Orbit and Ocular adnexa The Eye Embryology

Eyeball (2.5 cm) Eyelid = lid () Eyelash () Puntum () Medial & lateral canthus () Fornix () Iris () & pupil () Cornea () (1 cm) Limbus () (Bulbar) conjunctiva () Sclera ()

Cornea () Limbus () Conjunctiva () Anterior chamber () Iris () Posterior chamber () Lens () Vitreous () Iridocorneal angle () Ciliary body ()

Retina () Choroid () Sclera () Tenons capsule (= fascial sheath)

Bony Orbit:
Frontal bone Zygomatic bone Maxillary bone Ethomoidal bone Sphenoid bone Lacrimal bone Palatine bone

Medial wall: Maxilla, Sphenoid, Ethmoid, Lacrimal b.

Leteral wall: Greater wing of sphenoid Zygomiatica

Orbital floor: MaxillaPalatine Zygomatica Orbital roof: Frontal, lesser wing of sphenoid b.

Superior orbital fissure: Lesser wing of sphenoid greater wing of sphenoid

CN III CN IV CN V1 Superior ophthalmic vein

Inferior orbital fissure: sphenoidMaxilla Palatine

CN V2 Inferior ophthalmic vein

Vision: II (optic nerve) Sensation: V1 (ophthalmic nerve) Motor: III (oculomotor), IV (trochlear), VI (abducens) Pupil dilation: sympathetic Pupil constriction: parasympathetic Motor: VII (facial) not through the orbital apex -- orbicularis muscle
Frontal, lacrimal, nasocilliary

Sensory root form nasocilary branch of CN V1 Motor root form the inf. Division of CN III Sympathetic root form the internal carotid artery Parasympathetic axons form post-ganglionic fibers

(light reflex)

vision pupil constriction (parasympathetic)

(corneal) sensation orbicularis muscle blinking (motor) lacrimal tearing (parasympathetic)

1, 2 functions

Muscle

Innervation

Origin

Insertion

Primary function

Inserted Secondary Tertiary into the function function sclera distance

Intorsion Adduction 7.7mm

Superior rectus

Superior branch Annulus of Zinn of oculomotor from tendinous nerve ring Annulus of Zinn from tendinous ring

eye (anterior, superior surface)

Elevation

Inferior branch Inferior rectus of oculomotor nerve

eye (anterior, Depression Extorsion inferior surface) eye (anterior, Abduction lateral surface) eye (anterior, Adduction medial surface)

Adduction 6.5mm

Annulus of Zinn Lateral rectus Abducens nerve from tendinous ring Inferior branch Medial rectus of oculomotor nerve Annulus of Zinn from tendinous ring

6.9mm

5.5mm

Superior oblique

Annulus of Zinn via the Trochlea of superior Trochlear nerve oblique which forms a 'pulley system'.
Inferior branch of oculomotor nerve

eye (posterior, superior, lateral Intorsion surface)

Depression Abduction

Inferior oblique

Maxillary bone

eye (posterior, inferior, lateral Extorsion surface)

Elevation

Abduction

Outside to inside:
Skin Subcutaneous tissue Orbicularis oculi Orbital septum & tarsal plates M ller muscle (upper eyelid) Palpebral conjunctiva

Puntum (punta; ) Upper & lower calaniculus (canaliculi; ) Common calaniculus (90%) Lacrimal sac () Nasolacrimal duct ()

a. Lacrimal gland b. Superior lacrimal punctum c. Superior lacrimal canal d. Lacrimal sac e. Inferior lacrimal punctum f. Inferior lacrimal canal g. Nasolacrimal duct

Part Palpebral or tarsal conjunctiva

Area lines the eyelids

where the inner part of the eyelids and the eyeball meet, the palpebral conjunctiva is reflected at the superior fornix and the inferior fornix to become the bulbar conjunctiva. It is loose and flexible, Fornix conjunctiva allowing the free movement of the lids and eyeball. An ophthalmologist or optometrist can insert eye drops into the lower eyelid space. The substance works its way up the surface of the eyeball and diffuse into the internal eye.
Bulbar or ocular conjunctiva covers the eyeball, over the sclera. This region of the conjunctiva is bound tightly and moves with the eyeball movements.

(1) (2) (3) (4) (5)

Limbus Bulbar conjunctiva Forniceal conjunctiva Tarsal conjunctiva punctum

Anterior chamber: 250 L Posterior chamber: 60 L Vitreous cavity: 4~6 mL

Lens () Aperture
Pupil Cornea Lens ()

Film
Retina

Dark room
Sclera, choroid

Iris sphincter (parasym): Iris dilator (sympathetic)

Superficial oily layer

Predominantly by meibomian glands

Middle aqueous layer

Main and accessory lacrimal glands

Deep mucin layer

Conjunctival goblet cells

Contribute most refractive power: 43D Central cornea is thinner (0.5 mm) than periphery (0.7 mm)

1. 2. 3. 4. 5.

Epithelium Bowmans layer Stroma Descemets membrane Endothelium

Cover the posterior 4/5 of the surface of the globe Anterior opening: cornea Posterior opening: optic nerve
Thinnest (0.3mm): just behind the insertions of rectus muscles Thickest (1.0mm): posterior pole around the optic nerve head

Conjunctiva and limbal palisades Tenons capsule Episclera Corneoscleral stroma Aqueous outflow apparatus

Anterior border: cornea Posterior border: iris diaphragm of the pupil

Ciliary process: zonule (lens suspension) Ciliary epithelium: aqueous secretion (Trabecular meshwork: absorption) Ciliary muscle: lens thickening (accommodation; near vision) Ciliary vessels: nutrition

Anterior chamber Posterior chamber Vitreous

Iridocorneal angle Trabecular meshwork

Ciliary epithelium

Biconvex structure Contribute 20D of focusing power Accommodation ability: deceased by aging
Adolescents: 12-16D Age 50: 2D

Lacks vasculature and innervations Hardens by aging: senile cataract

2 functions:
As a transparent gel occupying the major volume of the globe As a route of nutrition to lens

98% of water and 0.15% macromolecules

2 major components: collagen and hyaluronan

Progressive liquefaction with age

Cup / Disc 10 layers

1 2 3

Foveola Fovea (centralis)

5 6 7 8 9 10

Macula (lutea)

Phtoreceptors:
Rods + 3 types of cones

Bipolar cells:
Rod on bipolars Cone on- and offbipolars

Interneurons
Horizontal and amacrine cells

Ganglion cells
Forming optic nerve

Macula lutea (yellow spot)

Major element: Zeaxanthin and lutein

Fovea is a concave central retinal depression approximately 1.5 mm in diameter

Only cones in fovea

3 parts:
Iris Ciliary body (located in the anterior uvea) Choroid ( located in the posterior uvea)

Firmly attached to 3 sites:

Scleral spur Vortex veins Optic nerve

Sphincter muscle
Parasympathetic innervation

Dilator muscle Posterior pigmented layer

Sympathetic 1-adrenergic stimulation Continuous with the non-pigmented epithelium of ciliary body

Ciliary epithelium and stroma

Pars plana Pars plicata Inner non-pigmented epithelium Pigmented epithelium

Ciliary muscle
Longitudinal Radial Circular

3 layers
Choriocapillaries (innermost) Small vessels (middle) Large vessels (outer)

Nourish the outer portion of retina

Regional Differences in the Optic Nerve

Segment Intraocular Optic disc Pre-laminar Laminar Intraorbital Intracanalicular Length (mm) 1.0 Diameter (mm) Blood Supply Retinal arterioles 1.5X1.75

Branches of posterior ciliary arteries

25 4-10

3-4

Intraneural branches of central retinal artery; pial branches from CRA and choroid Ophthalmic artery

Intracranial

10

4-7

Branches of internal carotid and ophthalmic artery

Internal carotic artery Ophthalmic artery 7 anterior ciliary a. (ACA) (4 rectus m., anterior segment) 20 short posterior ciliary a. (SPCA) (choroid, outer 1/3 retina, anterior segment) 2 long posterior ciliary a. (LPCA) (the same as above) 1 central retinal a. 4 branches (inner 2/3 retina)

Optic Optic Optic Optic

sulcus pit vesicle cup

Lens placode Lens vesicle

Derivatives of Embryonic Tissues

Neuroectoderm
Neurosensary retina Retinal pigment epithelium Pigmented ciliary epithelium Non-pigmented ciliary epithelium Sphincter and dilator muscles of iris Optic nerve, axons and glia Vitreous Corneal stroma and endothelium Sclera Trabecular meshwork Sheaths and tendons of extraocular muscles Connective tissues of iris Ciliary muscles Choroidal stroma Melanocytes (uveal and epithelial) Meningeal sheaths of the optic nerve Schwann cells of cliary nerves Ciliary ganglion Cartilage Connective tissues of orbit

Surface Ectoderm

Epithelium, glands, cilia of skin of eyelids and carnucle Conjunctival epithelium Lens Lacrimal gland Lacrimal drainage system Vitreous

Neural Crest Cells

Mesoderm

Fibers of extraocular muscles Endothelial lining of all orbital and ocular blood vessels Temporal portion of sclera Vitreous