SPECIAL SENSES ANATOMY AND PHYSIOLOGY OF THE EYES

AY 2019 -2020 Dra. Matic

Module 8 02/27/2020
VISUAL SYSTEM
 Part of the CNS that enables the ability to process visual
details
 Analyses features such as color, brightness, form, detail, 3
dimensionality, and motion of an object
 Conveys more information to the brain than any other
afferent system
 Analogous to “Camera System” – the purpose is to focus an
image to make it sharp, not too bent and not too bright, just
enough
EMBRYOLOGY Figure 1. Early week 4: Optic vesicle forms a two-layered optic cup; overlying
 The eye is derived from 3 of the primitive embryonic layers: ectoderm forms a lens pit
1. Surface Ectoderm of the head
-gives rise to:
 lens
 lacrimal gland
 epithelium of the cornea
 conjunctiva
 adnexal glands
 epidermis of the lids
Neural crest (arises from the surface ectoderm)
 corneal keratocytes
 endothelium of the cornea
 trabecular meshwork
 stroma of the iris and choroid
 vitreous Figure 2. Late week 4: Optic cup deepens and forms inner and outer layers;
 optic nerve meninges lens pit forms lens vesicle
 orbital cartilage and bone
 orbital connective tissue and nerves
 extraocular muscles FUNCTIONAL ANATOMY OF THE EYES
 subepidermal layers of the lids A. BONY ORBIT
2. Neural ectoderm of the forebrain
 optic vesicle and optic cup
 retina and retinal pigment epithelium
 pigmented and nonpigmented layers of ciliary
epithelium
 dilator and sphincter muscles of the iris
 optic nerve fibers and ganglia
3. Mesoderm
 vitreous
 extraocular and lid muscles
 orbital and ocular vascular endothelium Figure 3. The 7 bony walls of the orbit
 Houses the eyeball; 4 walls, 7 bones
*endoderm does not enter into the formation of the eye  Protection to the globe
*Mesenchyme, derived from mesoderm or the neural crest,  Connection to adjacent spaces: fissures, canals, foramina
is the term for embryonic connective tissue.  The two orbits are separated by the ethmoidal sinuses
*Most of the mesenchyme of the head and neck is derived **The infection in the ethmoid sinus can travel to the orbit and may
from the neural crest cause cellulitis of the eye
 It has a limited space; the volume of the adult orbit is
 4 week embryo: optic vesicles bulge bilaterally from the 30cc/30ml including the globe (1/5) and the orbital soft
forebrain then elongate as optic stalks tissues (fat and muscles).
 Optic vesicle will be optic cup which form retina, iris, and  Orbital septum- anterior limit of the orbital cavity, acts as a
ciliary body. The mouth of the cup will form pupil. barrier between the lids and orbit.
 The optic cup has two layers: Inner layer forms nervous  lamina papyracea- paper-thin medial wall
layer of retina while the outer layer forms the pigmented  along with thin orbital floor are easily damaged by direct
layer of retina. trauma to the globe, resulting in a “blowout” fracture with
 Lens pits  lens vesicles herniation of orbital contents inferiorly into the maxillary
 Optic stalk forms optic nerve and invaginated by hyaloid antrum or medially into the ethmoid sinus.
artery which will be central retinal artery.

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 Figure 4. The four walls of the orbit. The inferior is the most commonly
fractured wall.

 Annulus of Zinn- fibrous ring formed by the common origin

of the 4 rectus muscles
 Protects the surface of the eye for injury and excessive light
 The tendinous ring straddles the superior orbital fissure and
 Aperture for clear vision
through it (from superior to inferior) pass:
 Keep the cornea moist by spreading lacrimal fluid
1. superior division of the oculomotor nerve (CN III)  Eyelid position: 1-2mm below the superior border of cornea
2. nasociliary nerve (a branch of the ophthalmic nerve)  Has 2 layers:
3. inferior division of the oculomotor nerve (CN III)
4. abducens nerve (CN VI)
 The medial portion of the ring also encompasses
the optic foramen through which the optic
nerveand ophthalmic artery pass.

Principal arterial supply of the orbit: Ophthalmic artery

Venous drainage: Superior and Inferior ophthalmic veins
Figure 6. Sagittal section of the eyelid
1. Anterior layer
Clinical Correlations:
 Made up of the skin
 No subcutaneous layer/fats
 Eyelid is the thinnest skin of the body
 Skeletal muscles: voluntary control of the eyelid
o Orbicularis oculi – for eyelid closure and blinking
o Levator palpebrae superioris – upper lid retractor. for
eyelid opening
o Inferior rectus- lower lid, main retractor
o MOTOR INNERVATION: CN III
B. EYELIDS
2. Posterior layer
 Tarsus:
o a fibrocartilaginous tissue that gives eyelid hard texture
o responsible for the eversion of the eyelids
o lined with Meibomian gland – responsible for oil
production (the oil prevents fast evaporation)
 Conjunctiva:
o A mucosal/smooth surface, which maintains the moist of
the surface of the eye
o Prevents desiccation (drying) of the eyes
o Palpebral conjunctiva: inner lining of the eyelids
o Bulbar conjunctiva: outer lining of the eyelids
Figure 5. Anatomy of the eyelid
**The conjunctiva of the eyelid is connected with the conjunctiva of
the globe because it needs two smooth surfaces rubbing each other
to lessen the friction

 SENSORY NERVE SUPPLY TO THE LIDS: CN V1 and

V2
Clinical Correlations:
1. Lesions/infections

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  Law of Equal Innervation
Muscle Origin Insertion Innervation Main Action
Its tendon passes through
Abducts,
Body of a fibrous ring or trochlea, Trochlear
Superior depresses, and
sphenoid changes its direction, and nerve
oblique medially rotates
bone inserts into sclera deep to (CN IV)
eyeball
superior rectus muscle
Anterior Abducts,
Inferior part of Sclera deep to lateral elevates, and
oblique floor of rectus muscle laterally rotates
2.Tumors – Benign (Nevus & Hemangioma) orbit eyeball
Elevates,
Malignant (Basal Cell Carcinoma) Superior adducts, and
3. Trauma – lid lacerations Oculomotor
rectus rotates eyeball
nerve
4. Ptosis- eyelid drooping. a feature of both Horner’s (CN III)
medially
syndrome and third nerve palsy Depresses,
Inferior Common adducts, and
Sclera just posterior to
rectus tendinous rotates eyeball
corneoscleral junction
ring laterally
Medial
Adducts eyeball
rectus
Abducent
Lateral
nerve Abducts eyeball
rectus
(CN VI)
C. LACRIMAL APPARATUS **Almost all extraocular muscles are innervated by CN 3 (Oculomotor)
EXCEPT: “SO4LR6” – Superior Oblique (CN 4 - Trochlear)
Lateral Rectus (CN 6 – Abducens)
Points to Remember:
1. All RECTI muscles are adductors EXCEPT lateral rectus which is an
abductor.
2. All OBLIQUES are abductors including LR.
3. All SUPERIOR muscles are intorters.
4. All INFERIOR muscles are extorters.
5. SO & IR are depressors.
6. IO & SR are elevators

Clinical Correlations: Strabismus (Squint)

Figure 7. The lacrimal system consist of lacrimal gland, lacrimal punctum,
lacrimal canaliculi, lacrimal sac, and nasolacrimal duct
 Responsible for tear production and drainage
 Tears maintain clarity and smoothness
 Consists of:
o Lacrimal gland – produces lacrimal fluid (tears) E. GLOBE (EYEBALL)
o Lacrimal punctum – entry way and exit (small
elevation with central small opening)
o location: medial end of posterior margin of the upper
and lower lids
o Lacrimal canaliculi – pump and collect tears
o Lacrimal sac – provides passage of lacrimal fluid
towards nasal cavity
o Nasolacrimal duct – empties lacrimal fluid into the
nasal cavity and drain into inferior nasal meatus

ARTERIAL SUPPLY of Lacrimal Gland: Lacrimal artery

VENOUS DRAINAGE: Ophthalmic vein
LYMPHATICS: Preauricular lymph nodes
NERVE SUPPLY of Lacrimal gland: Figure 9. Anatomy of the human eye
sensory: CN V1 The eyeball consists of three layers:
para: CN VII -great petrosal nerve 1. Fibrous layer (outer coat) – sclera, cornea, conjunctiva
sympa: deep petrosal nerve 2. Vascular layer (middle coat) – choroid, ciliary body, iris
3. Nervous layer (inner coat), consist of retina, which has
D. EXTRAOCULAR MUSCLES both optic and non-visual parts
FIBROUS LAYER
SCLERA
 A white area that extends from the back of the of the eye
toward the front
 Anteriorly: continues with the cornea (stops at the limbus)
 Posteriorly: continues with dural sheath of the optic nerve
 Thick outer coat of the eye
 Maintains the shape of the globe

CONJUNCTIVA
Figure 8. There are 6 voluntary muscles of the eye, 4 recti (superior, inferior,  Mucosa on top of sclera with blood vessels
medial, and lateral) and 2 oblique (superior and inferior) muscles.  Thin lining of the eyeball and the eyelid under surface
 Muscles that work together to move the superior eyelids o Palpebral conjunctiva: inner lining of the
and eyeballs. 4 rectus 2 obliques eyelids

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 o Bulbar conjunctiva: outer lining of the
eyelids
 Has glands that produce mucin – which is produce by
goblet cells found in the conjunctiva
 Maintain smoothness
 Vascular supply is through the anterior ciliary artery
 Innervated by the 1st division of CN V (Ophthalmic) –
reason why in cases of inflammation (conjunctivitis) it is
painful
**The tear film is consists of oil, water (in the middle), and mucin (at
the back). Figure 11. Colored middle coat of the eye – UVEA (Latin for grapes)

CILIARY BODY
 Provides attachment for the lens
 Production of fluid in the eye – aqueous humor
 Ciliary muscle-Control lens shape; for accommodation
and focus

IRIS
Clinical Correlations: Discharge and Redness
 Gives color to the eyes
 Anterior segment of the uveal tract
 Positioned in front of the lens, dividing the anterior
chamber from the posterior chamber.
 Regulates light entry through pupillary size
 Thin, contractile, pigmented diaphragm with a central
aperture, the pupil
 Control is autonomic

CORNEA PUPILLARY LIGHT REFLEX

 Major refractive surface  When you enter a dark room, your eyes will
 Clear anterior most part of the eyeball accommodate/adjust to dilate so that you can see
 No blood vessels (making the cornea transparent); no fluid  Pupillary constriction
 Perfect shape is a sphere o Parasympathetic stimulation/shining bright light –
 Refracts light circular fibers of sphincter muscles contract to
 Has 5 distinct layers (ABCDE): constrict the eye (miosis), to limit the amount of light
o Anterior Epithelium entering
–mostly stratified  Pupillary dilation
squamous, non- o Sympathetic stimulation/dark illumination – radial fibers
keratinizing of dilator pupillae contract to dilate the eye (mydriasis),
o Bowman’s layer – to increaseamount of light entering the eye
modified portion of
stroma Direct Reflex: shining light directly on pupil will constrict it
o Corneal stroma – Consensual Light Reflex: shining light on one pupil will
90% of the corneal constrict the other pupil as well
thickness Accommodation Reflex: the visual response for focusing on
o Descemet’s near objects. It also has the name of the accommodation-
membrane – basal convergence reflex or the near reflex. It is synkinesis which
lamina of the consists of the convergence of both eyes, contraction of the
endothelium ciliary muscle resulting in a change of lens shape
o Endothelium – Figure 10. Layers of
(accommodation), and pupillary constriction.
single layer of flat cells: cornea
important in maintaining the state of Clinical Correlations: Uvealitis – inflammation
Eyepain/Headache, Blurring, and Redness
dehydration(deturgescence)
**Recurrent uvealitis is secondary to systemic problems like
**When the cornea is not a perfect sphere or there is an area that is
glucose or TB. It may be a sign of something more serious.
flat or curved, the light rays will not bend to a specific point or it will go
to a different direction which result to a blurry image and lead to
astigmatism. NERVOUS LAYER
Clinical Correlations: Pain/Blurring of Vision RETINA
1.Keratitis – corneal ulcers  Light-sensitive innermost coat of the eye
2.Foreign body  Transmits light energy as nerve signals to the brain
3.Dry eye syndrome  Consists of:
o Outer pigmented layer: absorbs light and stores vit. A
VASCULAR LAYER aka UVEA o Inner neural layer: detects light using photoreceptors
CHOROID
and sends nerve impulses to the occipital lobe of
 Highly vascular. posterior segment of uveal tract. between cerebrum through the optic nerves
the retina and sclera
 When light enters the eyes, all the light rays converge in the
 Very important for the nourishment of retina retina
o Retina contain the photoreceptors

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 o 2 types of photoreceptors: Rods – detect tones of visual
images and Cones – which detect colors

MACULA LUTEA
 3mm diameter. Oval, yellowish area at the center of the
posterior retina
 Fovea – 1.5mm oval depression in the center of the
macula, thinnest part of the retina providing optimal visual
acuity

Figure 14. Flow of aqueous humor: Ciliary body  Posterior chamber 

Pupil  Anterior chamber  Iridocorneal angle  Trabecular meshwork 
Canal of Schlemm  Aqueous veins

VITREOUS HUMOR
 Fills the posterior surface of the lens and the retina
 99% water. 1% collagen and hyaluronan
 Gelatinous mass – containing collagen and hyaluronic acid
 Supports posterior surface of lens
Figure 12. Retina and optic nerve  Assists in holding the neural part against the pigmented
part of the retina
OTHER COMPONENTS OF THE EYEBALL  If this fluid is not at right consistency, the pressure is
A.CHAMBERS OF THE EYE reduced against the retina

B.OPTIC NERVE (CN II)

 Collection of nerve fibers
 Transmits visual information from eye to brain
 1.2M axons, 50mm long
 Synapses at the lateral geniculate nucleus
 4 segments:
o Intra-ocular (within the eyeball): also known as the
blind spot – only axons are present
o Intra-orbital (inside the bony orbit): lined by dura,
Figure 13. Chambers of eye and its angle arachnoid, and pia mater
o Intra-canalicular (optic canal): firmly anchored to the
Anterior Chamber bone
 Fluid filled space between the iris and the cornea o Intra-cranial: just before it becomes the optic chiasm
 Anterior chamber angle (iridocorneal angle) is where the  OPTIC CHIASM
fluid drains out of the eye  located at the junction of the floor and anterior wall of the
 Trabecular meshwork: aqueous humor will pass through third ventricle
this towards the canal of Schlemm  made up of the junction of the two optic nerves.
 nasal fibers-cross to the opposite optic tract
AQUEOUS HUMOR  temporal fibers-ipsilateral optic tract
 Free-flowing clear fluid
 Supports the wall of the eyeball and maintains its shape PRIMARY VISUAL CORTEX (area V1)
 Nourishes the cornea and lens - found in the occipital lobe in both cerebral hemispheres. It
 Intraocular pressure (Normal 11-21mmHg) surrounds and extends into a deep sulcus called the calcarine
 determined by the rate of aqueous production and the sulcus.
resistance to outflow of aqueous from the eye.
 GLAUCOMA- acquired chronic optic neuropathy C.LENS
characterized by optic disk cupping and visual field loss. It  Concave lens, avascular, transparent crystalline structure,
is usually associated with raised intraocular pressure. covered by capsule
 If the fluid cannot drain through the canal of Schlemm,  Focuses the image on the photoreceptors of the retina
pressure builds up Remember cornea and lens are both avascular
 Refraction of light
 Consists of mostly water (65%) and protein (35%)
o Highest protein content of any tissue in the body
 Suspensory ligament (zonular fibers) suspend it from the
ciliary processes (hold the lens in place)
 Contracts at accommodation
**Although most refraction is produced by the cornea, the convexity of
the lens, particularly its anterior surface, constantly varies to fine-tune
the focus of near or distant objects on the retina. (Moore)

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  Contracted ciliary muscle: Near objects are in sharp
focus to the retina

Figure 15.General Pathway of Light: Light stimulus  Cornea 

Aqueous humor  Pupillary opening of the iris  Lens  Vitreous
humor  Retina  Retinal photoreceptors
HYPERMETROPIA
REFRACTION OF LIGHT  Farsightedness
On the way to the retina, light waves pass through the  Light focused behind the retina
refractive media of the eyeball: cornea, aqueous humor,  Due to:
lens, and vitreous humor. (Moore) o Poor refractive power
o Eyeball is too short
 Refraction – bending of light rays at an angulated interface  Correction: (+) or convex lens
 Light rays travel differently thru different media **Kids are more hyperopic because of shorter eyeballs
 Different media – different Refractive Indeces (RI)
o When light passes through different RI, they MYOPIA
change speed and travel slower  Nearsightedness
 Aqueous humor and vitreous humor have the same RI  Light focused in front of the retina
 Light id angled as it passes through the cornea and lens.  Due to:
Hence, they are the two structures that contribute to o Lens with too much refractive power
refraction o Eyeball is too long
 Correction: (-) or concave lens

ASTIGMATISM
 Curvature of the lens is not uniform
 Multiple focal point
 Correction: cylindrical lens

PRESBYOPIA
 Lack of accommodation with age (40 years old)
 Lens far less elastic due to progressive protein denaturation
 Not an error of refraction
 Correction: (+) or convex lens

NICE TO KNOW:
When light enters the eye, it crosses at the lens, so the
image produced is inverted as it reaches the retina.

But why do we see upright images? Because eyes are only

the receptors, and eventually the brain will process
Figure 16. Dioptric power of the eye everything. All the impulses will be transmitted to the brain,
specifically in the visual cortex, which will finalize the
REFRACTIVE ERRORS image that you actually see.
 Light rays are not clearly focused on the retina
 Defects of focusing – discrepancy between the size of the
eye and refractive power of dioptric media

NORMAL VISION: EMMETROPIA

 No refractive error; normal
 Light focuses on the retina
 Relaxed ciliary muscle: Distant objects are in sharp focus
on the retina

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 **The eye is optically equivalent to the usual photographic camera.
It has a lens system, an aperture system equivalent to the pupil,
and a retina that corresponds to the film

Reference:
1) Moore, K. L., & Dalley, A. F. (2014). Clinically oriented
anatomy. 7th Ed. Philadelphia: Lippincott Williams & Wilkins.
2) Hall, J. E., & Guyton, A. C. (2016). Guyton & Hall textbook of
medical physiology 13th Ed. Philadelphia, PA: Saunders
Elsevier.
3) Sadler, T.W., & Langman, J. (2012). Langman’s medical
embryology. 12th Ed. Philadelphia: Lippincott Williams &
Wilkins.
4) Linda Constanzo. (2011). BRS Physiology. 5th Ed.
Philadelphia: Lippincott Williams & Wilkins.
5) Paul Riordan-Eva (2018). Vaughan & Asbury’s. General
Ophthalmology. 19th edition. McGraw-Hill Education, Inc.
6) Lecture by Dra. Matic

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