Organon Visuum

Tri Indah Winarni, MD, PhD

Anatomy Dept. Faculty of Medicine Diponegoro
University
 Eyeball development
• Neuroectoderm/Diencephalon:
Optic cup  optic vesicle
– Retina (pigment and neural layer)
– Iris and cilliary body
• Ectoderm
– Lens
– Eyelids (palpebra)
– Lacrimal Gland
• Mesenchyme differentiated to be:
– Sclera
– Cornea
– Choroid
– Vitreous body
Development of the eye. (A) Evagination of the primary optic vesicle. (B) Invagination
of the surface epithelium and formation of the optic cup by invagination at the
embryonic fissure. (C) Detachment of the lens from the surface epithelium. (D) The
ciliary region and iris are formed from neuroectoderm, and the lens from the posterior
cells of the lens vesicle. (E) The completed eye. IPE, iris pigmented epithelium; RPE,
retinal pigment epithelium; CB, ciliary body. (Akagi and Takahashi, 2005)
 Orbitae
• Cavum orbitae
– Structure (medial is the most weak wall)
composed by cellulae ethmoid  orbital
compression injury  nasal cavity and
orbital connected  orbital emphysema
– Foramina and fissures
• Foramina ethmoidales (anterior and posterior)
• Lacrimal fossa
• Optic canal (N. II and ophthalmic artery)
• Superior orbital fissure : N.III, IV, V1, VI and
superior ophthalmic vein
• Inferior orbital fissure: infraorbital nerve (branch
of N.V2 and artery, inferior ophthalmic vein)
 Emphysema Orbitae
Orbital swelling and proptosis from vigorous sneezing. Air escaped into the
orbit through a medial blow-out fracture of the lamina papyracea ossis
ethmoidalis
 Anatomy of the bony orbit

Sphenoid
Lacrimal
 Eyelids (Palpebrae)
• Contains connective tissue (tarsal plate)
– Maintain shape and eyeballs protection
– Levator palpebra muscle attachment
• Musculature
– Orbicularis oculi (N.VII)
– Levator palpebrae superior (N.III)
– Superior tarsal (Sympathetic nerve)
• Conjunctiva mucosa, innervated by N. V-1
– Palpebra
– Fornix conjunctiva
– Bulbi
 Pathologic Conditions
• Paralyse N. III  Ptosis or drop eye
• Horner’s syndrome  pseudoptosis
• Bells Palsy  corneal blink reflex (-)
ipsilateral inability to close eyelid 
conjunctiva dries  can cause ulcerate
cornea  blindness
• Conjunctivitis :
– Pain
– Bloodshot eye
 PTOSIS

Ptosis Pseudoptosis
Bell’s Palsy (N. VII entrapment at
facial canal)
Nervus Facialis (N VII)
Conjunctivitis
EXTRAOCULAR MUSCULATURE
 EXTRAOCULAR MUSCLES
• Four rectus, two oblique, orbicularis oculi
and levator palpebrae
• Origin: annulus tendineus, EXCEPT
superior oblique muscle (lacrimal bone)
and Inferior oblique muscle (sphenoid
bone)
• Insertion: sclera
• Function: Eyeball movement
 Pathologic conditions
• Medial Strabismus
– N. VI lession  lateral rectus muscle paralyse

• Diplopia
– N. IV lession: double vision when looking
down (descending stairs)
 Lacrimal gland
Afferent somatik Umum (sensorik)

Pterygopalatine ganglion
(Parasympathetic)

Superior Cervical ganglion (sympathetic)

Lacrimal ductules  superior conjuctiva fornix  anterior
surface of ocular bulb (eyelids movement) lacrimal
punctum  lacrimal canaliculi  lacrimal sac 
Nasolacrimal duct  Meatus nasi inferior (Cavum nasi)
 INNERVATIONS
• N. II (Opticus)
• N. V-1 (Opthalmicus)
– Sensorik
– MandibularisN. III (Occulomotorius)
– Innervates all of extraocular mucle except Superior Oblique and
lateral rectus mucles
– Edinger-Westphal nucleus  Ciliary ganglion  postganglionair
M. Cilliaris and Sphincter pupillae (parasympatethic fibre)
• N.IV (Trochlearis)
• N.VI (Abducens)
• N. VII (Facialis)
– Motorik: m. orbicularis oculi
– Parasympathetic: Pterygopalatine ganglion  lacrimal gland &
nasal glands
• Ganglion Cervicalis Superior (Cornu lateralis Th 1-2)
– Sympathetic innervations
N II (OPTICUS)
LESION OF OPTIC PATHWAYS
Opthalmic Nerve (N. V1)
1. N. Frontalis
2. N. Lacrimalis
3. N. Nasociliaris
Occulomotor Nerve (N.III)
1. Motorik fibres  extraocular muscles
except superior oblique & lateral
rectus muscles
2. Parasympathetic fibres (Edinger-
Westphal nucleus)  constrictor
pupillae
 N. III (Occulomotorius)

GSE= general somatic efferent  extraocular muscle

GVE= general visceral efferent (parasympatis)  smooth muscle (sphincter
pupillae)
N. III (Occulomotorius)
N. V1 & V2, N. III, N. IV, and N. VI
Komponen serabut saraf: afferent somatik umum (sensorik)
Distribusi: kulit di supra and infra orbitae, cavum nasi, dan glandula
lacrimalis
 Efferent Visceral Khusus

1 = Nucleus motoris facialis

12 = Nucleus salivatorius
superior
8 = Nucleus tractus solitarius
13 = N. petrosus major
14 = Ganglion pterygopalatina
9 = Chorda tympani
17 = Ganglion mandibularis

Afferent Visceral Khusus

Efferent Visceral Umum

N. Facialis mempunyai 3 komponen serabut saraf:

1. Efferent Visceral Khusus  Otot2 mimic yg merupakan derivate arcus brachilais II
2. Afferent Visceral khusus (Gustatotik)  2/3 anterior lidah
3. Efferent Visceral Umum (parasympatis)  Glandula salivarii (sublingualis &
submandibularis)
 Vasculature
• Ophthalmic artery
– R.r. frontalis  supraorbitalis, supratrochlearis
– R. lacrimalis  Lacrimal gland
– Nasocilliaris  ethmoidalis anterior et posterior
(cavum nasi)
– Intraorbilaris:
• central artery of retina
• Anterior and posterior ciliary branches (eyeballs)
• Ophthalmic Veins
– Superior ophthalmic vein  superior orbital fissure 
cavernous sinus
– Inferior ophthalmic vein anastomoses with superior 
cavernous sinus
Opthalmic artery
Eyeball (Bulbus Oculi)
 Ocular tunic
• Fibrous tunic (Sclera – limbus cornea- cornea)
– Cornea is a principle refractor
• Insufficient corneal refraction focal point behind retina 
hypermetropia
• Excessive corneal refraction  focal point in front of retina
 myopia
– Injury or inflammation  keratitis  lost of
transparency  blindness
• Vascular tunic
– Choroid layer
– Ciliary body: Ciliary muscles  lens acomodation
– Iris: sphincter and dilator muscles  miosis and
mydriasis respectively
• Neuronal tunic (Retina)
– Neural retina
– Pigmented retina
PUPILLARY REACTION
 PATHOLOGIC CONDITIONS

Mydriasis
Pupil unisochore
Herpes simplex keratitis
 Chamber of eye
• Contains aqueous humor produced by
ciliary process into posterior chamber 
anterior  sinus venosum sclerae
(Schlemm’s canal) venous system
• Anterior cavity (corneal – iris)
• Posterior cavity (iris-lens) or vitreous
chamber
• Lens (contains connective tissue cells)
– Zonular fibre connects lens to ciliary body
– Ciliary muscle alters lens shape
 PATHOLOGIC CONDITIONS
• Cataract
– Progressive opacities  chronic blindness 
cataract extraction
– Cause: degenerative disorders (aging),
trauma, UV light, and metabolic disorders
• Glaucoma (emergency eye disease)
– Caused by humor aquous drainage
impairment
– It need to be treat immediately because can
cause acute blindness
 CATARACT

Cataract Degenerative Juvenile Cataract

GLAUCOMA
 Neuro-opthalmology
• Pupillary responses:
– Negative unilateral: trauma intracranial 
brain tissue compression  tentorium
herniation  N. III
– Negative bilateral: sign of brain stem death
• Visual fields defect (see previous slide)
• Oculomotor disorders (see previous slide)