VISUAL & LACRIMAL APPARATUS
Azian Abd Latiff
Faculty of Medicine
Universiti Teknologi MARA
Orbit
Bony cavity on each side of the root of the nose.
Functions:
socket for the eyeball
protection of the eyeball
Shape : pyramidal with 4 walls
Base : orbital opening
Wall : roof; floor; medial; lateral
Apex : at the posterior end of the orbit
(medial end of the superior orbital fissure)
Orbit : contents
eyeball
extraocular muscles
blood and lymphatic vessels
ophthalmic artery
superior & inferior ophthalmic veins
nerves
CN II, III, IV, V1, VI
sympathetic plexus
lacrimal gland
fat
ciliary ganglion
Muscle Origin Insertion Nerve Main
supply action
Superior Elevates,
rectus adducts &
rotates eyeball
medially
Inferior Oculomotor Depresses,
rectus adducts &
Common Sclera just nerve rotates eyeball
tendinous posterior (CN III) laterally
Medial ring to cornea Adducts
rectus eyeball
Lateral Abducent Abducts
rectus nerve eyeball
(CN VI)
Muscle Origin Insertion Nerve Main action
supply
Superior Body of Its tendon Trochlear nerve Abducts,
oblique sphenoid passes through (CN IV) depresses &
a fibrous ring or medially rotates
bone trochlea, eyeball
changes its
direction and
inserts into the
sclera deep to
superior rectus
muscle
Inferior Anterior Sclera deep to Oculomotor Abducts,
oblique part of lateral rectus nerve (CN III) elevates &
muscle laterally rotates
floor of eyeball
orbit
Structures related to the superior orbital fissure
Structure of the eyeball
Three concentric layers of the eyeball
outer layer : cornea & sclera
middle layer : vascular layer/uveal tract
choroid, ciliary body & lens
inner layer : retina
Three compartments of the eye
Anterior Space between cornea, iris &
chamber lens
Posterior Space between posterior part of
chamber iris, ciliary process, zonule & lens
Vitreous Posterior to the lens and Zinn
chamber ligaments
Both anterior and posterior chambers contain
aqueous humor.
The vitreous chamber contains vitreous body.
Right eye (seen from above), showing the sclera,
retina, fovea centralis & ciliary body
Cornea
Is the anterior 1/6 portion of the outer layer.
Transparent & avascular
5 layers:
epithelium : stratified non-keratinised squamous
epithelium (5-6 layers)
: nerve endings present (sensitive)
Bowmans membrane
stroma (collagen fibres, keratocytes)
Descemets membrane
endothelium : simple squamous epithelium
Three-dimensional drawing of the cornea
Sclera
Is the posterior 5/6 portion of the outer layer
Dense connective tissue white colour.
Tenons capsule attaches the sclera to the orbit.
Tenons space present between the capsule and the sclera.
3 layers:
episcleral layer, true sclera & lamina fusca
Border between cornea and sclera limbus/ corneoscleral
junction.
Canal of Schlemm receives the aqueous humor venous
plexus.
Obstruction intraocular pressure GLAUCOMA
Canal of Schlemm (CS) is a circumferential canal lined by endothelium
which is located in the inner aspect of the corneal margin (C) immediately
adjacent to the angle of the anterior chamber (AC).
Choroid
Pigmented & highly vascular
4 layers:
epichoroid/suprachoroid melanocytes present
vascular layer
choriocapillary layer
capillaries in a single plane
extends to the ora serrata
function nutrition for the retina
Bruchs membrane
between choroid and retina
basal membrane of retinas pigmented epithelium
Ciliary body
Is the anterior expansion of the choroid at the level of the lens.
Similar to the choroid but does not have a choriocapillary layer.
Consists of 2 important structures:
ciliary process
attachment for Zinn ligament
ciliary epithelium produces aqueous humor
ciliary muscles
contraction & relaxation of the muscles help in
accomodation
X 128
X 30 X 320
Ciliary body. CB ciliary body; C uveal tract; I iris; L- lens;
S suspensory ligament; M smooth muscle; PC posterior
chamber; CS canal of Schlemm
The choroid (C) is a layer of loose vascular supporting tissue
lying between the sclera (S) externally and the retina (R)
internally. P pigmented epithelial cells
Iris
Continuation of the choroid.
Covers the lens except for the pupil.
5 layers:
anterior surface fibroblasts & melanocytes
stroma
vascular layer
posterior surface
epithelium covers the body & ciliary process (number of pigments
determine the colour)
2 sets of involuntary muscles:
sphincter pupillae contraction myosis
dilator pupillae contraction midriasis
Lens system
Biconvex
Transparent, avascular
Held by Zinn ligaments
Anteriorly covered by the iris
Pupil in the centre of the iris
3 major components:
capsule of the lens
subcapsular epithelium
lens fibres
Section of the anterior portion of the lens. The subcapsular epithelium
secretes the lens capsule which is stained red. The lens capsule is a
thick basement membrane containing collagen type IV and laminin.
Lens fibers are cells that have lost their nuclei and organelles
becoming thin, elongated and transparent.
Retina
2 areas :
photosensitive posterior to ora serrata
non-photosensitive anterior to ora serrata
Consists of :
photosensitive cells : rods and cones
supporting cells : Mller cells, astrocytes, microglia
neurones : horizontal cells, amacrine cells
Retina
10 layers :
Pigmented epithelium Pigment granules (fuchsin) present
Rods & cones layer Photosensitive
External limiting membrane Muller cells present
External nuclear layer Nuclei of rods and cones
External plexiform layer Area of synapsis between photoreceptors
& bipolar cells
Inner nuclear layer Nuclei of the bipolar neurons
Inner plexiform layer Area of synapsis between bipolar &
ganglion cells
Ganglion cell layer
Nerve fibre layer Axons from the optic nerve
Internal limiting membrane Processes of Muller cells
COMPARISON OF RODS & CONES PHOTORECEPTORS
RODS CONES
Similarities Photoreceptor Photoreceptor
(outer & inner segment) (outer & inner segment)
Differences
Shape Long & thin Shorter & wider
Number 120 million 6 million
Pigment rhodopsin iodopsin
Sensitivity Night vision Day & night vision
Electron micrograph of a section of the retina.
Two different regions in the retina:
Fovea centralis
directly opposite the centre of the lens
greatest visual acuity
surrounding it macula lutea
Blind spot/optic disc
no photoreceptors
axons of ganglionic cells from the optic nerve
Fovea centralis
Afferent fibers of the retina converge at one point medial to the fovea,
penetrate the sclera (S) and form the optic nerve (ON). D dura mater;
P pia mater; U uveal tract; A central artery of retina
Visual pathways
Rods and cones (photoreceptors) process the visual image
Optic nerves reach the diencephalon at the optic chiasma
fibers proceed to fibers proceed to lateral
lateral geniculate (same geniculate (opposite side
side of the brain) of the brain)
Lateral geniculate body
relay visual information to reflex centers in the brain stem
(superior colliculi)
relay visual information to visual cortex of the cerebrum
Congenital anomalies and diseases
of the eye
Coloboma choroid fissure fails to close
Congenital cataracts
Microphthalmia
Anophthalmia absence of eyeball
Congenital aphakia absence of lens
Cyclopia single eye
Conjunctivitis
Blepharitis inflammation of the eyelids
Glaucoma raised intraocular pressure
Blindness
Diabetic retinopathy
A disease that causes damage to the blood vessels in the
retina.
Accessory structures of the eye
Eyelids
Thin, skin-covered folds supported by the tarsal plates.
Reflex blinking helps to prevent dryness of the eyes
Contraction of levator palpebrae superioris raises the eyelids
Glands present are:
Glands of Moll
modified sweat glands
Glands of Zeis
sebaceous glands that open into the hair follicles
Meibomian glands (in the tarsal plates)
secrete a substance like sebum to prevent the tear film in the
cornea and sclera from drying
Sagittal section of the superior (upper) eyelid
Accessory structures of the eye
Conjunctiva
A transparent mucous membrane.
Conjunctiva sac : slit space between eyelids and conjunctiva-covered
eyeball (site for insertion of contact lens).
Function : produces a lubricating mucous to prevent desiccation of the
eyes.
Histology :
palpebral conjunctiva (lines the eyelids)
stratified squamous epithelium stratified columnar + goblet
cells secrete mucous
bulbar conjunctiva (lines the anterior eyeball except the cornea)
non-keratinised squamous epithelium
fornix (between bulbar & palpebral conjunctivas)
attached to the limbus
Accessory structures of the eye
Lacrimal apparatus
Lacrimal glands - produce tears to lubricate the eyes.
Lacrimal puncta
Lacrimal canaliculus - drains the excess tears into the
lacrimal sac.
Lacrimal sac drains the tears into the nasolacrimal duct.
Nasolacrimal duct opens into the inferior nasal meatus.
