EYE, ORBIT, ORBITAL

REGION, AND EYEBALL

 INTRODUCTION
• The eye is the organ of vision and consists
of the eyeball and optic nerve
• The orbit contains the eyeball and its
accessory visual structures
• The orbital region is the area of the face
overlying the orbit and eyeball and
includes the upper and lower eyelids and
lacrimal apparatus
 BONY ORBIT
• Also called eye sockets
• They are bilateral and symmetrical cavities
• They enclose the eyeball and its associated
structures
• It can be thought as a pyramidal structure,
with the apex pointing posteriorly and the
base situated anteriorly
 BONY ORBIT CONT’D
Borders
• Roof- frontal bone, lesser wing of sphenoid
• Floor- maxilla, palatine and zygomatic bones
• Medial- ethmoid, maxilla, lacrimal and sphenoid
bones
• Lateral- zygomatic bone, greater wing of sphenoid
bone
• Apex- located at opening to optic canal, optic
foramen
• Base- opens out into the face, bounded by eyelids
 BONY ORBIT CONT’D
Contents
• Extra-ocular muscles
• Eyelids
• Nerves
• Blood vessels
 Any space within the orbit that is not occupied is
filled with orbital fat
 This tissue cushions the eye, and stabilises the
extraocular muscles
 BONY ORBIT CONT’D
Pathways into the orbit
There are 3 main pathways by which structures can
enter and leave the orbit
• Optic canal- transmits optic nerve and ophthalmic
artery
• Superior orbital fissure- transmits lacrimal, frontal,
trochlear, occulomotor, nasociliary and abducens
nerves and superior ophthalmic vein
• Inferior orbital fissure- transmits the zygomatic
branch of maxillary nerve, inferior ophthalmic vein
and sympathetic nerves
 BONY ORBIT CONT’D
Minor openings include;
• Nasolacrimal canal
• Supraorbital foramen
• Infraorbital canal
 EXTRAOCULAR MUSCLES
• They are located within the orbit
• They are extrinsic and separate from the eyeball itself
• They control the movements of the eyeball and the superior
eyelid
• They are seven in number;
 Levator palpebrae superioris
 Superior rectus
 Inferior rectus
 Medial rectus
 Lateral rectus
 Superior oblique
 Inferior oblique
 LEVATOR PALPEBRAE SUPERIORIS
• Only muscle involved in raising the superior eyelid
Origin
lesser wing of sphenoid immediately above the
optic foramen
Insertion
superior tarsal plate of upper eyelid
Innervation
occulomotor nerve
Action
elevates upper eyelid
 RECTI MUSCLES
• They characteristically originate from the
common tendinous ring
• It is a ring of fibrous tissue which surrounds the
optic canal at the back of the orbit
• The names recti is derived from the Latin for
‘straight’- this represents the fact that the recti
muscles have a direct path from origin to
insertion
• This is in contrast with the oblique eye muscles,
which have an angular approach to the eyeball
 SUPERIOR RECTUS
Origin
superior part of the common tendinous ring
Insertion
superior and anterior aspect of the sclera
Innervation
occulomotor nerve
Action
elevation(main), adduction and medial
rotation of the eyeball
 INFERIOR RECTUS
Origin
inferior part of common tendinous ring
Insertion
inferior and anterior aspect of sclera
Innervation
occulomotor nerve
Action
depression(main), adduction and lateral
rotation of eyeball
 MEDIAL RECTUS
Origin
medial part of common tendinous ring
Insertion
anteromedial aspect of sclera
Innervation
occulomotor nerve
Action
adducts the eyeball
 LATERAL RECTUS
Origin
lateral part of common tendinous ring
Insertion
anterolateral aspect of sclera
Innervation
abducens nerve
Action
abducts the eyeball
 OBLIQUE MUSCLES
• Unlike the recti group of muscles, they do not
originate from the common tendinous ring
• From their origin, they take an angular
approach to the eyeball
• They attach to the posterior surface of the
sclera
 SUPERIOR OBLIQUE
Origin
body of sphenoid bone
Insertion
sclera of the eye posterior to superior rectus
Innervation
trochlear nerve
Action
depresses, abducts and medially rotates the
eyeball
 INFERIOR OBLIQUE
Origin
anterior aspect of the orbital floor
Insertion
sclera of eye, posterior to lateral rectus
Innervation
occulomotor nerve
Action
elevates, abducts and laterallrotates the eyeball
 THE EYELIDS
• They are thin, mobile folds that cover the eyeball
anteriorly
• They offer protection from excessive light or injury
• They also maintain lubrication by distributing tears over
the surface of the eyeball
• They are split into upper and lower portions, which meet
at the medial and lateral canthi of the eye
• The opening between the two eyelids is called the
palpebral aperture/opening
• The lateral canthus is in direct contact with the eyeball
• The medial canthus is separated by a small triangular
space, the lacus lacrimalis
 LAYERS OF THE EYELID
The eyelids consists of 5 main layers- from
superficial to deep
• Skin and subcutaneous tissue
• Orbicularis oculi
• Tarsal plates
• Levator apparatus
• Conjunctiva
 LAYERS OF THE EYELID CONT’D
Skin and Subcutaneous Tissue
• The layer of skin is among the thinnest in the human
body
• In the subcutaneous layer, there is loose connective
tissue but no subcutaneous fat- and subsequently, the
eyelids are readily distended by oedema or blood
• The eyelashes are attached here with their
accompanying modified sweat glands- the ciliary
glands of Moll
• There are also sebaceous glands located in this layer,
known as the glands of Zeis
 LAYERS OF THE EYELID CONT’D
Tarsal plates
• Located deep to the palpebral region of the orbicularis
oculi
• There are two plates
– Superior tarsus (upper eyelid)
– Inferior tarsus (lower eyelid)
• They act to form the scaffolding of the eyelid, and are
composed of dense connective tissue
• In the tarsal plates lie the Meibomian/tarsal glands, a
specialised type of sebaceous gland that secretes an oily
substance onto the eye to slow the evaporation of the
eye’s tear film and prevent the eyelids from sticking
together when closed
 LAYERS OF THE EYELID CONT’D
Levator Apparatus
• Made up by the levator palpebrae superioris and superior tarsal
muscles
• The both act to open the eyelid and are only present in the upper
eyelid
Superior tarsal muscle
Origin
underside of levator palpebrae superioris
Insertion
superior tarsal plate
Innervation
sympathetic fibres from superior cervical ganglion
Action
assists the levator palpebrae superioris in opening the eyelid
 LAYERS OF THE EYELID CONT’D
Conjunctiva
• The palpebral conjunctiva forms the deepest layer
of the eyelid
• It is a thin mucous membrane, which is reflected
onto the sclera of the eyeball (bulbar conjunctiva)
• It is firmly attached to the tarsal plates and blends
with the skin at the margins of the lids
• The subtarsal sulcus is a shallow groove on the
back of the lids, about 2mm from the margin,
where foreign bodies tend to lodge
 ARTERIES OF THE EYELIDS
• Ophthalmic artery- lacrimal, medial palpebral,
supraorbital and supratrochlear arteries
• Facial artery- angular branch
• Superficial temporal artery- transverse facial
artery branch
 VENOUS DRAINAGE OF THE EYELIDS

• Medially, blood drains via the medial palpebral

vein into the angular and ophthalmic veins
• Laterally, blood drains into the superficial
temporal vein from the lateral palpebral vein
 INNERVATION OF THE EYELIDS
Sensory innervation is by branches of trigeminal nerve
• Ophthalmic nerve- supplies uper eyelid through
supraorbital, supratrochlear, infratrochlear and
lacrimal branches
• Maxillary nerve- supplies lower eyelid through
infraorbital and zygomaticofacial branches
Motor innervation is by
• Facial nerve- orbicularis oculi
• Occulomotor nerve- levator palpebrae superioris
• Sympathetic fibres- superior tarsal muscle
 LACRIMAL APPARATUS
Consists of the following
• Lacrimal gland
• Excretory ducts of lacrimal gland
• Lacrimal canaliculi
• Nasolacrimal duct
 THE LACRIMAL GLAND
• An almond shaped gland approximately 2cm
long
• Serous type exocrine glands that secrete
lacrimal fluid onto the surfaces of the
conjunctiva and cornea of the eye
• Lacrimal fluid is a watery physiological saline
containing the bacteriocidal enzyme, lysozyme
• Lacrimal fluid acts to clean, nourish and
lubricate the eyes and forms tears when
produced in excess
 ANATOMICAL LOCATION OF LACRIMAL GLAND
The lacrimal gland is located anteriorly in the
superolateral aspect of the orbit, within the
lacrimal fossa
Relations
• Superior- zygomatic process of frontal bone
• Anterior- orbital septum
• Posterior- orbital fat
• Inferolateral- lateral rectus muscle
ANATOMICAL STRUCTURE OF LACRIMAL GLAND
• It can be divided into two main parts by the
lateral expansion of the tendon of levator
palpebrae superioris
– Orbital- larger and sits on the lateral margin of the
levator palpebrae superioris
– Palpebral- smaller and is located along the inner
surface of the eyelid
• It is a compound tubuloacinar gland,
comprised of lobules-which are formed by
multiple acini
 LACRIMAL APPARATUS CONT’D
Excretory ducts of lacrimal gland
• Convey lacrimal fluid from the lacrimal glands to the
conjunctiva sac
Lacrimal canaliculi
• Commence at a lacrimal opening on the lacrimal
papilla near the medial angle of the eye and drain
lacrimal fluid from the lacus lacrimalis to the lacrimal
sac
Nasolacrimal duct
• The lacrimal sac is a dilated end of this duct
• Conveys the lacrimal fluid to the inferior nasal meatus
 VASCULATURE OF LACRIMAL GLAND
• The main arterial supply is from the lacrimal
artery- a branch of ophthalmic artery
• Venous drainage is via the superior
ophthalmic vein- drains into the cavernous
sinus
• Lymphatic drainage is to the superficial
parotid lymph nodes- drains into the superior
deep cervical nodes
 INNERVATION OF LACRIMAL GLAND
• The sensory innervation is via the lacrimal nerve-
a branch of ophthalmic nerve
• It also receives autonomic nerve fibres
Parasympathetic
– Preganglionic fibres carried in the great petrosal nerve
– Postganglionic fibres travel with the maxillary nerve
– Stimulates fluid secretion from the gland
Sympathetic
– Fibres originate from superior cervical ganglion
– Inhibits fluid secretion from the gland
 THE EYEBALL
• It is a bilateral and spherical organ, which
houses the structures responsible for vision
• It lies in the bony orbit suspended by the six
extrinsic muscles of the eye
• Measures approximately 23mm in diameter
• All anatomical structures within the eyeball
have a circular or spherical arrangement
 STRUCTURE OF THE EYEBALL
• It is divided into three layers
• These layers have different structures and
functions
• The layers include;
– Fibrous layer
– Vascular layer
– Inner layer
 FIBROUS LAYER
• It is the outermost layer
• Consists of the Sclera and Cornea which are
continuous with each other
• Their main function is to provide shape to the eye and
support the deeper structures
• The two layers differ primarily in terms of the
regularity of arrangement of the collagen fibres of
which they are composed and the degree of hydration
of each
• The corneal limbus is the angle formed by the
intersecting curvatures of sclera and cornea at the
corneoscleral junction
 FIBROUS LAYER CONT’D
Sclera
• Tough opaque part
• Comprises the majority (85%) of this layer
• Provides attachment to the extraocular and
intrinsic muscles
• It is visible through the bulbar conjunctiva
as the white part of the eye
• It is relatively avascular
 FIBROUS LAYER CONT’D
Cornea
• It is transparent and positioned centrally at the front of
the eye
• Occupies about 15% of the eyeball
• Light entering the eye is refracted by the cornea
• The convexity of the cornea is greater than that of the
sclera, and so it appears to protrude from the eyeball
when viewed laterally
• It is completely avascular, receiving its nourishment
from capillary beds around its periphery, the aqueous
humor and lacrimal fluid
• It is highly sensitive to touch
 VASCULAR LAYER
• Lies underneath the fibrous layer
• Also called uvea or uveal tract
• Consists of the following;
– The choroid
– Ciliary body
– Iris
 VASCULAR LAYER CONT’D
The Choroid
• A dark reddish brown layer between the sclera and
retina
• It is a layer of connective tissue and blood vessels
• Forms the largest part of the vascular layer of the
eyeball and lines most of the sclera
• Provides nourishment to the outer layers of the retina
• Engorged with blood in life, this layer is responsible for
the ‘red eye’ reflection that occurs in flash photography
• The choroid is continuous anteriorly with the ciliary
body
 VASCULAR LAYER CONT’D
Ciliary body
• It is a ring-like thickening of the layer posterior to the
corneoscleral junction, which is muscular as well as
vascular
• It connects the choroid with the circumference of the iris
• It controls the shape of the lens and contributes to the
formation of aqueous humor
• Comprised of 2 parts; ciliary muscle and ciliary processes
• The ciliary muscle consists of a collection smooth muscle
fibres which are attached to the lens by the ciliary
processes
 VASCULAR LAYER CONT’D
Iris
• It is situated between the lens and the cornea
• It is a thin contractile diaphragm, with an aperture in
the centre (pupil) for transmitting light
• The diameter of the pupil is altered by 2 involuntary
muscles, which are innervated by ANS
• The circularly arranged sphincter pupillae,
parasympathetically stimulated, decreases its
diameter
• The radially arranged dilator pupillae,
sympathetically stimulated, increases its diameter
 INNER LAYER
• It consists of the retina, the light detecting part of
the eye
• It is the sensory neural layer of the eyeball
• The retina consists of 2 functional parts with
distinct location
– Optic part
– Non-visual retina
• The optic part is sensitive to visual light rays and
has 2 layers
– Neural layer
– Pigmented layer
 INNER LAYER CONT’D
Neural layer
– Innermost layer
– Consists of photoreceptors, light detecting
cells
– Located posteriorly and laterally in the eye
Pigmented layer
– Outer layer
– Attached to the choroid layer and acts to
support the neural layer
– Continues around the whole inner surface
 INNER LAYER CONT’D
• The non-visual retina is an anterior continuation of
the pigmented layer and a layer of supporting cells
• The non-visual retina extends over the ciliary body and
the posterior surface of the iris to the pupillary margin
• Clinically, the internal aspect of the posterior part of
the eyeball, where light entering the eyeball is
focused, is referred to as the fundus of the eyeball
• The retina of the fundus includes a distinctive circular
area called the optic disc/papilla, where the sensory
fibres and vessels conveyed by thee optic nerve enter
the eyeball
 INNER LAYER CONT’D
• Because the optic disc contains no
photoreceptors, the optic disc is insensitive to
light
• Consequently, this part of the retina is commonly
called the blind spot
• Just lateral to the optic disc is the macula of the
retina or yellow spot
• The macula is a small oval area of the retina with
special photoreceptors cones that is specialized
for acuity of vision
 INNER LAYER CONT’D
• At the centre of the macula, a depression, the
fovea centralis, is the area of most acute vision
• The fovea is approximately 1.5 mm in
diameter; its centre, the foveola, does not
have the capillary network visible elsewhere
deep to the retina
• The optic part of the retina terminates
anteriorly along the ora serrata, the irregular
posterior border of the ciliary body
 OTHER STRUCTURES IN THE EYEBALL
Lens
• Located anteriorly, between the vitreous humor
and the iris
• It is a transparent biconvex structure enclosed in
a capsule
• The highly elastic capsule of the lens is anchored
by zonular fibres to the encirculing ciliary
processes
• Its shape is altered by the ciliary muscle of the
ciliary body, altering its refractive power
OTHER STRUCTURES IN THE EYEBALL CONT’D
• Parasympathetic stimulation via the occulomotor
nerve causes sphincter-like contraction of the ciliary
muscle
• The ring becomes smaller and tension on the lens is
reduced
• In the absence of nerve stimulation, the diameter of
the relaxed muscular ring is larger
• The active process of changing the shape of the lens
for near vision is called accommodation
• The thickness of the lens increases with aging so that
the ability to accommodate typically becomes
restricted after age 40
 OTHER STRUCTURES IN THE EYEBALL CONT’D
Anterior and posterior chambers
• They are 2 fluid filled areas in the eye
• The anterior is located between the cornea and the
iris
• The posterior is between the iris and ciliary
processes
• The chambers are filled with aqueous humor- a
clear plasma-like fluid that nourishes and protects
the eye
• The aqueous humor is produced constantly and
drains via the trabecular meshwork
OTHER STRUCTURES IN THE EYEBALL CONT’D
Vitreous body
• Encloses a watery fluid, the vitreous humor
• The vitreous humor is a transparent jelly-
like substance in the posterior four-fifths of
the eyeball posterior to the lens
• In addition to transmitting light, the
vitreous humor holds the retina in place
and supports the lens
 VASCULATURE OF THE EYEBALL
• The eyeball receives arterial blood primarily via the
ophthalmic artery- a branch of internal carotid
artery
• The ophthalmic artery gives rise to many branches,
which supply different components of the eye
• The central artery of the retina is the most
important branch- supplying the internal surface of
the retina
• Venous drainage is by the superior and inferior
ophthalmic veins which drains into the cavernous
sinus
 APPLIED ANATOMY
Fractures of the Bony Orbit
There are 2 major types of orbital fractures
• Orbital rim fracture- this is a fracture of the bones
forming the outer rim of the bony orbit
• Blowout fracture- partial herniation of the orbital
contents through one of its wall. The medial and
inferior walls are the weakest, with contents
herniating into the ethmoid and maxillary sinuses
Any fracture of the orbit will result in intra-orbit
pressure, raising the pressure in the orbit, causing
exophthalmus- protrusion of the eye
 APPLIED ANATOMY CONT’D
Cranial nerve palsies
Damage to one of the cranial nerves supplying the
extraocular muscles will cause paralysis of its
respective muscles
• Oculomotor nerve- the affected eye is displaced
laterally by lateral rectus and inferiorly by superior
oblique
• Trochlear nerve- no obvious affect of the resting
orientation of the eyeball, the patient will complain
of diplopia (double vision)
• Abducens nerve- affected eye will be adducted by
the resting tone of the medial rectus
 APPLIED ANATOMY CONT’D
Horner’s Syndrome
It refers to a triad of symptoms produced by damage to
the sympathetic trunk in the neck
• Partial ptosis- drooping of upper eyelid due to
denervation of the superior tarsal muscle
• Miosis- pupillary constriction due to denervation of
the dilator pupillae muscle
• Anhydrosis- absence of sweating on the ipsilateral side
of the face due to denervation of the sweat glands
Horner’s syndrome can represent serious pathology
such as tumour of apex of lung, aortic aneurysm or
thyroid carcinoma
 APPLIED ANATOMY CONT’D
Styes and Chalazion
Styes
• An infection of a hair follicle or Meibomian glands
around the eyelash
• If affecting the hair follicles, they are described as
external; if they affect the Meibomian glands they
are internal
Chalazion
• Painless granuloma of the Meibomian glands
• Can be distinguished from stye by the absence of
pain
 APPLIED ANATOMY CONT’D
Dacryoadenitis
It refers to inflammation of the lacrimal glands. It can
present acutely or chronically
• Acute dacryoadenitis- typically due to viral or
bacterial infection such as Epstein-Barr virus,
staphylococcus
• Chronic dacryoadenitis- usually due to a non-
infectious inflammatory condition such as sarcoidosis
Clinical features include swelling, pain and excess tear
production. The swelling can lead to visual impairment,
secondary to pressure on the eye
 APPLIED ANATOMY CONT’D
Glaucoma
It refers to a group of eye diseases that result in
damage to the optic nerve. There are 2 main clinical
classifications of glaucoma
• Open angle- where the outflow of aqueous
humor through the trabecular meshwork is
reduced. It causes a gradual reduction of
peripheral vision
• Closed angle- where the iris is forced against the
trabecular meshwork, preventing any drainage of
aqueous humor. It can rapidly lead to blindness
 APPLIED ANATOMY CONT’D
Papilloedema
• Refers to swelling of the optic disc that occurs
secondary to raised intracranial pressure
• Common causes include
– Intracerebral mass lesions
– Cerebral haemorrhage
– Meningitis
– Hydrocephalus
• The high pressure within the cranium resists venous
return from eye. This causes fluid to extravasate from
the blood vessels and collect in the retina, producing a
swollen optic disc