
(COUF, Ophthalmology 5th edition, Elsevier 2020)

The iris:
The most anterior part of the uvea, the iris is a disk-shaped membrane.
pigmented epithelium which gives color, and is perforated in its center by an opening
circular, the pupil which automatically regulates itself according to the light intensity.
The average pupil diameter is 4 to 5 mm.
-dilating muscle of the pupil and the pupillary sphincter.
Like all segments of the uvea, the iris has a rich vascularization. Its
Innervation is provided by the trigeminal nerve and the sympathetic.

sympathetic innervation - dilator muscle with

parasympathetic innervation - pupillary sphincter.

Le corps ciliaire :
Intermediate part of the uvea, which plays a fundamental role in accommodation and
secretion of
the aqueous humor.
 It is composed of:
The epithelium
The ciliary muscle: smooth muscle embedded in the ciliary body
Brucke-Wallace muscle made up of longitudinal fibers
The muscle of Rouget-Muller is made up of circular fibers.
.
The pars plicata or the ciliary crown: 2 mm wide, an area consisting of 60 to 90
mounds or folds of the choroid
The pars plana: smooth brown flat surface, 4 mm wide, continues with the ora serrata.
peripheral limit of the retina.
The identification of its parts is very important during intravitreal injection or a
vitrectomy.
Vascularization: of the great arterial circle of the iris.
Innervation: ciliary plexus located in the supraciliary formed by the long ciliary nerves
and short.

[Link]. 10. The parts of the ciliary body (B. Bodaghi, P. LeHoang, Uveitis, Atlas Collection)
Ophthalmology, Elsevier Masson, 2009

The choroid:
 The choroid is part of the posterior uvea.
rich in vessels and nerves.
- it occupies the posterior 2/3 of the globe
- it continues forward with the stroma of the ciliary body
at the level of the ora serrata.
At the back, it adheres to the papilla that it surrounds.
- Its vascularization is ensured by the ciliary arteries.

3. Fig. 11. Structure of the ocular tunics (B. Bodaghi, P. LeHoang, Uveitis, Atlas Collection
in Ophthalmology, Elsevier Masson, 2009
II.3. The neural layer

The retina is a highly sensitive nerve membrane that lines the back of the eye.
It is a film made up of 10 layers of cells.
It is very vascularized: important network of veins and arteries.
It is made up of hundreds of millions of nerve cells: the cones and the
sticks.
Cones react more in daytime lighting than in nighttime lighting. There are 3 types.
of cones: blue, green, red. The cones are responsible for vision.
colors.
Rods need much less light to produce a potential.
receiver, they ensure night vision.

Fig. 12. The cells of the retina (Claire Meyniel, Anatomy of the visual pathways, DU
Neurophthalmology Paris 2018-2019
 The neurosensory retina:
- composed of the first neurons of the optic pathway including:
Photoreceptors: Cones and rods
Bipolar cells and ganglion cells: the axons form the optical fibers
(which gather at the level of the papilla to form the optic nerve)
The vessels: the central vessels (the central artery and vein of the retina follow the nerve
optic then divides into several branches after the papilla (responsible for nutrition
internal layers of the retina
Function of the retina:
Phototransduction: Synergistic action between photoreceptors (Cones and rods)
and retinal pigment epithelium

The external articles: surrounded by the pigment epithelium contain a pigment

visual (Rhodopsin = Opsin + vitamin A or retinal).
Rods: responsible for peripheral and night vision
Cones: responsible for the vision of details and colors. Mainly grouped
in the central retina (within an oval area, the macula)
In the retina, there is the peripheral retina and the central retina or the macula.
- Lamacula - responsible for daytime vision (the cones)
- peripheral retina - responsible for night vision (rods).
Fig. 13. The macula (Claire Meyniel, Anatomy of the Visual Pathways, DU Neuro-Ophthalmology)
Paris 2018-2019

Lamaculaet lafovéa
Depression located on the optical axis
Cone concentration
Allows the vision of details in daylight lighting
Lamacula lutea, yellow spot, appears located at the center of the posterior pole and has a
diameter of approximately 5.5 mm.

The fovea is a region of the retina located at the center of the macula. This region is of the
of utmost importance for vision.
4. Fig. 14. The anatomical structure of the macula (Basic and Clinical Science Course. Retina
and Vitreous. AAO. 2017-2018)

II.4. The contents of the eyeball

Made of transparent media allowing the passage of light rays up to the
retina.
aqueous humor
Aqueous humor is a clear and fluid liquid that fills the anterior chamber.
(bounded by the cornea and the iris). It is continuously secreted by the ciliary processes and
drained by the Schlemm's canal (the iridocorneal angle).

b. The lens
The lens is a transparent biconvex lens, avascular, surrounded by a
capsule. Zonular fibers anchor the lens to the ciliary body.
Its thickness is 4 to 5 mm, which noticeably increases with age due to the
continued production of crystalline fibers.
It plays a significant role in the ocular diopter, indeed its power is
around 21 diopters. The lens is capable of deforming (ciliary muscle) and
 modify one's convergence power - Transition from distant vision to near vision
(loss of accommodation power = presbyopia).

Fig. 15. The structure of the lens (COUF, Ophthalmology 5th edition, Elsevier 2020)
The vitreous body
The Vitreous Body is a transparent gel, surrounded by a thin membrane (the Hyaloid). It
filling 4/5 of the ocular cavity and lining the inner surface of the retina.

Fig. 16. The vitreous body

III. OPTICAL FIBERS
The optical pathways allow the transmission of retinal light impressions to
cortical centers of vision.
 Optic nerve: The anterior end is the papilla (visible on fundus examination)
the eye). It crosses the orbit and enters the skull through the optic holes.

Chiasma: Partial crossing of the fibers of the optic nerves (hemidecussation,

only fibers from the nasal hemi-retinas.

Optic bands: posterior parts of the chiasm. Containing fibers from the
2 hemi-retinas looking in the same direction.

Fig. 17. The optical pathways - diagram (Claire Meyniel, Anatomy of the visual pathways, DU
Neuro-ophthalmology Paris 2018-2019

The optical ribbons: Bypass the cerebral peduncles and end in the
external knee body (protrusion on the lateral side of the cerebral peduncle.)
The optical radiations: neurons following the geniculate body. Form a sheet of
white matter intracerebrally (external surface of the lateral ventricle to the cortex)
internal visual face of the occipital lobe.
The optic nerve
The intra-orbital portion is divided into 2 parts:
Intraocular part (retrolaminar).
Orbital part: has the shape of an elongated S
2- intra canal portion: located in the optical canal.
3- Intracranial portion: located in the middle floor of the base of the skull.
The sheaths of the optic nerve:
The dura mater: envelops the optic nerve from the intracranial opening of the optic canal.
up to the sclera.
The arachnoid consists of 2 layers made of collagen fibers.
The pia mater: the innermost sheath of the optic nerve.
The space between the pia mater and the arachnoid contains cerebrospinal fluid.

Fig. 18. The segments of the optic nerve (Claire Meyniel, Anatomy of the visual pathways, DU
Neuro-Ophthalmology Paris 2018-2019
The optic papilla: it is the head of the optic nerve that divides into 3 portions.
The pre-laminar region: which is located in front of the lamina cribrosa (the papillary disc).
Contains the unmyelinated optic fibers and the central blood vessels of the retina.
At the center, there is a depression called papillary excavation.
The laminar region: the screened blade is a transverse blade whose openings are
traversed by the still unmyelinated optical fibers.
The retro-laminar region: at this level, the optic nerve doubles in volume due to the
myelination of optical fibers.

Fig. 19. The optic nerve head (Kanski J., Bowling B., Clinical Ophthalmology. A
systematic Approach, Edition VIII, Elsevier 2015

IV. THE ANNEX STRUCTURES

Eyelids
The eyelids are mobile cutaneous-muscular-membranous flaps that cover and
protect the anterior part of the globe.
They are formed from depth to surface by
a mucous membrane plan (conjunctiva),
a deep muscle plan,
a fibrous-elastic plan (tars)
a superficial muscular plan
a cutaneous plan.

We distinguish the upper eyelid and the lower eyelid.

Fig. 20. Constitution of the upper eyelid (Marie Caroline Trone, Liem Trinh,
Ophthalmology - Illustrated summary sheets for the IECN, VG, 2016

Each eyelid has 2 surfaces: anterior and posterior, a free border, and 2 angles.
The anterior face: each eyelid has a skin fold parallel to the free margin that
divide the eyelid into 2 parts:
Tarsal portion located from the free edge to the groove.

Orbital or septal portion - between the tarsal portion and the orbital rim.
The posterior surface: covered by the tarsal conjunctiva.
The free edges: they delineate the palpebral fissure.
The anterior lip serves as the implantation site for the eyelashes with the glands.

sweat and sebaceous.

The posterior lip is the site of the orifices of the Meibomian glands.
The 2 lips are separated by the gray line.
The angles: external canthus and internal canthus

Fig. 21. Constitution of the lower eyelid (Marie Caroline Trone, Liem Trinh,
Ophthalmology - Illustrated summary sheets for the IECN, VG, 2016

The lacrimal apparatus

The lacrimal apparatus consists of:
The structures that secrete tears include the main lacrimal gland and the
accessory lacrimal glands
The structures that facilitate the drainage of tears - the lacrimal pathway system.
The lacrimal secretion system:
The main lacrimal gland: It is a grape-like gland, located under the rim
superior-external orbital. Innervation - lacrimal nerve, branch of the ophthalmic (V1).
 The accessory tear glands:
Serous secretion glands - in the upper and lower conjunctival sacs.
The mucus glands: predominant at the level of the inner canthus and the cul-de-sac
inferior
- The glands of the ciliary apparatus: the sweat glands and sebaceous glands of the eyelashes and the

Meibomian glands. And they secrete the oily layer of the tear.

Fig. 22. The lacrimal apparatus (Marie Caroline Trone, Liem Trinh, Ophthalmology - Quick Reference)
illustrated synthesis for the IECN, VG, 2016

The tear drainage system:

The lacrimal lake: It is a small triangular space located between the lacrimal portion.
the 2 eyelids;
The tear ducts or lacrimal points:
The lacrimal canaliculi: follow the lacrimal puncta
The tear sac: It is a cylindrical membranous reservoir.
The lacrimal-nasal canal: follows the sac and opens into the inferior nasal meatus.
Fig. 23. The tear film – [Link]/pages/the-
tears/[Link])
3. The extraocular muscles or oculomotor muscles
The mobility of the eyeball is ensured by 6 ocular muscles. Including 4.
straight muscles and 2 oblique muscles. These muscles form a cone with a posterior apex
and to the back base.

Fig. 24. The ocular [Link]/[Link])

Fig. 25. Action of the oculomotor muscles
V. THE ORBIT
The orbit is a bony cavity located in the upper part of the facial mass. The 2
Orbital cavities separated by the nasal cavity contain and protect the eyeball.
The walls of the orbit:
The upper wall: is formed in front by the orbital portion of the frontal bone and in
behind, by the small wing of the sphenoid
The lateral wall: is made up of the frontal bone at the top, the zygomatic bone at the bottom and the
greater wing of the sphenoid at the back.
Lower wall: is made up of the zygomatic bone at the front and in
outside the maxillary bone in front and inwards, the orbital process of the palatine at the back.
The medial wall: is formed by the ascending branch of the maxillary bone, the lacrimal bone,
the planar bone, finally the sphenoid bone.

Infraorbital groove or canal: it allows passage for the infraorbital nerve.

 Fig. 26. The walls of the orbit (COUF, Ophthalmology 5th edition, Elsevier 2020)

Orifices of the orbit

The optic hole or canal: passage to the optic nerve and the ophthalmic artery.
The sphenoidal fissure or superior orbital fissure: passage of multiple elements
vascular nerve, notably the oculomotor nerve, the trochlear nerve (pathetic), the nerve
external ocular muscle, the ophthalmic nerve and the ophthalmic vein.
- The inferior orbital fissure or spheno-maxillary fissure allows passage to the nerve
infraorbital, zygomatic nerve and inferior ophthalmic vein.
- The upper orifice of the nasolacrimal duct gives rise to the lacrimal canal.
nasal that connects the orbit with the nasal cavities
Fig. 27. The openings of the orbit (COUF, Ophthalmology 5th edition, Elsevier 2020)