23
occasionally bone. Some amphibians havecartilage.
Sclera
ELISE TORCZYNSKI
Theouter coatof the eye is a roughly sphericalshell
of fibrous tissue that is transparent anteriorly (the
cornea) and white and opaqueposteriorly (the
sclera). The sclera protects the intraocular contents
from injury and mechanical displacement. The
normal sclera is constantly subjected to stress and
strain by the pull of the ocular muscles, which insert
on its surface. The toughnessof the sclera, coupled
with the intraocular pressure, resists deformation by
the contracting muscles through the full range of
ocular movements. If deformation of the sclera
occurred readily, then the choroid andretina would
be displaced, resulting in metamorphopsia.' Direct
blows to the sclera, as from a fist, missile, or blunt
object, may produce momentary changesin scleral
shape. The choroid andretina are more likely to be
damaged from such blows than is the sclera, but
scleral rupture may occur. Experimentally induced
Tuptures of the sclera are radial and centered over
the equator? Further, the sclera shields the ciliary
vessels and nerves in the emissary canals from
damage.
The adult sclera is poorly distensible, although
Somerelaxation of the scleral tension follows defor-
mation.>* The sclera is a viscoelastic tissue that
exhibits a biphasic response to a sudden, deforming
force—a rapid, brief lengthening (the elastic
compo-
nent), followed by a slow stretching (the viscid
component).5 In children with infantile glaucoma,
© sclera and the cornea react to increased intra-
cular pressure by stretching, resulting in the buph-
iar globe. Limited distention of the immature
inte Coat at the limbus produces an annular or
tealary staphyloma (Fig, 1). Ectasias or staphy-
nae found at any age following injury or as a
Whether of inflammation at thesite of damage,
ect Or not the intraocular pressure is elevated.
sclera: Sla is a localized, outward protrusion of thin
tissue’ * St@Phyloma is an ectasia lined by uveal
tae Sclera is found only in vertebrates. Nonver-
birds are ave an ocellus. The scleras in fish and
Strengthened by plaquesofcartilage and
The sclera in nonhuman vertebrates is thinner than
that in humans, especially behind the muscular
insertions, and collapses easily.
The sclera appears opaque under ordinary light-
ing, but light does enter the globe in a diffuse,
nonfocused manner. Light can be perceived through
the sclera even whenthe corneais markedly opaque.
The relative translucency of the sclera is easily
tested in enucleated globes by placing the sphere
against a strong beam oflight. When light is di-
rected through the posterior sclera, the pupil and
areas of depigmentationin iris or ciliary body glow
a dull red. Light directed through the corneaillumi-
nates the posterior contents of the globe, showing
modifications in choroidal andretinal pigmentation;
in lightly pigmented globes, markingsoftheciliary
vessels and vortex veins are readily visible through
the sclera. Transillumination is used to outline
intraocular tumors.
Thecornea and thesclera are both predominantly
collagenoustissues, but the transparency ofthefirst
and the opacity of the latter result from differences
in the size and orientation of the fibers, water
content, and mucopolysaccharides.6 Corneal fibers
have uniform diameter, and parallel bundles are
organized in layers. The fibers are evenly spaced,
with the interspaces filled with mucopolysaccharides
and water. Scleral collagen fibers vary in width, the
outer fibers being thicker than the inner fibers.7-!0
The bundles do notlie in orderly, regular lamellae
butare interlaced in an irregular fashion. Collagen,
high in hydroxyproline, forms 75% of the dry weight
of the sclera; the remainder is made up of noncol-
lagenous proteins and mucopolysaccharides.? Elas-
tic tissue, as determined by the amount of desmo-
sine and isodesmosine, amino acids unique to
elastin, formsless than 2% ofthe dry weight.'! In the
scleral spur and trabecular meshwork, the elastic
tissue forms 5% of the dry weight. Mucopolysaccha-
rides constitute 0.7% to 0.9% of the dry weightof the
sclera. Forty-five percent of the acid mucopolysac-
charides is dermatan sulfate. Chondroitin sulfate
but not keratin sulfate is present.?
The sclera is 68% water,? although reported values
vary from 65% to 75%. Thesclera is opaque when
the water content is between 40% and 80%. When
the water content is below 40% or above 80%, the
sclera becomes transparent.” The sclera placed in
physiologic saline will imbibe fluid to a maximum
increase of 15% of its original weight, whereas the
cornea will increase 100%. Dry spots, called dellen,
occur on the sclera near the limbusor adjacent to
small elevations of conjunctiva. The dried sclera
looks blue gray. Dellen are rarely larger than 1 to 2
1
 ulumination its
fibers glisten when
removal of the overlying
and in certain Pathol tissue, In UNg
children
The blue color of ogic Conditionsit
generalized, the Scl era, either focally
results from
a Tyndall ¢ of
that seen with Similar to
blue nevi: light
the sclera strikes transmitted throug
faintly blue. Occ the uvea and is Teflected Outwar
h
asionally, blues
cleras are d
tations of a Co
nnective tissue
Osteogenesis imp disorder,
erf
Pseudoxanthoma ecta, Ehlers-Danlos Syndrome,
With advancing elasticum, and keratoconus.it
age
from the depositio , the sclera is Slightly yellow
n
tissues act as a tra of lipids. Dense Collagenous
p for esterified
lesterol esters an
d sphingomyelin
increase in
i
Small blue, gray,
or brown spots may
on the sclera. Th be visible
e di i iS i

acia perforans. Discrete, discolored

areas located superiorly orinf
eriorly, 2104 ae
Posterior to the limbus, less
than | mm in bey
and usually gray or brown,
are most akan
nerve loops of Axenfeld2!
Occasionally, aaa
cytes in the emissary canalsof theve
ssels an an i
Produce small, irregularly delin
eated spots as
Surface of the sclera2 Excessive a
d
Seen in the nevusof Ota (oculodermal
Sis). In elde in ‘haa
rly People, discolored sp n
located anterior to the horizontal ca t
in persons
mm. Soaking th scleral plaques. Plaques arerarely
e Spot w it younger than 60 years, but 50% of ; thoes ovet
Ta, and the def h artificial tears rehydrates years have plaques"3%; the sclera gute
t of normal
‘Ne sclera is €ct disapp ears,
Telatively In
j active metaboli thickness but the degenerated wr
having no intr cally, mentation
in: sic Capillary be Microscopically plaques show - ee
ons and Solute d and few fibroc sed I
s, Smaller th ytes, scleral fibers, loss of
Serum albu an or equalin si Se (Fig. 3).
m Nn, diffuse
th;
ze to In =
slowerrate
than t
onurie
; gen aa often triangular, ¥
ce
the pressure is n the suprachoroidal space, id Content of Selers with Age
2 mm lower where
Pressure, and
Sure is near ze
the episcleral
ti ssue, where th Age in Yeo
ro. Transscleral e pres
Y a drop in intr movement is sl - Lipid Fraction 3 ar
ao cular Pressure.! owed te \:5
3-17 Cholesterol esters
Cholesterol _ as \ 6,
Free fayseat o HI
cs s as : a
Tobphospholipid 02
Of scars, as seen Sphingomyelin .
in other tissues, Total lipids ait
Sclera, does not occur si00
in « .
Expressed in pid compos
Thesclera Norm
ally is white, an
d under proper (eed ottWe"Se
sclera and co!
ue/ RM: The lipliidpid 915)
 Voll / Chap 23 SCLERA

ee scleral Pigmentations. /, focal staphyloma, located anywhere

on sclera atsite of
feted - or injury. 2, nerve loop of Axenfeld darkened by melanocyte
s, located superiorly or
hori ly. 3, acquired melanosis at limbus, may result from irritation. 4, scleral plaques,
anterior to
zontal
recti. 5, nerve loop without melanocytes. 6, aqueousvein of Ascher.
Spot, usually near limbus. 7, a delle, a depressed dry
. 8, triangular deposits of homogentisic acid in ochronosis, anterior to horizontal
Fecti.
Limbus(L) is transitional zone of cornea, conjunctiva, and
sclera. (Courtesy of Stephen Gordon)

brown
: Spots se Ge
insertigng Orn on thesclera just in front of the four-fifths of the surface of the eye; the cornea
same locati the horizontal rectus muscles—the covers the remainder.® 27-8
are Younger as scleral plaques—but the patients Thethickness ofthe sclera varies.It is | mm thick
sclera » Skin, ~ andHomogei ntisic acid is deposited in the posteriorly and thins at the equator to 0.6 mm.
IN Patients
patientewith
cue alkapieandin!
Cattilage, andis found in i the urine
i Immediately behind the insertions of the rectus
muscles the sclera is only 0.3 mm thick. Thescleral
coat thickens to 0.6 mm where the tendons of the
ROSS ANATOMY rectus muscles attach (Fig. 4). Adjacent to the
The Sel limbusthesclera is 0.8 mm thick. The sclera thins
Tadius ofentel has a dia with age?
meter of 22 mm and a
Shell ig ? i of 12 mm.In Thesclera is an incomplete sphere that terminates
the adult male the
Werage, The g ‘“rger than in anteriorly at the anterior scleral foramen. Posteri-
the adult female, on
clera covers somewhat mo orly, the sclera is modified in the region of the optic
re than nerve as the posterior scleral foramen. The outer
 Vol]

a1201 12001004

Fig. 3. (Left) Gross specimen from 82-year-old woman with two

scleral plaques medially. (Right) Fragmented, calcified scleral
fibers in plaque on far right. (Hematoxylin-eosin, X 125)

P
T
surface of the sclera is covered by the episclera and |
its inner surface by the laminafusca and potential 1S
spaceof the suprachoroidea. Thesclera is perforated A
by emissarial canals for arteries, veins, and nerves. L
The tendinousinsertions of the extraocular muscles EN
are anchoredinthe sclera. pA
|
S
ANTERIOR SCLERAL FORAMEN AND INTERNAL
SCLERAL SULCUS
Fig. 5. Anterior scleral foramen andinternalscleral sulcus.
The anterior scleral foramen is not a discontinuity (Upper) Externally, foramen and sulcus are oval (solid line);
in the outer coat of the eye but is an anatomical internally, circular (dotted line). Shaded crescent of surgical
concept of the sclera without the cornea. Thesclera limbusis broadcast at 12 and 6 o’clock, thinning at 3 and 9
meets and merges with the cornea at the anterior o’clock. Cross-sectional diagrams indicate line connecting
scleral foramen. Thescleral side is called the inter- Bowman’s membrane and Descemet’s membrane horizontally
nal scleral sulcus, and it encircles the posterior and vertically. (Lowerleft) Sulcus laterally. Arrow connectin
termination of the cornea (Fig. 5). The sulcus is internal and external terminations is parallel to optic axis
(center). Concavity of sulcus corresponds to shaded crescent
slightly curved and the concavity is directed posteri- External
above. (Lowerright.) Sulcus superiorly andinferiorly
orly. The posterior margin of the cornea is convex
termination projects anteriorly, overhanging internal termination.
Notedirection of arrow.

andfits into the concavity of the sclera. The ee

and sclera are distinct tissues whose Te ante
scopic and chemical features segregate 7 is gross!
rior scleral foramen, although the eae from t
continuous with and not easily separa’gal
sclera acrossthis dividing line.” The fecornea meet
spaced fibers and keratosulfate 7 fibers random
and change abruptly to the large praracteristc °
layered, and the dermatan sulfate amet. ly
the sclera at the anterior scleral ea y 1s sit
Fig. 4. Tendinousinsertion of rectus muscle thickens sclera and Theanterior scleral foramen ae ori onl
lies external to ora serrata (arrowhead). Scleral features are not oval, with its long axis (11.6 mm) "YA" toyed
altered by the tendinousfibers. Anteriorciliary artery, lowerleft. andits short axis (10.6 mm) VeRN ¢ m,
0° ©
(Hematoxylin-eosin, x 79) is circular and has a diameter
 Voll / Chap 23 SCLERA
The transition from sclera to cornea is best seen
in an enucleated globe that has beenrefrigerated
following enucleation. When cooled, the cornea
swells, becomesthicker andslightly opacified, while
scleral thickness is unaltered (Fig. 6). The transition
from sclera to cornea, although evident in a gross
specimen, is virtually indistinguishable in routinely
prepared microscopicsections because ofthe similar
structure and staining properties of the cornea and
sclera, although they can be differentiated with
special stains.”
in gross
Fig. 6. (Upper) Corneoscleral junction and limbus
specimen when cooled. Cornea(left) is swollen. Sclera (right)
maintains constant thickness. Convexity of cornea joins concav-
ity of sclera at anterior scleral foramen(internalscleral sulcus),
indicated byarrows. (Lower) Transition from sclera (S) to cornea
(C) is barely perceptible. Anatomical limbus is delineat
ed by
dotted lines. Anterior line connects termini of Bowman’s and
Descemet’s membranes; posteriorline, | mm behind and parallel
with anterior line, passes through posterior end of Schlemm’s
canal. Scleral spur (arrow) is internal to bilobed canal of
Schlemm. Surgical incision, made perpendicular to the sclera,
extends from midlimbus externally through Descemet’s mem-
o-
brane peripherally (SL between arrowheads). (Hematoxlyin-e
sin, X 79)
Theexternal scleral sulcus is a shallow depression
on the outer sclera with the concavity facing out-
ward, just posterior to the corneoscleral junction.
The externalscleral fibers of the internal scleral
sulcusendin a thin layeranteriorly that merges with
Bowman’s membrane.Vertically, the external sclera
and Bowman’s membraneare displaced more ante-
riorly than the posterior layers because of the
elliptical nature of the foramen. Laterally, the
external layers overlie the internal termination. The
mid layers of sclera end in the depth of the concay-
ity of the internal scleral sulcus. The innerlayers of
the sclera—thescleral roll—surround the posterior
wall of Schlemm’s canal.
From the posterior end of Schlemm’s canal a
small truncated band of scleral fibers projects
inward 0.09 mm, toward but notinto the anterior
chamber; this is the scleral spur. The scleral spuris
the attachment for the meridional ciliary muscle.
Tension on the scleral spur by the muscle tends to
open the trabecular meshwork, located internal to
the canal of Schlemm.
The spur and roll form the most interior part of
the internalscleral sulcus.® The scleral spur androll
are made of circumferential scleral fibers that
encircle the limbus, markingthe surface of the sclera
at the junction of the cornea andsclera. The fibrous
loop of scleral roll and spur may be detached as a
single unit.3! Extensions of the innerscleral fibers
form the corneoscleral trabecular meshwork, which
terminates in Descemet’s membrane.
The fine structures of the chamber angle are
described elsewhere in these volumes.
LIMBUS
The term /imbus, although fraught with vagaries
because the region lacks distinct anatomical bor-
ders, is a useful one. To the anatomist, the limbusis
a zone whoseanteriorlimit is a line drawn from the
end of Bowman’s membrane to the end of Desce-
met’s membrane and whoseposterior limitis a line
about 1 mm posterior to and parallel with the
anterior line passing through the posterior edge of
the canal of Schlemm (Fig. 6). To the surgeon, the
posterior boundaryof the limbusis less well defined,
andthe line is usually perpendicular to the surface
rather than parallel with the Bowman-Descemet
line. The surgical limbusis the blue crescent of the
corneoscleral junction, exposed by removal of the
conjunctiva (Fig. 5 and 6). Theclinician also speaks
of limbal lesions when referring to spots, lumps,
bumps, and cavitations that occur in the most
peripheral corneal, conjunctival, subconjunctival,
episcleral, or scleral tissues at and immediately

6 Vol |
posterior to the corneoconjunctival junction and to
lesions that straddle the junction (Fig. 2). All agree
that the limbusis a circumcorneal zone, about 1mm
a the extraocular muscles in a counterclockwito™® of
in extent posterior to clear cornea.
Externally, the limbus is covered by epithelium
called limbal, that is, peripheral corneal epithelium
and anterior conjunctival epithelium. The epithe-
lium is nonkeratinized,stratified squamous and has
an occasional gobletcell in the conjunctival portion.
Deep to the point of epithelial transformation, the
subepithelial tissues, Tenon’s capsule, and episclera
fan out. These tissues are usually inconspicuous
except when edematousand inflamed. The corneo-
conjunctival epithelium is the site of predilection for
dysplasias and carcinomas. The anatomical limbus
of the globe extends both anterior and posterior to
the corneoscleral junction andis part sclera and part
cornea. Internally, the anatomical limbus includes
the aqueous veins, canal of Schlemm,scleral roll,
and trabecular meshwork, both corneoscleral and
uveal.
As mentioned, the surgical limbus is blue, as the
tissue is part corneal and part scleral, and permits
light reflected from the uveal tissues to shine
through. Incisions for cataract extraction and glau-
coma surgery are madein the surgical limbus. The
direction of the incision determines that point at
whichthe surgeon enters the anterior chamber.If an
incision is perpendicular to the limbus,it will enter
the anterior chamber in clear cornea (Fig. 6). An
incision parallel to the visual axis (borders of the
anatomical limbus) enters the anterior chamber
between Schlemm’s canal and the termination of
Descemet’s membrane,thatis, through the trabecu-
lar meshwork.
If the posterior boundary of the limbus seems
indeterminate, the internal borders are more befud-
dling. Anatomist, surgeon, and clinician use the
term limbus almost exclusively for the outer region.
Thelimbus, internally, as defined by the anatomist,
contains the structures of the chamber angle; hence,
angle or other proper anatomical term such as
trabecular meshwork is generally used for the inner
region. The surgeon makesa limbal incision, thatis,
externally, but does not enter the anterior chamber
through the limbus, but rather through Descemet’s
membrane or trabecular meshwork. In general
parlance, limbus denotes the outer corneoscleral
junction and not the angle, chamber, or
the inner
area.
EXTRAOCULAR MUSCLES
The extraocular muscles insert on the outer curva
- layers of the sclera to a diameter a
ture of the sclera, 5 mm or moreposterior to the
_—
‘Chap 23
limbus. The pattern of the insertions of
muscles is called the spiral of Tillaux = Tectus
from the progressively more Posteriorin, Tesults
tion. The medial rectus muscle inserts direc.
posterior to the limbus; the inferior rectus, ae m
the lateral rectus, 6.9 mm; and the super 5 mm;
7.7 mm. Theora serrata lies internal to the j
ot,
of sclera and tendon. Junction
The tendons of the extraocular Muscles vary in
width and length. The collagenous fibers of
th
tendon are arranged in parallel bands
that fan out tl
the junction with sclera and interweave with the
scleral fibers. The wovenscleral and muscular fibers
are inseparable and the muscular tendon Cannot
be
freed without ripping thesclera.
Branches of anterior ciliary arteries follow the
tendinous insertions and supplythe anterior episcle-
ral plexus before plunging into the substance ofthe
sclera. Each of the rectus muscles has two anterior
ciliary arteries, with the exception of thelateral
rectus muscle, which has only one.
Theinsertions of the superior oblique andinferior
oblique muscles are posterior to the scleral equator.
The long tendon for the superior oblique muscle
inserts superiorly and slightly laterally. Its anterior
end enters the sclera at the equator,just lateral to
the midline. The insertion is slightly concave, with
the concavity facing forward.
Theinferior oblique muscle has no tendon, and
the muscularfibers insert into the external wall of
the sclera. The most posterior point of the inferior
oblique muscle lies 5 mm temporal to the optic
nerve on the horizontal meridan, external to the
macula. Theinsertion curvesslightly inferior oe
horizontal andextendslaterally to the equator. .
arc ofthe insertion is concave, with the concavi
directed inferiorly and anteriorly.
POSTERIOR SCLERAL FORAMEN
Thescleral shell posteriorly is modifie
of the optic nerve as the posterior scl :
The posterior foramen differs from t ia
foramen in that scleral fibers crisscross a
and notthe latter. The canal for the 2
located 3 mm medial to the midline oint 0}
below the horizontal meridian. The ™CPOthe
canal for the optic nerve lies slig! a cone.
horizontal meridian. The canal is 2 : base
with a narrow neck internally 4m am ee
externally. The inner aperture 1s as in ou
diameter. The cone quickly a 3.5 me
t 0705s
The anterior layers of the scler

voll / Chap 23 SCLERA
we
Fig. 7. Inner scleralfibers cross the posteriorscleral sulcusas the
lamina cribrosa (between arrows), supporting optic nervehead.
External layers of sclera turn outward (lower right) to parallel
axons of the optic nerve. Sclera continues as dura (not shown).
(Hematoxylin-eosin, x 79)
posterior scleral foramen form the lamina cribrosa
(Fig. 7). The lamina is an extension ofdiscrete
bands or bundles of several layers of scleral fibers
that extend across the posterior scleral foramen,
leaving openings. The perforations are short canals
formed by and lined by several layers of scleral
fibers, a stacked series of superimposed congruent
openings providing a passage for the axonsof the
optic nerve. The connective tissue bands are covered
byglial tissue.?? The fibers of the outer two-thirds of
the sclera do not cross the foramen but turn out-
ward at right angles to blend with fibers of the dural
covering of the optic nerve. At the lamina cribrosa
myelination of the fibers of the optic nerve ceases.
The laminais slightly curved, with the concavity
facing inward. In glaucomatous eyes, the lamina
cribrosa is bowed posteriorly, forming a beanpot
configuration. In totally cupped, glaucomatous
discs, the perforationsin the lamina cribrosa may be
identified when the optic disc is examined ophthal-
moscopically. The outer layers of the lamina cri-
brosa blend with the pial columnsof the extraocular
Portion of the optic nerve. The inner rim of the
canal is the smallest diameter through which the
herve fibers pass. Mechanical obstructions to axo-
plasmic flow occurinternal to the lamina,resulting
i swollen axons and papilledema.
EMISSARIA
The nerves, arteries, and veins pass through the
sclera in emissaria, or passageways, that are sepa-
Pie from the sclera by a thin layer of loose
th Nective tissue. The anterior ciliary arteries pass
Tough the sclera just in front of the insertions of
7
the rectus muscles in a slightly oblique direction
from posterior to anterior. Branches of the ciliary
vessels extend anteriorly along the episclera to join
with the subconjunctival vascular plexus and fan out
laterally as the episcleral plexus. One large branch
passes throughthe sclera to enter the ciliary body
and join with the major arterial circle of the iris
formed by branches from the long posterior ciliary
arteries. The arteries that pierce the sclera do not
break upinto a capillary bed in the sclera but rather
provide nutrients for the uvealtract.
Aqueous veins from the canal of Schlemm may
exit directly through the sclera or may form deep,
intermediary, and superficial plexi in the sclera just
posterior to the limbal region. More than 25 collec-
tor channels leave Schlemm’s canal at irregular
intervals, but most are distributed in the horizontal
meridians. The aqueous veins of Ascher vary from
0.01 to 0.1 mmin diameter and contain clearfluid as
they emerge from the sclera (Fig. 2).
Anterior ciliary veins, two for each artery, leave
the interior of the globe through emissaria over the
ciliary body, often sharing a canal with a nerve loop
(Fig. 8). The ciliary nerves may enter the sclera from
the suprachoroidal space, pass outwardly, often
reaching the surface, then fold back on themselves
before entering the ciliary body (nerve loop of
Axenfeld).
Posterior to the equatorthe sclera is pierced by
the canals for the vortex veins, usually four in
number but occasionally more. Their location is
constant, and canals for accessory vortex veins are
within 1 to 2 mm of the main vein. Two or more
choroidal vortex systems may anastomose within
the sclera with only one large trunk on the surface.
The superior vortex veins are farther posterior (7 to
Fig. 8. Folded knuckle of ciliary nerve (arrow) almost reaches
scleral surface as nerve loop of Axenfeld. Branch of anterior
ciliary vessel shares emissarial canal. Muscle (above) is folded
forward. (Hematoxylin-eosin, < 79)
 Fig. 9. Emissaria for vortex vein. Collagen is less dense in canal. (Hematoxylin-eosin, < 10)
8 mm) to the equator than the inferior pair (5 to 6
mm). The superior temporal vortex vein exits the
sclera close to the most posterior edge of the
insertion of the tendon for the superior oblique
muscle. The vortex emissaria pass obliquely through
the sclera and are 3 to 4 mm long (Fig. 9). The
vortex veins receive the blood from the uvealtract,
including partsoftheciliary body andiris, as well as
all the choroid.
Fifteen to 20 short posterior ciliary arteries pierce
the sclera adjacent to the optic nerve (Fig. 10). Most
are clustered slightly temporal to the optic nerve.
One or more trunks or branches may proceed
through the internal sclera surrounding the optic
nerve to form the incomplete vascular circle of
Zinn-Haller near the inner scleral rim. Rarely,
vascular twigs enter from the choroid. The emissaria
for the ciliary vessels may be perpendicular, oblique,
or spiral. Anastomoses with otherciliary arteries
and branchings also occur in the sclera (Fig. 11).
4 ats 2
~~ O0
Fig. 10. Curved canal of short posterior ciliary artery in sclera
near optic nerve. (Hematoxylin-eosin, X 31)
Thevessels pass directly to the choroid an
id do not
form capillary bed in the sclera.
The horizontal canals for the long posterior
ciliary arteries and nerves enter the sclera 3.6 mm
nasalto the optic nerve and 3.9 mm temporalto the
optic nerve. The nasal canal is easily identified but
the temporal canal is partially covered by the
insertion of the inferior oblique muscle. The canals
pass through thesclera in an oblique manner, from
posterior to anterior, entering the suprachoroidal
space at the equator. The nasal long posteriorciliary
artery does not branch, but the temporal artery
gives off a macular branch that enters the supra-
choroidal space beneath the fovea. In some eyes,
melanocytes in variable numbersare foundin the
emissaria. Intraocular tumors occasionally leave the
globe through the emissaria.
re cad
ae eryinin sescleral
Fig. 11. Three branches ofshort posterior ote pt (arrow)
canal surrounded by abundant adventitia. Melanocy™ x
eee xylin-e0s! in,
are deposited in surrounding tissues. (Hematoxy
125)

Fig. 12. (Upper) Lamina fusca is visible when
the sclera is
divested of choroid and is irregularly pigmen
tedinferiorly.
Markings of vortex veins in lower right. (Lower
) Melanocytes
(arov) of lamina fusca intermix wit
h fibers of inner sclera.
(Hematoxylin-eosin, x 125)
INTERNAL SURFACE
anne brown, inner surface of the sclera is
ineguar commen? fusca. Melanocytes form a thin,
indented nine on the inner sclera which is lightly
Vortex ae the ciliary arteries and nerves and the
choroid (Fie in the suprachoroidal space and outer
fusca and 8. 12). Scleral fibers that cross the lamina
those in theachoroidal space are thinner than
bundles nt Sclera and their numberis few. Such
Nd chor ae 4 weak attachment between sclera
"sels and herves omissary canals for the major
entbetwee “rves are the principal pointsof attach-
1 Beater Sclera and uvea, Collagenous bundles
Muscle bee es Cross the supraciliary space.
inserwt the ciliary body have been
ar© Tate. to Ins rt in the sclera,but such insertions
i i
“UCROgC
th o PIC A
ys NATOMY
the Mic TOSeq i
Sclera “ and ultramicroscopic features of
atively monotonous (Fig. 13). The
sclera is a densely
colla enous, hypocell
whosefeatures ar€ i
modifiied anteriorl
afly yatatth
the
and Posteriorly for the opt ellim
inbus
ic nerve, and less so at us the
and have an average diameter of 62 nm.* Bundles of
thinner fibers, possibly Precollagen, are found near
the fibrocytes. The length of the bundle s is not
known. The bundles have a slightl
y fusiform shape
with tapering ends and branch dichot
omously.”” The
interfi
brillar space contains mucopolysaccharide
s.
In myopic eyes the fibers posteriorly have a greater
Tange of diameters, and the average size
is 83 nm
compared with 96 nm in normal eyes.*4
The bundles course in whorls, loops, and arches,
curving around and about the muscular insertions
and the optic nerve (Fig. 14). The bundles are
approximately parallel to the surface, but thestrict
layering that is found in the corneais notthe rule.
The bundles are not at the same depth throughout
their length but enter deeper and more superficial
layers at random. The bundles posterior to the
tendons of the rectus muscles are slightly curved,
natant
with the concavity directed forward.Inner bundles
near Schlemm’s canal and those aroundthe optic
nerve are relatively circumferential, but by no
meansareall the bundles so oriented. The strength
and toughnessofthe sclera arerelated to thefeltlike
matting of the bundles. A modest numberofelastic
fibers lie parallel to the collagenous fibers.>° The
fibers at the emissaria are roughly parallel to the
direction of the canal. Limited numbers of the thin
bundles attach to the wall of the vessel or nerve in
the canal. The scleral walls of the canals are not
lined bycells.
Flat elongated cells, the scleral fibrocytes or
fibroblasts, are few in numberandare separated by
collagen. The long axisof cell and nucleusis parallel
to the surface (Fig. 15). Long, thin cytoplasmic
extensions from the cells are attenuated to a diam-
eter one-half to one-third the size of the collagen.
Occasionally, a bundle of collagenous fibers is
surrounded by a thin cellular process, but most
bundles are not enveloped by cellular component,
regardless of the directions taken by the bundles. A
greater number of cells—fibrocytes and melano-
cytes—are found in the lamina fusca. The a
cytoplasm contains rough eat
polyaiiiaronias and Sanaa
i us feature 1s _
onthenerves of the sclera include thin bad from
the short posteriorciliary nerves behind the equator
10
Chap 2

Fig. 13. Thin spindle-shaped fibrocytes and melanocytes (lower left) intermingle with scleral collagen,
Collagen fibers shown in longitudinal, cross, and oblique section. Processes (arrows) are thinner than
adjacentcollagen bundles, Macroperiodicity of collagen fibersis 640 A. F, nuclei of fibrocytes (x 13,050)
and branches of the long posterior ciliary nerves
anteriorly (Fig. 16). Some axons extend to the
trabecular meshwork and others to the cornea. Posterior
Adrenergic fibers are not found. The principal
component is sensory.

THE EPISCLERA

Theepisclera is a thin fibrovascular layer covering

the outer sclera. The layeris thickest anterior to the
muscular insertions and contains many anteriolar
branches from theanteriorciliary vessels. These
anastomose extensively, forming a plexus that lies
between the muscular insertions and the. anterior
terminationofthe sclera. The vessels form distinct
layer deep to the conjunctival vessels and are
usually not conspicuous but may bevery prominent
whenthetissueis inflamed. Loosely wovencollagen
bundles mingle with the vessels. ‘Superior Inferior
Anteriorly, the episclera, Tenon’s capsule, and the Fig. 14. Variable patterns of general direction of scleral -
conjunctiva fan out from the posterior end of near muscular insertions and around optic nerve. Insertions °
Bowman’s membrane(Fig. 17). Tenon’s capsule is extraocular muscles: SO, superior oblique; 10,inferior ool
an avascular layer of collagen that surrounds the L, lateral; M, medial; S, superior; /, inferior. (Redrawn
globe and formssleevesfor the tendonsofthe rectus Kokott W: Klin Monatsbl Augenheilkd 92:117, 1934)
 Fig. 15. Nucleusofscleral fibrocyte has evenly distributed chromatin and thin cytoplasmic extensions. Collagen (C) fibers in
cross section have variable diameters. ( 20,590)
muscles. Anteriorly, it is inseparable from the
conjunctiva and posteriorly it blends with the dura
. the optic nerve. Tenon’s capsule is sandwiched
= two vascular layers anteriorly—the subcon-
‘Mnctival plexus and the episcleral plexus—which
Tourish it,
=ieee is thin equatorially and thicker
Provide oa ere the short posterior ciliary vessels
Usually ae vascular network. The vessels are
undles in th ss except when inflamed. Fibrous
85 dense 4 ani are generally thinner and
pti is mo ‘ose of the sclera. The background
thos, © ofTethe
plentiful,
sclera’ and
nd fi fibrocytes are plumper
"MBRYOLOgy
Uch oj
“Test callyf the
tha Coat develops from the neural
velop the primitive optic cup. The
first hint of condensation of embryoniccollagen into
sclera occurs about the 43rd postovulatory day in
primates in the region anterior to the equator. The
retinal pigment epithelium induces the choroid and
sclera.!© In developmental colobomas, the pigment
epithelium at the line of closure is defective and fails
to induce the choroid and sclera, which remain thin
and do notattain normal thickness. Thescleral wall
of a coloboma maynotbulge exteriorly but there is
an internal staphyloma. In avian eyes, mesoderm
forms a small portion of the median temporal
enn
sclera.*”
PHTHSIS BULBI
Damaged globes are often enucleated for one of two
conditions: end-stage glaucoma or phthsis bulbi.
The glaucomatous eye is slightly enlarged, having a
diameter of 25 to 26 mm,and thesclerais thin. The
 Fig. 16. Innersclera with small nerve containin; g myelinated (M) and unmyelin
ated (U) fibers. Melanocytes andfibrocytes in
laminafusca encircle some bundles of collage: n with thin, highly attenuat
ed cell processes. SC, suprachoroid; S,sclera. (x
5510).

phthsical globe, with an intraocular pressure near

zero,is small, shrunken, and disorganizedinternally.
When the damaged eyelacks internal pressure to
withstand thepull of the muscles, the entire shapeof
the sclera changes, and the backward pull of the
Tecti produces a squared appearancein the globe.
The forward pull of the obliques, opposed by the
Tecti, compresses the equatorial region. Thefibrous
coat thickens, most prominently posteriorly, and
folds inward. The folding may be initiated a
internaltraction bandssuch as those associated will :
fibrous ingrowth orcyclitic membranes. With malt:
Fig. 17. At limbus, congested subconjunctival vessels (above) are ration, internal fibrous bands
contract and hisiclog:
segregated from episcleral plexus onoutersclera. Tenon’s capsule cally simulate scleral collagen. It is not kno 7
is indicated by arrows. Schlemm’s canalcontains blood. (Hema- whetherdenseinternal scarring resultsin the ace
toxylin-eosin, X 79) intraocular pressure or the lack of ocular ten
 voll / Chap 23. SCLERA
fosters intraocular fibrosis; nevertheless, the two
occur in virtually all globes that become phthsical.
The blind, disfigured eye may be enucleated for
cosmetic reasons Or to relieve pain.
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