DYANA T. WATANIA

Anatomi dan Fisiologi Mata

ORBIT

Pear shapedVolume: ± 30 ccHeight: ± 35 mmWidth: ± 45 mmDepth: ± 40 – 45 mmInfluenced by: race and sex

ORBIT

7 bones:1. Frontal2. Zygomatic3. Maxillary4. Ethmoidal5. Sphenoid6. Lacrimal7. Palatine

ORBIT

ORBIT

Orbital margin Superior:

Frontal bone Medial:

Frontal bone Post lacrimal crest of lacrimal bone Ant lacrimal crest of maxillary bone

Inferior: Maxillary bone Zygomatic bone

Lateral: Zygomatic bone Frontal bone

ORBIT

ORBIT

Roof: Orbital plate of Frontal bone Lesser wing of Sphenoid bone

Lateral wall: Zygomatic bone Greater wing of Sphenoid bone

ORBIT

Floor: Maxillary bone Palatine bone Orbital plate of Zygomatic

Medial wall: Frontal process of Maxilla Lacrimal bone Orbtial plate of Ethmoid bone Lesser wing of Sphenoid bone

ORBIT

ORBIT

ORBIT

ORBIT

ORBIT

Foramina:1. Optic foramen2. Supraorbital foramen3. Anterior ethmoidal foramen4. Posterior ethmoidal foramen5. Zygomatic foramen

Duct: nasolacrimal ductCanal: infraorbital canal

ORBIT

Fissures: Superior:

Outside the annulus of Zinn1. Lacrimal N.2. Frontal N.3. Troclear N.4. Sup Ophthalmic vein

Inside the annulus of Zinn1. Sup and Inf div of Oculomotor N.2. Abducent N3. Nasocilliary branch4. Symphatetic roots of cilliary ganglion

Inferior: Inf. Ophthalmic vein Infraorbital and Zygomatic branch of V-2

ORBIT

ORBIT

Vascular supply 20 short posterior ciliary arteries (+10 short post

cilliary nerves) 2 long ciliary arteries (+nerves) Anterior ciliary arteries

Pairs in the sup, med, and inf rectus From ophthalmic artery Single from lacrimal artery in the lat rectus

ORBIT

Vortex veins: Drain: choroid, ciliary body, and iris Each eye: 4-7 veins (could more) Usually in each quadrant Exit 14-25 mm from the limbus Between the rectus mucles

ORBIT

ORBIT

NERVES

Cranial Nerves: 6 of 12 CN directly innervates the eye and periocular

tissue CN II – CN VII

3 CN innervates the EOM Oculomotor Nerve Troclear Nerve Abducent Nerve

NERVES

Ciliary Ganglion 1 cm in front of annulus of Zinn Lat to ophthalmic artery 3 roots

Long sensory root: 10-12 mm long From Nasociliary branch of V-1 Sensory fibres for conea, iris, and ciliary body

NERVES

Short motor root: From inferior div of CN III Synapse in the ganglion Carry parasymphatetic fibres Supply iris sphincter

Symphatetic root: From the plexus around internal carotid artery No synapse Supply: dilator muscle, ocular blood vessels

NERVES

NERVES

EXTRA OCULAR MUSCLES

7 EOM:1. Medial Rectus2. Lateral Rectus3. Superior Rectus4. Inferior Rectus5. Superior Oblique6. Inferior Oblique7. Levator Palpebrae Superioris

EXTRA OCULAR MUSCLES

Fuction:1. Med Rectus: Adduction2. Lat Rectus: Abduction3. Sup Rectus:

1’ Elevation 2’ Intortion 3’ Adduction

4. Inf Rectus: 1’ Depression 2’ Extortion 3’ Adduction

EXTRA OCULAR MUSCLES

5. Sup Oblique: 1’ Intortion 2’ Depression 3’ Abduction

6. Inferior Oblique: 1’ Extortion 2’ Elevation 3’ abduction

7. Levator Palp Sup: elevate the sup eyelid

EXTRA OCULAR MUSCLES

Innervation: CN III: Sup rectus, Med rectus, Inf rectus, Inf oblique,

Levator palp sup CN IV: Sup Oblique CN VI: Lat rectus

4 rectus muscles: annulus ZinnSpiral of Tillaux

EXTRA OCULAR MUSCLES

EXTRA OCULAR MUSCLES

EXTRA OCULAR MUSCLES

EXTRA OCULAR MUSCLES

EXTRA OCULAR MUSCLES

EYELID

EYELID

Skin Thinnest

Margin Punctum Meibomian orifices Gray line Eyelashes Glands of Zeiss Glands of Moll

Subcutaneous connective tissue Loose No fat

EYELID

Orbicularis oculi muscle CN VII Voluntary muscle Orbital part: prestarsal, preseptal Palpebral part

Septum: Thin connective tissue Act as barrier

EYELID

Levator muscle Whitnall’s ligament Muller’s mucle Anterior part Posterior part 50-55 mm long

Tarsus: Dense connective tissue No cartilage Length: 29 mm Thickness: 1 mm Height: 11 mm (upper tarsus), 4 mm (lower tarsus) Meibomian glands: 30-40(upper tarsus), 20-30(lower tarsus)

EYELID

EYELID

EYELID

EYELID

EYELID

EYELID

EYELID

Lymphatic drainage

EYELID

Conjuctiva Palpebral Foniceal Bulbar

EYELID

Vascular supply: Facial system – ext carotid artery Orbital system – int carotid artery

Superficial and deep plexusesArterial:

Marginal arterial arcade Peripheral arterial arcade

Venous: Superficial/pretarsal system – internal and external

jugular vein Deep/posttarsal system - cavernous sinus

EYELID

EYELID

Accessory structures:Caruncle

Small, fleshy, ovoid Sebaceous gland Fine colourless hairs

Plica semilunaris Narrow, highly vascular Crescent shape Rich in goblet cells

LACRIMAL SYSTEM

Secretory apparatusGlands:

Main: lacrimal gland 8-12 major lacrimal ducts Orbital and Palpebral parts

Accessory: Krause Wolfring

Secretion: Basal Reflex

LACRIMAL SYSTEM

Excretory:PunctaAmpullaCanaliculiCommon canaliculusLacrimal sacLacrimal duct → inferior turbinateValves:

Rosenmuller Hasner

LACRIMAL SYSTEM

LACRIMAL SYSTEM

LACRIMAL SYSTEM

LACRIMAL SYSTEM

Inervation:Afferent: V-1Efferent: sup. salvary nucleus →

intermediolat of N.VII → greater superf. Petrosal nerve → sphenopalatine ganglion → zygomaticotemporal nerve → lacrimal nerve

LACRIMAL SYSTEM

Tear film:1. Mucinuous layer:

goblet cell Even distribution Stabilize

2. Aqueous: lacrimal glands Intermediate layer

3. Oily layer: meibomian glands Reduces evaporation Stabilize

LACRIMAL SYSTEM

GLOBE

NOT a true sphereAP diameter: 23-25 mm3 compartments:

Anterior chamber Posterior chamber Vitreous cavity

GLOBE

CORNEA

5 layers:1. Epithelial2. Bowman’s layer3. Stromal layer4. Descemet’s membrane5. Endothelium

CORNEA

CORNEA

CORNEA

About 43 DThickness:

Central: 0.5 mm Peripheral: 0.7 mm

AsphericAverage diameter: 12 mmRadius: 7.4 -8.4 mmOptically clearAvascular

SCLERA

3 layers:1. Episclera2. Stroma3. Lamina fusca Thinnest: 0.3 mm behind the insertion of

rectus muscles Thickest: 1.0 mm around the optic nerve

head White Strong, act as skeleton

SCLERA

LIMBUS

important for 2 reasons: its relationship to the chamber angle its use as a surgical landmark

Structures:1. conjunctiva and limbal palisades2. Tenon's capsul3. Episclera4. corneoscleral stroma5. aqueous outflow apparatus

LIMBUS

surgical limbus : 2 equal zones: 1. an anterior bluish gray zone

overlying clear cornea and extending from Bowman's layer to Schwalbe‘s line

2. a posterior white zone overlying the trabecular meshwork and extending

from Schwalbe's line to the scleral spur, or iris root

LIMBUS

ANTERIOR CHAMBER

Bordered: anteriorly by the cornea posteriorly by the iris diaphragm and the pupil

AC angle:1. Schwalbe's line2. Schlemm's canal and the trabecular meshwork3. scleral spur4. anterior border of the ciliary body (where its

longitudinal fibers insert into the scleral spur)5. iris

ANTERIOR CHAMBER

ANTERIOR CHAMBER

deeper in aphakia, pseudophakia, and myopiashallower in hyperopia

TRABECULAR MESHWORK

a circular spongework of connective tissue lined by trabeculocytes

Divided into 3 layers:1. uveal portion2. corneoscleral meshwork3. juxtacanalicular tissue, which is directly

adjacent to Schlemm's canal

TRABECULAR MESHWORK

TRABECULAR MESHWORK

UVEAL TRACT

Consists of:1. iris2. ciliary body (located in the anterior uvea)3. choroid (located in the posterior uvea)firmly attached to the sclera at only 3 sites:

1. the scleral spur2. the exit points of the vortex veins3. the optic nerve

UVEAL TRACT

Iris Stroma Vessels and nerves Posterior pigmented layer Dilator muscle Sphicnter muscle

Variety in colour

UVEAL TRACT

UVEAL TRACT

Ciliary body Ciliary epithelium and stroma 2 parts:1. Pars plana2. Pars plicata Cilliary muscle:1. Longitudianal2. Radial3. Circular

UVEAL TRACT

UVEAL TRACT

Choroid: Posterior portion Perfusion: long and short posterior ciliary arteries 3 layers of vessels:1. Choriocapilaries - inner2. Small vessels - middle3. Large vessels – outer Drain: vortex vein

LENS

CapsuleEpitheliumFibresZonule of Zinn / suspensory ligament

LENS

RETINA

a thin, transparent structure that develops from the inner and outer layers of the optic cup

In cross section, from outer to inner retina, its layers are:

1. RPE and its basal lamina2. rod and cone inner and outer segments3. external limiting membrane4. outer nuclear layer (nuclei of the

photoreceptors)5. outer plexiform layer

RETINA

6. inner nuclear layer7. inner plexiform layer8. ganglion cell layer9. nerve fiber layer (axons of the ganglion

cells)10. internal limiting membrane

RETINA

RETINA

RETINA

Macula Clinical retina specialists tend toregard the macula as

the area within the temporal vascular arcades Histologically, it is the region with more than 1 layer

of ganglion cell nuclei macula lutea ("yellow spot")

Two major pigments: zeaxanthin and lutein

RETINA

VITREOUS

Occupies four fifths of the volume of the globe

Volume : close to 4.0 Mlgel-like structure99% waterConsists of:

fine collagen fibrils (chiefly type II) cells

VITREOUS

VITREOUS

TERIMA KASIH