Anatomy and Physiology of The Eyes Dr.Nurcahya Ardian Bramantha,SpM Ophthalmology Department Kasih Ibu Hospital
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Anatomy and Physiology
of The Eyes
Dr.Nurcahya Ardian Bramantha,SpMOphthalmology Department
Kasih Ibu Hospital
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IK MAM!" M#N$#%ASKAN S&"K"&ANAOMI O&BIA, B"%B"S OK"%I DAN
O&'AN AKS#SO&I"S S#&A ("N'SIN)A
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#ye small *ery important+unctionMata ecil memilii +ungsi
sangat penting-/ in+ormation *isual-/ in+omasi penglihatan
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EYE
Surrounded by orbitalbonesDikelilingi oleh tulang mataCushioned by pads of fatDilindungi oleh bantalan
lemak Extraocular muscles helpmove the eye in dierentdirections!tot mata luar membentupergerakan mata pada
arah yang berla"anan
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!#$%T
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O&BIA
• O&BIA% MA&'IN (O&M#D B) 0
– (&ONA%
– 1)'OMAI2
– MA3I%%A
• S"!#&IO& MA&'IN (O&M#D B) OS. (&ONA%
–S"!&AO&BIA% (O&AM#N
• IN(#&IO& MA&'IN (O&M#D B) OS. 1)'OMAI2 4 MA3I%%A
– IN(&AO&BIA (O&AM#N
• %A#&A% MA&'IN (O&M#D B) 1)MOMAI2 !&O2. O( (&ONA%
BON# 4 (&ONA% !&O2. O( 1)'OMAI2 BON#
• M#DIA% MA&'IN (O&M#D B) MA3I%%A BON#
– (OSSA SA22I %A2&IMA%IS
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Orbital 5all
!rbital #oof&'rontal bone kl( lakrimal di fossalacrimalisSphenoid bone
)ateral *all&SP+E,!%D bone-ygomatic bone strongest
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Orbital 5all
!rbital 'loor&
'ormed by & .axilla bone/ 0ygomatic bone 1Palatine bone
$ts dg lateral 2ssura orbitalis inf or
)empeng orbital tlg .axilla blo"out fractures
.edial *all&
Ethmoid bone paper thin ke antor menebal
)acrimal bone
'rontal bone
!rbital Apex optic nerve canal
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$lood Supply
• Arteries& – %ntracranial %nternal Carotid a3 4st
branch& !phthalmic a3 passes
beneath 1 accompanies , %%/branches as&• Central #etinal a3 enters the , %%/ 5 6 47
mm behind the globe
• )acrimal a3 lacrimal glds 1 eyelid• )ong 1 Short postor Ciliary a3 uvea
• .uscular branches antor Ciliary a3
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$lood Supply
• 8Arteries& – Short postor Ciliary a3 , %% 9
choroid
– )ong postor Ciliary a3 ciliary body9 ma(or arterial circle: of the iris;anastomose "< antor Ciliary a3=
–
Antor
Ciliary a3 antor
sclera/episclera/ limbus/ con(unctiva/ :
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$)!!D S>PP)Y
• ?eins& – Supor 1 %nf or !phthalmic v3
• Communicate "< Cavernous sinus 1
Pterygoid venous• Drain the skin of the periorbital skin
lethal cavernous sinus thrombosis
;in cellulitis periorbital=
– Antor Ciliary v3
– Central #etinal v3
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Annulus of Zinn
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#)# BA%%
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C!,@>,CT%?A
Transparent
Covers postor palp 1 antor surface of sclera
Continuous "<&
o The lid margin;mucocutaneous (unc=
Palpebral con(
o 'ornices ;supor 1 inf or=
o The limbus ;corneal
epithelium= $ulbarcon(
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C!,@>,CT%?A
8The Con(unctiva&
Palpebral Con( 2rmly
adherent to the tarsus
$ulbar Con( loosely
attached to Tenon’scapsule
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TE,!, CAPS>)E•'ibrous membrane/ envelopes from limbus to , %%
•)imbus Con(/ Tenons/ Episclera 2xed together
•Posteriorly lies the sclera/ contact "< orbital structure1 muscle cone
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SC)E#A 1 EP%SC)E#A
– 'ibrous ;collagen=
– Antor corneaB postor scleral foramen ;laminacribrosa= pass the axon bundle of the , %%
– Antor sclera episclera ;thin/ elastic/ blood
vessels= – %nner surface lamina fusca ;pigment/ outer
layer of suprachoroidal space=
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SC)E#A 1 EP%SC)E#A
– Thickness& / mm ;at insertion ofmuscle= 6 / mm
– Penetrated around the , %%&• Short 1 long postor ciliary arteries• Short 1 long ciliary nerve
– )ong postor ciliary a3 1 long ciliary n3pass in shallo" groove at 1 F o’clockmeridians
–
G antor
ciliary a3 1 v3 penetrate G mmfrom limbus – ,erve supply& ciliary nerve
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C!#,EA
•
Transparant/ avascular• Thick & 77 Hm ;central=
• Ivertical & 43mm
• Ihori0ontal & 443Jmm
• ,erve supply & ?4
• Corneal layers &• Epitel
• .embr $o"man
• Stroma
• .embr Descemet
• Endotel
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>?EA) T#ACT
%#%S
Pigmented/ Extension ofciliary body
Dividing the C!A 1 C!P
Central round aperture
Pupil balance of
parasympathetic ;m3Sphincter pupillae/ , %%%= 1sympathetic ;m3 Dilatorpupillae= activity
$lood supply& .a(or circle ofthe iris
,erve supply ;sensory=&Ciliary nerve
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C!#P>S C%)%A#%S
•Pars plicata ciliary process
aKueous formation
• Pars plana ;G mm/posteriorly=
• Epithelium& nonpigmented/
pigmented• Ciliary muscle&
• Circular 1 radial 2bers
contract 1 relax 0onular 2bers
• )ongitudinal 2bers open
pore of T.• $lood 1 nerve supply&
L %ris/ through ?ortex veins
ACC!.!DAT%!,
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C+!#!%D
•
$et"een sclera 6 retina• Dark bro"n
• Pigmented / vasculari0ed
• ,utrision 4< outer retina/
vitreus/ lens
• Choroidal blood vessels&• ChorioMcapillaris
• Drainage& ?ortex veins
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)ens
G mm thick/ F mm N/$iconvex/ avascular/colorless/ almost completelytransparent
7O "ater/ 7O protein 9
trace mineralsSupported by 0onule of -innat eKuator 6 corpus ciliaris
Capsule& semipermeablemembrane
Potassium in the lensAscorbic/ Qlutathione
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%ridocorneal Angle
• AKuous outRo"• @unc of peripheral cornea 6 iris root• Sch"albe line 6 Trabecular mesh"ork 6 can3schlemms M
collector channels 9 4U aKueous veins episcleral venous system
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?itreus
Clear/ avascular/ gelatinous body ;FFO "ater/ 4Ocollagen 9 hyaluronic acid=/ U< volume 1 "eight ofthe eyeball
!uter surface hyaloid membrane contact "<
postor lens capsule/ 0onular 2bers/ pars planaepithelium/ retina/ , %% head
?itreous base ;attachment=& pars plana epithelium 1retina (ust behind the ora serrata
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#ET%,A
Semitransparent/multilayered/ U< postor inner aspect of globe
!ra serrata
anterior edge of retina
;ragged edge=/7 mm behind S);temporal=/ 7/J mm ;nasal=
At the P, %% 1 !ra Serrataret 1 #PE 2rmly bound
limiting ret detachment
Thickness& /4 mm at !S//7 mm at postor pole
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#ET%,A
.acula&•Postor pole/
•7/7 6 / mm N
• mm N center maculalutea "< fovea centralis
Vanthophyll /photoreceptors
•4/7 mm N center retinalavascular 0one
•/U7 mm N center foveola;thinnest part of retina=
cone photoreceptor
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#ET%,A
– $lood supply&
• Choriocapillaris&
– 4< outer 9 fovea irreparable damage
"hen #D
– 'enestrated
– $lood barrier #PE
• Central retinal artery
–
U< inner – ,onfenestrated blood retinal barrier
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EVT#A!C>)A# .>SC)ES
%,SE#T%!, of #ECT .>SC)ES
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A2IONS
.>SC)ES
.edial#ectus
Adduction
)ateral#ectus
Abduction
Superior#ectus
Elevation %ntorsion Adduction
%nferior#ectus
Depression
Extorsion Adduction
!bliKue
Sup
%ntorsion Depressio
n
Abduction
!bliKue%nf
extorsion Elevation Abduction
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EVT#A!C>)A# .>SC)ES
• $lood Supply&
– !phthalmic artery ;muscular branch=
– Also&
• )ateral rectus m3 )acrimal artery
• %nferior !bliKue m3 %nfraorbital
artery
• ,erve Supply&
– , %%% S#/ .#/ %#/ %!
– , %? S!
– , ?% )#
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O2"%A& ADN#3A
• #)#B&O5S
• #)#%IDS
•
A!!A&A"S %A2&IMA%IS
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O2"%A& ADN#3A
EYE$#!*S
The folds of thickenedskin
Covered "< hair
The Qlabella hairlessbet"een U eyebro"s
EYE)%DS
Skin )ayer
!rbicularis !culi.uscle ;!!.=
Areolar TissueTarsal Plate
Palpebral Con(unctiva
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EYE)%D
43 Skin )ayer&– Thin/ loose/ elastic
– 'e" hair follicles
–
,! subcutaneous fatU3 !!.&– Concentric close the lids
– %nside the lid& Pretarsal 1 Preseptal
portion– !utside the lid& Spread around the
orbital margin ;orbital portion=
– Supplied by , ?%%
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EYE)%
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EYE)%D
3 Areolar Tissue&– Submuscular communicates "<
aponeurotic layers
G3 Tarsal Plate&
–.ain supporting structure of the lids
dense 2brous 1 elastic tissue– )ateral 1 medial attached to orbital
margins by palpebral ligaments–
>pper 1 )o"er thin fascia ;!rbitalSeptum=
73 Palpebral Con(unctiva&– Adhere 2rmly to the tarsal plate
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• The )id .argins& – Q#AY )%,E mucocutaneous (unction
– Anterior .argin&• Eyelashes upper/ up"ardB lo"er/ do"n"ard
• Qlands of -eis sebaceous glds at base ofeyelashes
• Qlands of .oll s"eat glds
Posterior .argin&
•Small ori2ces of meibomian < tarsal glds
– )acrimal Punctum&• .edial end of the postor margins
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• Palpebral 'issure& – )ateral canthus /7 cm from orb rim
– .edial canthus more elliptic/
surround lacrimal lake&• )acr caruncle modf3 s"eat 1 sebaceousglds
• Plica semilunaris rd eyelid of lo"eranimal sp
– Epicanthus&• ,ormal in Asian population 1 Young infants
• +iding caruncle
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• !rbital Septum& – )ies bet"een !rb rim 1 tarsus
– Serves as barrier
– Pierced by&• the several vessels 1 nerves ;lacrimal/
supra<infratrochlear/ supraorbital=
• )evator palp superior muscle ;)PS.=
– $lends "<&• Supor& Tendon of )PS. 1 supor tarsus
• %nf or& inf or tarsus
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• )id #etractors& –
.usculofacial complex ;striated 1 smoothmuscles= !pening the eyelids
– >pper lid m3 )evator Palp Supor/ divided into&
• Aponeurosis ;antor= elevate antor lamella
• .uller’s muscle ;smooth m3 2bers=elevating postor lamella
inserting supor eyelid into postor surface of!!. upper lid skin crease
– )o"er lid m3 #ectus %nf or
– Smooth muscle innervated by sympatheticnerves
– Striated muscle innervated by , %%%
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O2"%A& ADN#3A
• $lood Supply 1 )ymphatics& – Arteries&
• )acrimal 1 !phthalmic arteries ;lat 1 medbranches= anastomoses& submusc3
Areolar tissue – ?eins&
• Arranged in pre 1 post tarsal plexuses
• %nto !phthalmic veins
– )ymphatics&• )ateral side preauricular 1 parotid nodes
• .edial side submandibular l3n3
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O2"%A& ADN#3A
• The )acrimal Apparatus&
– The lacrimal complex&• The .ain )acrimal glds
• The Accessory )acrimal glds• The Canaliculi
• The )acrimal sac
• The ,asolacrimal duct
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• The .ain )acrimal Qlands&
– !rbital portion&
• %n the lacrimal fossa
• Separated from palp3 portion by lateralhorn of m3 )evator Palp
– Palpebral portion&• @ust above the temporal segment of the
supor con( fornix• Secretory ducts "< 4 ori2cies connects
orb 1 palp portion to the supor con( fornix
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• The Accessory )acrimal Qlands& – Wrause 1 *olfring glds subs
propria palp con(
• Drainage of tear& – )acr lake upper<lo"er puncta
canaliculi lacr sac nasolacrduct meatus nasal cavity
– .echanism& capillary attraction/gravity/ blinking 1 pumping actionby +orner’s muscle
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%acrimal Apparatus
• ear secretion.
• %ayers o+ precorneal tear 6lm.
• Drainage o+ tear.
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• $lood 1 )ymphatic supply&
– Arteries& )acrimal artery
– ?eins& (oins "< !phthalmic vein
– )ymph drainage& (oins "< con( lymphaticpreauricular l3n3
• ,erve supply&
– Sensory& )acrimal nerve ;4st div of , ?=
–
Secretory& Qreat Petrosal nerve ;from suporsalivary nucl=
– Sympathetic nerve& accompanying the)acrimal artery 1 nerve
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!PT%C ,E#?E
The %ntra ocular&4/7 mm N
The %ntra orbital&U7 6 mmB mm N
The !ptic Chiasm&,ear the top of sella tursica
Decussation
The #etrochiasmatic
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HANK )O"