Kuliah Anatomi Fisiologi Dr.bram

7/26/2019 Kuliah Anatomi Fisiologi Dr.bram

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Anatomy and Physiology

of The Eyes

Dr.Nurcahya Ardian Bramantha,SpMOphthalmology Department

Kasih Ibu Hospital



IK MAM!" M#N$#%ASKAN S&"K"&ANAOMI O&BIA, B"%B"S OK"%I DAN

O&'AN AKS#SO&I"S S#&A ("N'SIN)A



#ye small *ery important+unctionMata ecil memilii +ungsi

sangat penting-/ in+ormation *isual-/ in+omasi penglihatan



EYE

Surrounded by orbitalbonesDikelilingi oleh tulang mataCushioned by pads of fatDilindungi oleh bantalan

lemak Extraocular muscles helpmove the eye in dierentdirections!tot mata luar membentupergerakan mata pada

arah yang berla"anan





!#$%T



O&BIA

• O&BIA% MA&'IN (O&M#D B) 0

– (&ONA%

– 1)'OMAI2

– MA3I%%A

• S"!#&IO& MA&'IN (O&M#D B) OS. (&ONA%

–S"!&AO&BIA% (O&AM#N

• IN(#&IO& MA&'IN (O&M#D B) OS. 1)'OMAI2 4 MA3I%%A

– IN(&AO&BIA (O&AM#N

• %A#&A% MA&'IN (O&M#D B) 1)MOMAI2 !&O2. O( (&ONA%

BON# 4 (&ONA% !&O2. O( 1)'OMAI2 BON#

• M#DIA% MA&'IN (O&M#D B) MA3I%%A BON#

– (OSSA SA22I %A2&IMA%IS



Orbital 5all

!rbital #oof&'rontal bone kl( lakrimal di fossalacrimalisSphenoid bone

)ateral *all&SP+E,!%D bone-ygomatic bone strongest



Orbital 5all

!rbital 'loor&

'ormed by & .axilla bone/ 0ygomatic bone 1Palatine bone

$ts dg lateral 2ssura orbitalis inf or

)empeng orbital tlg .axilla blo"out fractures

.edial *all&

Ethmoid bone paper thin ke antor menebal

)acrimal bone

'rontal bone

!rbital Apex optic nerve canal



$lood Supply

• Arteries& – %ntracranial %nternal Carotid a3 4st

branch& !phthalmic a3 passes

beneath 1 accompanies , %%/branches as&• Central #etinal a3 enters the , %%/ 5 6 47

mm behind the globe

• )acrimal a3 lacrimal glds 1 eyelid• )ong 1 Short postor Ciliary a3 uvea

• .uscular branches antor Ciliary a3



$lood Supply

• 8Arteries& – Short postor Ciliary a3 , %% 9

choroid

– )ong postor Ciliary a3 ciliary body9 ma(or arterial circle: of the iris;anastomose "< antor Ciliary a3=

–

Antor

Ciliary a3 antor

sclera/episclera/ limbus/ con(unctiva/ :





$)!!D S>PP)Y

• ?eins& – Supor 1 %nf or !phthalmic v3

• Communicate "< Cavernous sinus 1

Pterygoid venous• Drain the skin of the periorbital skin

lethal cavernous sinus thrombosis

;in cellulitis periorbital=

– Antor Ciliary v3

– Central #etinal v3



Annulus of Zinn



#)# BA%%



C!,@>,CT%?A

Transparent

Covers postor palp 1 antor surface of sclera

Continuous "<&

o The lid margin;mucocutaneous (unc=

Palpebral con(

o 'ornices ;supor 1 inf or=

o The limbus ;corneal

epithelium= $ulbarcon(



C!,@>,CT%?A

8The Con(unctiva&

Palpebral Con( 2rmly

adherent to the tarsus

$ulbar Con( loosely

attached to Tenon’scapsule



TE,!, CAPS>)E•'ibrous membrane/ envelopes from limbus to , %%

•)imbus Con(/ Tenons/ Episclera 2xed together

•Posteriorly lies the sclera/ contact "< orbital structure1 muscle cone



SC)E#A 1 EP%SC)E#A

– 'ibrous ;collagen=

– Antor corneaB postor scleral foramen ;laminacribrosa= pass the axon bundle of the , %%

– Antor sclera episclera ;thin/ elastic/ blood

vessels= – %nner surface lamina fusca ;pigment/ outer

layer of suprachoroidal space=



SC)E#A 1 EP%SC)E#A

– Thickness& / mm ;at insertion ofmuscle= 6 / mm

– Penetrated around the , %%&• Short 1 long postor ciliary arteries• Short 1 long ciliary nerve

– )ong postor ciliary a3 1 long ciliary n3pass in shallo" groove at 1 F o’clockmeridians

–

G antor

ciliary a3 1 v3 penetrate G mmfrom limbus – ,erve supply& ciliary nerve



C!#,EA

•

Transparant/ avascular• Thick & 77 Hm ;central=

• Ivertical & 43mm

• Ihori0ontal & 443Jmm

• ,erve supply & ?4

• Corneal layers &• Epitel

• .embr $o"man

• Stroma

• .embr Descemet

• Endotel



>?EA) T#ACT

%#%S

Pigmented/ Extension ofciliary body

Dividing the C!A 1 C!P

Central round aperture

Pupil balance of

parasympathetic ;m3Sphincter pupillae/ , %%%= 1sympathetic ;m3 Dilatorpupillae= activity

$lood supply& .a(or circle ofthe iris

,erve supply ;sensory=&Ciliary nerve



C!#P>S C%)%A#%S

•Pars plicata ciliary process

aKueous formation

• Pars plana ;G mm/posteriorly=

• Epithelium& nonpigmented/

pigmented• Ciliary muscle&

• Circular 1 radial 2bers

contract 1 relax 0onular 2bers

• )ongitudinal 2bers open

pore of T.• $lood 1 nerve supply&

L %ris/ through ?ortex veins

ACC!.!DAT%!,



C+!#!%D

•

$et"een sclera 6 retina• Dark bro"n

• Pigmented / vasculari0ed

• ,utrision 4< outer retina/

vitreus/ lens

• Choroidal blood vessels&• ChorioMcapillaris

• Drainage& ?ortex veins



)ens

G mm thick/ F mm N/$iconvex/ avascular/colorless/ almost completelytransparent

7O "ater/ 7O protein 9

trace mineralsSupported by 0onule of -innat eKuator 6 corpus ciliaris

Capsule& semipermeablemembrane

Potassium in the lensAscorbic/ Qlutathione









%ridocorneal Angle

• AKuous outRo"• @unc of peripheral cornea 6 iris root• Sch"albe line 6 Trabecular mesh"ork 6 can3schlemms M

collector channels 9 4U aKueous veins episcleral venous system



?itreus

Clear/ avascular/ gelatinous body ;FFO "ater/ 4Ocollagen 9 hyaluronic acid=/ U< volume 1 "eight ofthe eyeball

!uter surface hyaloid membrane contact "<

postor lens capsule/ 0onular 2bers/ pars planaepithelium/ retina/ , %% head

?itreous base ;attachment=& pars plana epithelium 1retina (ust behind the ora serrata



#ET%,A

Semitransparent/multilayered/ U< postor inner aspect of globe

!ra serrata

anterior edge of retina

;ragged edge=/7 mm behind S);temporal=/ 7/J mm ;nasal=

At the P, %% 1 !ra Serrataret 1 #PE 2rmly bound

limiting ret detachment

Thickness& /4 mm at !S//7 mm at postor pole





#ET%,A

.acula&•Postor pole/

•7/7 6 / mm N

• mm N center maculalutea "< fovea centralis

Vanthophyll /photoreceptors

•4/7 mm N center retinalavascular 0one

•/U7 mm N center foveola;thinnest part of retina=

cone photoreceptor



#ET%,A

– $lood supply&

• Choriocapillaris&

– 4< outer 9 fovea irreparable damage

"hen #D

– 'enestrated

– $lood barrier #PE

• Central retinal artery

–

U< inner – ,onfenestrated blood retinal barrier





EVT#A!C>)A# .>SC)ES

%,SE#T%!, of #ECT .>SC)ES



A2IONS

.>SC)ES

.edial#ectus

Adduction

)ateral#ectus

Abduction

Superior#ectus

Elevation %ntorsion Adduction

%nferior#ectus

Depression

Extorsion Adduction

!bliKue

Sup

%ntorsion Depressio

n

Abduction

!bliKue%nf

extorsion Elevation Abduction



EVT#A!C>)A# .>SC)ES

• $lood Supply&

– !phthalmic artery ;muscular branch=

– Also&

• )ateral rectus m3 )acrimal artery

• %nferior !bliKue m3 %nfraorbital

artery

• ,erve Supply&

– , %%% S#/ .#/ %#/ %!

– , %? S!

– , ?% )#



O2"%A& ADN#3A

• #)#B&O5S

• #)#%IDS

•

A!!A&A"S %A2&IMA%IS



O2"%A& ADN#3A

EYE$#!*S

The folds of thickenedskin

Covered "< hair

The Qlabella hairlessbet"een U eyebro"s

EYE)%DS

Skin )ayer

!rbicularis !culi.uscle ;!!.=

Areolar TissueTarsal Plate

Palpebral Con(unctiva





EYE)%D

43 Skin )ayer&– Thin/ loose/ elastic

– 'e" hair follicles

–

,! subcutaneous fatU3 !!.&– Concentric close the lids

– %nside the lid& Pretarsal 1 Preseptal

portion– !utside the lid& Spread around the

orbital margin ;orbital portion=

– Supplied by , ?%%



EYE)%



EYE)%D

3 Areolar Tissue&– Submuscular communicates "<

aponeurotic layers

G3 Tarsal Plate&

–.ain supporting structure of the lids

dense 2brous 1 elastic tissue– )ateral 1 medial attached to orbital

margins by palpebral ligaments–

>pper 1 )o"er thin fascia ;!rbitalSeptum=

73 Palpebral Con(unctiva&– Adhere 2rmly to the tarsal plate



• The )id .argins& – Q#AY )%,E mucocutaneous (unction

– Anterior .argin&• Eyelashes upper/ up"ardB lo"er/ do"n"ard

• Qlands of -eis sebaceous glds at base ofeyelashes

• Qlands of .oll s"eat glds

Posterior .argin&

•Small ori2ces of meibomian < tarsal glds

– )acrimal Punctum&• .edial end of the postor margins



• Palpebral 'issure& – )ateral canthus /7 cm from orb rim

– .edial canthus more elliptic/

surround lacrimal lake&• )acr caruncle modf3 s"eat 1 sebaceousglds

• Plica semilunaris rd eyelid of lo"eranimal sp

– Epicanthus&• ,ormal in Asian population 1 Young infants

• +iding caruncle



• !rbital Septum& – )ies bet"een !rb rim 1 tarsus

– Serves as barrier

– Pierced by&• the several vessels 1 nerves ;lacrimal/

supra<infratrochlear/ supraorbital=

• )evator palp superior muscle ;)PS.=

– $lends "<&• Supor& Tendon of )PS. 1 supor tarsus

• %nf or& inf or tarsus





• )id #etractors& –

.usculofacial complex ;striated 1 smoothmuscles= !pening the eyelids

– >pper lid m3 )evator Palp Supor/ divided into&

• Aponeurosis ;antor= elevate antor lamella

• .uller’s muscle ;smooth m3 2bers=elevating postor lamella

inserting supor eyelid into postor surface of!!. upper lid skin crease

– )o"er lid m3 #ectus %nf or

– Smooth muscle innervated by sympatheticnerves

– Striated muscle innervated by , %%%



O2"%A& ADN#3A

• $lood Supply 1 )ymphatics& – Arteries&

• )acrimal 1 !phthalmic arteries ;lat 1 medbranches= anastomoses& submusc3

Areolar tissue – ?eins&

• Arranged in pre 1 post tarsal plexuses

• %nto !phthalmic veins

– )ymphatics&• )ateral side preauricular 1 parotid nodes

• .edial side submandibular l3n3



O2"%A& ADN#3A

• The )acrimal Apparatus&

– The lacrimal complex&• The .ain )acrimal glds

• The Accessory )acrimal glds• The Canaliculi

• The )acrimal sac

• The ,asolacrimal duct





• The .ain )acrimal Qlands&

– !rbital portion&

• %n the lacrimal fossa

• Separated from palp3 portion by lateralhorn of m3 )evator Palp

– Palpebral portion&• @ust above the temporal segment of the

supor con( fornix• Secretory ducts "< 4 ori2cies connects

orb 1 palp portion to the supor con( fornix





• The Accessory )acrimal Qlands& – Wrause 1 *olfring glds subs

propria palp con(

• Drainage of tear& – )acr lake upper<lo"er puncta

canaliculi lacr sac nasolacrduct meatus nasal cavity

– .echanism& capillary attraction/gravity/ blinking 1 pumping actionby +orner’s muscle



%acrimal Apparatus

• ear secretion.

• %ayers o+ precorneal tear 6lm.

• Drainage o+ tear.



• $lood 1 )ymphatic supply&

– Arteries& )acrimal artery

– ?eins& (oins "< !phthalmic vein

– )ymph drainage& (oins "< con( lymphaticpreauricular l3n3

• ,erve supply&

– Sensory& )acrimal nerve ;4st div of , ?=

–

Secretory& Qreat Petrosal nerve ;from suporsalivary nucl=

– Sympathetic nerve& accompanying the)acrimal artery 1 nerve



!PT%C ,E#?E

The %ntra ocular&4/7 mm N

The %ntra orbital&U7 6 mmB mm N

The !ptic Chiasm&,ear the top of sella tursica

Decussation

The #etrochiasmatic





HANK )O"

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Kuliah Anatomi Fisiologi Dr.bram