The Eye

Movements of the Eyeball

Structure of the Eye
Contents of the Eyeball
Clinical notes

Movements of the Eyeball

Elevation is
the rotation of
the eye
upward.
Abduction is
the rotation of
the eye
laterally.

Depression is
the rotation of
the eye
downward.

The eye
rotates either
medially or
laterally.
Adduction is
the rotation of
the eye
medially.

Rotatory movements
of
the eyeball use the
pupil anterior pole
as the marker.

Extrinsic Muscles Producing Movement of the Eye

Origin:
Tendinous ring on
posterior wall of orbital
cavity.
Superior rectus

Insertion:
eyeball just
posterior to
corneosclera
l junction.

Superior oblique
muscle

Lateral rectus
Inferior rectus

Medial
rectus

Inferio
r
obliqu
e
muscl
e

Extrinsic Muscles Producing Movement of the Eye

The tendon of the superior
oblique muscle passes through
a fibrocarti-laginous pulley
(trochlea) attached to the
frontal bone.
Superior oblique
muscle

The tendon now turns backward

and laterally and is inserted into
the sclera beneath the superior
rectus muscle.

Extrinsic Muscles Producing Movement of the Eye

Media
l

Inferio
r
obliqu

Superior oblique: Depresses the eye when

looking medially
Inferior oblique: Elevates the eye when looking
medially
Superior rectus: Elevates the eye when looking
laterally
Inferior rectus: Depresses the eye when looking
laterally
Medial rectus: Adduction when pupil moving
along horizontal plane
Lateral rectus: Abduction when pupil moving
along horizontal plane

Cranial 4 (Trochlear): innervates the superior oblique

Cranial Nerve 6 (Abducens): innervates the lateral rectus
Cranial Nerve 3 (Oculomotor): innervates all the remaining
muscles
(ie medial rectus, inferior oblique,

Testing Extraocular Movements

When you ask a patient to
look
medially and downward at
the tip of his or her nose,
you are testing the
superior oblique at its
best position.
1. Stand in front of the patient.
2. Ask them to follow your finger with their eyes
while keeping their head in one position
3. Using your finger, trace an imaginary "H" or
rectangular shape in front of them, making sure
that your finger moves far enough out and
up/down so that you're able to see all
appropriate eye movements (ie lateral and up,
lateral down, medial down, medial up).
4. At the end, bring your finger directly in
towards the patient's nose. This will cause the
patient to look cross-eyed and the pupils should
constrict, a response referred to as

Conversely, by asking the

patient to look medially and
upward, you are testing the
inferior oblique at its best
position.

Left CN 6 Palsy
Patient was asked to look
left. Note that left eye will
not abduct.

Pathology

Paralysis of the 4th Cranial Nerve

Right CN 3 Palsy - Note: Right

eye is deviated laterally, there
is ptosis of right lid, and the
right pupil is dilated.

Fascial Sheath of the Eyeball

The fascial sheath surrounds the
eyeball from the optic nerve to the
corneoscleral junction.
It separates the eyeball from the
orbital fat and provides it with a
socket for free movement. The
medial and lateral check
ligaments attach the socket to the
orbital wall.
It is perforated by the tendons of the
orbital muscles and is reflected onto
each of them as a tubular sheath.
The lower part of the fascial sheath,
is thickened and serves to suspend
the eyeball; it is called the
suspensory ligament of the eye.

Structure of the Eye

The eyeball consists
of three coats:
1. fibrous coat,
2. vascular
pigmented coat,
3. nervous coat.
The fibrous coat
The sclera
(posterior
opaque part)
The cornea
(anterior
transparent
part)

The sclera is
directly continuous
in front with the
cornea at the
corneoscleral
junction, or
limbus.

The Sclera
The opaque
sclera is
composed of
dense fibrous
tissue and
is white.
Posteriorly,
it is
pierced by the
optic nerve
(lamina
cribrosa) and is
fused with the
dural sheath of
The
that sclera
nerve.is also
pierced by the
ciliary arteries
and nerves and
their associated
veins, the venae
vorticosae.

This figure illustrates a blood

vessel that penetrates the
sclera and extends to the
prominently vascularized
choroid through an
emissarial canal ( single
arrows ). Pigmented
melanocytes are also
present. The fibers of the
inferior oblique muscle are
present at the site of
insertion upon the outer
sclera ( double arrows ).

The scleral stroma is

predominantly composed
of collagen fibers that vary
in diameter and are in
haphazard array. Scattered
fibroblasts occur between
the collagen bundles.

The Cornea
The transparent
cornea is largely
responsible for the
refraction of the light
entering the eye.
It is in contact
posteriorly with the
aqueous humor.
Blood Supply The cornea is avascular
and devoid of lymphatic drainage. It is
nourished by diffusion from the aqueous
humor and from the capillaries at its
edge.
Nerve Supply Long ciliary nerves from
the ophthalmic division of the trigeminal
nerve.

HISTOLOGY: The stratified squamous

epithelium of the cornea overlies the
basal lamina and Bowman's layer.
The clefts within the collagenous
stroma represent artifacts of tissue
processing. No blood vessels or
lymphatics are normally present
within the cornea.
Function: The cornea is the most important refractive medium of the eye. This
refractive power occurs on the anterior surface of the cornea, where the
refractive index of the cornea (1.38) differs greatly from that of the air. The
importance of the tear film in maintaining the normal environment for the
corneal epithelial cells should be stressed.

Vascular Pigmented Coat

The iris
The choroid
- outer pigmented layer;
- Inner vascular layer.

The ciliary body

The ciliary body

1. The ciliary ring is the posterior
part of the body, that encircles the
lens.
2. Towards the posterior surface of
the lens there are ciliary
processes which are connected
with the suspensory ligaments to
the lens and contain capillaries. The
capillaries secrete the fluid
(aqueous humor) into the anterior
segment of the eyeball.
3. The ciliary body contains smooth
muscle fibers called ciliary
muscles that is composed of
meridianal and circular fibers of
smooth muscle and help to control
the shape of the lens.

The ciliary muscle

Action:
When the ciliary muscle is relaxed
the ligaments are taut, and the lens
is stretched thin enabling it to focus
on distant objects.
Ligaments are
taut

Ligaments are
loose

Suspensory ligaments
connect the ciliary muscle
to the lens.

When the ciliary muscle is contracted the suspensory ligaments

become less taut, and the lens becomes rounder so that it can focus
on objects that are nearby (accommodation).

The ciliary muscle

Nerve supply:
Sympathetic nerve fiber
stimulation causes
relaxation of the muscle,
whereas parasympathetic
stimulation causes muscle
contraction.
The parasympathetic fibers
come to the ciliary muscle
from the oculomotor nerve.
After synapsing in the
ciliary ganglion, the
postganglionic fibers pass
forward to the eyeball in the
short ciliary nerves.

The Iris and Pupil

Pupil

Iris
The iris contains blood
vessels, pigment cells and
smooth muscles.

The periphery of the iris is

attached to the anterior surface
of the ciliary body.
It divides the space between the lens and the cornea into an anterior
and a posterior chamber filled with the aqueous humor.

Chambers of the Eye

The anterior and posterior
chambers of the anterior
cavity of the eye are filled with
aqueous humor.
Aqueous humor is continually
produced at the ciliary
processes of the ciliary body.

The aqueous humor passes through

the pupil into the anterior chamber
and drains into the canal of
Schlemm (scleral venous sinus) at
the limbus of the cornea.

Sphincter and dilator

pupillae
The smooth muscle fibers of the iris control the diameter of the central
opening (pupil) and are involuntary. It consists of circular and radiating
fibers.
The circular
The radial
fibers form
fibers form the
the
dilator
sphincter
pupillae and
pupillae and
consist of a
are arranged
thin sheet of
around the
radial fibers
margin of the
that lie close
pupil.
to the
The sphincter pupillae constricts the pupil in the presence
of bright
posterior
light and during accommodation.
surface.
The dilator pupillae dilates the pupil in the presence of light of low
intensity or in the presence of excessive sympathetic activity such as
occurs in fright.

Sphincter and dilator pupillae

The sphincter pupillae is
supplied by parasympathetic
fibers from the oculomotor
nerve.
After synapsing in the
ciliary ganglion, the
postganglionic fibers pass
forward to the eyeball in the
short ciliary nerves.
The dilator pupillae is
supplied by sympathetic
fibers, which pass forward to
the eyeball in the long ciliary
nerves.

Nervous Coat: The Retina

1. Pigmented
layer

2. Neural layer

The pigmented layer is a single-cell layer of pigmented cells that

absorb light after it passes through the retina.

The neural layer consists of three layers of cells that include the
photoreceptors, cells that initiate the processing of visual information
and blood vessels that supply the neural layer.

Visual receptors
There are two types of photoreceptors:
Rods are more sensitive to
light but there is only one type
of rod and color discrimination
is not possible with rods.

Cones are less sensitive to

light but there are three
types of cones with
sensitivities in different
regions of the light
spectrum. Cones provide
color discrimination and
greater detail.
The photoreceptors synapse with bipolar cells. The transmission of
visual information through the bipolar cells is modulated by
horizontal cells found in this layer.

This is a high power image of the retina,

showing its characteristic multiple layers.

Ocular fundus
The axons of the ganglion cells
leave the retina by converging on
the optic disc and penetrating
through the wall of the eye.
The left ocular fundus as seen
with an ophthalmoscope.

The cornea and lens focuses light

on a spot of the retina that
contains only cones and is called
the macula lutea.

In the center of the macula

lutea there is a depression called
the fovea which provides the
greatest visual acuity.

The Lens
The lens consists of:
1) an elastic capsule, which
envelops the structure;
2) a cuboidal peithelium,
which is confined to the
anterior surface of the
lens;
3) lens fibers, which are
formed from the cuboidal
epithelium at the equator
of the lens.

The lens is attached

to the ciliary
processes of the
ciliary body by the
suspensory
ligament.

Vitreous Body
The posterior cavity of the eye is
behind the lens and is filled with a
gelatinous body called the
vitreous body.
The vitreous body maintains the
shape of the eye, supports the
lens, and presses the neural layer
against the pigmented layer.
The hyaloid canal is a narrow
channel that runs through the
vitreous body from the optic disc
to the posterior surface of the
lens; in the fetus, it is filled by the
hyaloid artery, which disappears
before birth.

Visual Pathways
retina
(partial decussation)
lateral geniculate

thalamus
visual cortex

A comparison of the information coming from each eye in the

overlapping visual fields gives us depth perception.