Ophthalmic Anatomy

Front 1

Epibulbar (mucosal) epithelium

Back 1

+goblet cells, NO rete ridges, keratin nor granular layer

Front 2

epidermis

Back 2

+rete ridges, keratin, granular layer, NO goblet cells

Front 3

conjunctival epithelium

Back 3

mucin secreting goblet cells

Front 4

corneal epithelium

Back 4

NO mucin secretors

Front 5

Skin layers:
Basal cell

Back 5

cuboid or columnar w/ large nuclei aligned in single row above BM

Front 6

skin layers:
Prickle cell

Back 6

polygonal w/ numerous hairlike filamentous connections btwn cells

Front 7

skin layers:
Granular

Back 7

flat, long squamous cells w/ multiple keratohyaline granules

Front 8

skin layers:
Keratin

Back 8

multiple eosinophilic layers of protein w/ no cellular details visible

Front 9

Tears
Mucus

Back 9

innermost layer; secreted by conj; permits smooth/even distribution over corneal epi

Front 10

Tears
Aqeous

Back 10

middle layer; secreted by glands or Crause & Wolfring; permits diffusion of O2 & metabolites to the cornea; >90% of tear volume

Front 11

tears
lipid

Back 11

outermost layer; secreted by meibomian glands; retards tear evaporation

Front 12

corneal thickness

Back 12

superior>nasal>inferior>temporal

Front 13

Schwalbes line

Back 13

junction between K endo & nonpigmented TM endo

Front 14

Muller cells

Back 14

nuclei in INL; modified glial cells; basal process extend to form ILM; outer cell processes extend beyond ONL & are connected to photoreceptors by terminal bars (AKA ELM)

Front 15

NFL

Back 15

clinical significance=JXR, reticular retinoschisis

Front 16

inner plexiform layer

Back 16

axons of bipolar & amacrine cells & synapses of ganglion cells

Front 17

inner nuclear layer

Back 17

retinal BVs supply inner 1/3 (& all layers superficial to this)

Front 18

outer plexiform layer

Back 18

connections btwn photoreceptors, horizontal cells, bipolar cells
In macula=Henle’s layer; Clinical significance=CME; senile retinoschisis

Front 19

outer nuclear layer

Back 19

Photoreceptors nuclei

Front 20

ILM

Back 20

footplates of muller cells; discontinuous over lattice degen

Front 21

RPE

Back 21

interdigitates w/ apical processes or rod & cone segments; densely adherent to Bruchs; taller w/ more pigment in macula; comprise outer blood-retinal barrier

Front 22

bruch's membrane

Back 22

5 layers: RPE basement membrane (BM), Inner collagenous zone (ICZ), elastic layer, OCZ, choriocapillaris BM

Front 23

choriocapillaris

Back 23

circulation from posterior ciliary arteries (i.e. no communication w/ ophthalmic artery)

Front 24

macula

Back 24

rods: cones=12:1 (up to 20:1); rod density is greatest 20-40 deg eccentric to fovea; cone density is greatest at fovea; at fovea, rods=cones; cones=40-50% are outside of macula

Front 25

blood retinal barrier

Back 25

inner=BV endothelium; outer=RPE

Front 26

aqueous

Back 26

more acidic & hypertonic than plasma; 15 x more ascorbate, sig less protein (0.2% vs 7%)

Front 27

Conventional aqueous outflow

Back 27

TM, Schlemm’s, episcleral/conj veins (85-90%), IOP dependent

Front 28

Non-Conventional aqueous outflow

Back 28

uveoscleral (10-15%), independent of IOP

Front 29

Optic canal

Back 29

in lesser wing of sphenoid, 8-10mm long & 6.5mm wide @ optic foramen; sympathetics, ON, ophthalmic art, nasociliary n, CN3, CN6

Front 30

Ethmoidal foramina

Back 30

at jxn of ethmoid & frontal bones

Front 31

Sup orb fissure

Back 31

separated from optic canal by bony optic strut; CN4, lacrimal & fronal N, sup orbital vein

Front 32

Inf orb fissure

Back 32

CN V2 (maxillary N), sphenopalatine ganglion branches, zygomatic N, Inf orb V;
walls: medially=maxilla; anteriorly=zygomatic; laterally=Gr wing of sphenoid & palatine bone

Front 33

Orbit Floor

Back 33

MaPZ (maxilla, palatine, zygomatic)

Front 34

Orbit Medial wall

Back 34

maxilla, lacrimal, ethmoid, medial part of frontal

Front 35

Whitnall’s Lat orbital tubercle

Back 35

entirely on zygomatic bone (2mm inf to frontozygomatic suture)
Lockwoods ligament
Lateral rectus check ligament
Lateral canthal tendon
Lateral horn of levator aponeurosis

Front 36

Lockwoods ligament

Back 36

globe hammock; part of lower lid retractor system (w/ intermuscular septae & tenons); posterior—arises from fibrous attachments on inf side of inf rectus; extends anteriorly as capsulopalpebral fascia (lower lid retractor); medial & lateral horns—attach to retinacula (media= posterior lacrimal crest; lateral= Whitnall’s tubercle)

Front 37

Whitnall’s ligament

Back 37

superior transverse ligament; sheath of ant levator muscle; 10mm superior to tubercle attaching to frontal bone & lacrimal gland capsule
laterally—arises from compact sheath of ant levator & attaches to capsule of lacrimal gland & lateral orbital wall above lat orb tubercle;
medially—arrises from trochlea; +extensions to retinacula; limits eyelid elevation

Front 38

orbital septum

Back 38

fibrous sheet arises from arcus marginalis (jxn of orbital periosteum & pericranium; fuses on ant surface of levator (upper) & retractor (lower) aponeurosis w/ pre-aponeurotic fat separating

Front 39

Lacrimal Sac fossa

Back 39

bound by lacrimal (post lacrimal crest) & maxillary bones (ant lacrimal crest); in DCR, ostomy is made in maxillolacrimal suture line; lined by pseudostratified columnar epi; ant to septum (not w/in orbit); orbicularis contracts (CN 7)-->preseptal portion puts traction on lacrimal diaphragm (fascia lateral to sac)-->lacrimal pump process

Front 40

lacrimal Ducts

Back 40

3-5mm into inferior meatus before opening at valve of hasner (mucosal fold)

Front 41

lacrimal gland

Back 41

in frontal bone in ant lat orbit; orb & palpebral lobes are separated by lateral horn of levator; orbital lobe empties into palpebral lobe which empties into conj fornix; blood supply from lacrimal artery (branch of ophthalmic artery)

Front 42

Accessory lacrimal Krause & Wolfing (lid)

Back 42

eccrine
aqueous

Front 43

Accessory lacrimal glands in plica & caruncle

Back 43

eccrine
aqueous (Sebaceous)

Front 44

meibomiam gland

Back 44

holocrine
oil

Front 45

glands of zeiss

Back 45

follicles of cilia & caruncle
holocrine
oil

Front 46

glands of moll

Back 46

apocrine
mucus

Front 47

Goblet cell:

Back 47

in conj, plica, caruncle
holocrine
mucus

Front 48

typical sweat gland

Back 48

eccrine

Front 49

lacrimal gland

Back 49

eccrine
aqueous

Front 50

vascular supply to cardinal muscles

Back 50

Lacrimal artery—supplies lateral rectus (1 vessel); all others=ophthalmic artery

Front 51

Annulus of Zinn

Back 51

origin of all 4 recti; Sup oblique & levator are superior to annulus; inf oblique originates medially on the maxilla

Front 52

Innervation of muscles

Back 52

superior (oblique & recus) are innervated by contralateral nuclei
all others have ipsilateral innervation

Front 53

Smallest muscle belly

Back 53

Superior oblique

Front 54

Longest tendon

Back 54

Superior oblique

Front 55

shortest tendon

Back 55

inferior oblique

Front 56

Superior oblique

Back 56

Anatomic origin at orbital apeax. Mechanical origin at trochlea. Max effect when adducted 51 deg

Front 57

Inferior oblique

Back 57

Anatomic & mechanical origin both from anteromedial orbital floor

Front 58

Superior rectus

Back 58

Recession=widening of palpebral fissure; resection=narrowing of fissure as SR is loosely attached to levator complex

Front 59

Inferior rectus

Back 59

Recession=widening of palpebral fissure; resection=narrowing of fissure as IR’s sheatrh gives rise to capsulopapebral fascia

Front 60

Twitch movement

Back 60

Glycolysis; en plaque innervations

Front 61

Tonic movement

Back 61

Aerobic metabolism; en grappe innervation

Front 62

neuromuscular innervation

Back 62

Muscle is innervated at posterior 1/3, anterior 2/3 junction

Front 63

V1 (ophthalmic)

Back 63

"NFL" (nasociliary, frontal, lacrimal);
Frontal-->supraorbital & supratrochlear N

Front 64

V2 (maxillary)

Back 64

goes through foramen rotundum: infraorbital, zygomatic, sup alveolar N, pterygopalatine ganglion
Zygomatic-->zygomaticofacial & zygomaticotemporal

Front 65

Sup Orb Fissure

Back 65

CN 3,4,V1 & 6

Front 66

Inf Orb fissure

Back 66

CN V2

Front 67

Optic nerve

Back 67

intracranial portion has little slack; (“125-1017”=1 intraocular, 25=intraorbital, 10=intracanalicular, 17=intracranial); enters skull inf to frontal lobe & ACA & medial to ICA & is then no longer sheathed

Front 68

Optic chiasm

Back 68

inf fibers cross first; post portion=macular fibers; ~1cm above pituitary

Front 69

Lat geniculate body

Back 69

ipsilateral=2,3,5; contralateral=1,4,6

Front 70

Optic radiations

Back 70

inf radiations pass close to internal capsule—infarct-->sup hemianopic contralateral VF defect & contralat hemiparesis

Front 71

Fused central nucleus

Back 71

levator palpebrae

Front 72

Eyelid functions

Back 72

closure = CN7; Opening=CN3 (levator) & sympathetics (Muellers)

Front 73

Pupil constriction

Back 73

parasymp run w/ CN3-->ciliary ganglion-->short ciliary N

Front 74

Pupil sympathetic pathway

Back 74

3 neuron chain:
1)hypothalamus-->along brainstem-->
2) Intermediolateral column of spinal cord (ciliospinal center of budge (C8-T2))-->exits brainstem @ T1 & joins cervical sympathetic chain-->
3)superior cervical ganglion -->travels along carotid plexus -->branches join ophthalmic division of V1-->through ciliary ganglion to nasociliary & short ciliary nerve

Front 75

Vertical gaze

Back 75

1) frontal lobe (Frontal eye fields or superior colliculus)-->
2) rostral interstitial nucleus of MLF -->deccusates-->CN III & IV nuclei; pursuit control is aided by interstitial nucleus of Cajal

Front 76

Horiz. Gaze

Back 76

PPRF

Front 77

Lacrimation

Back 77

parasympathetics (from sup salivatory glands) leave brain w/ nervous intermedius (glossopalatine N) & travel w/ CN7 through Gr petrosal canal & geniculate ganglion (after emerging from canal, now called Gr superficial petrosal N)-->joined by deep petrosal N sympatheticenter pterygoid canal (vidian canal)-->extis canal (now called vidian N) to SYNAPSE in pterygopalatine/sphenopalatine ganglion to join CN V2-->lacrimal gland

Front 78

eyelid Layers

Back 78

skin, orbicularis, tarsus, muellers, conj

Front 79

Gray line

Back 79

marginal edge of pretarsal orbicularis (muscle of Riolan)

Front 80

eyelid vascular supply

Back 80

Internal carotid-->ophthalmic (orbital) artery; External carotid-->facial artery-->transverse facial artery-->angular & malar branches

Front 81

Medial canthal tendon

Back 81

anterior—attaches to frontal process of maxilla-->origin of superficial head of pretarsal orbicularis;
posterior—inserts on posterior lacrimal crest & fossa

Front 82

Orbicularis

Back 82

fxn=lid closure, brow depression, tear drainage; CN7

Front 83

orbicularis:
orbital

Back 83

anterior limb to medial canthal tendon & periosteum== forced lid closure; superiorly-->continuous w/ corrugators

Front 84

orbicularis
Preseptal

Back 84

wraps around lacrimal sac & post lacrimal crest; laterally forms lateral palpebral raphe overlying lateral orbital rim

Front 85

orbicularis
Pretarsal

Back 85

post lacrimal crest & ant limb of medial & lat canthal; medially heads: 1)superficial --> medial canthal tendon 2)deep --> horners tensor tarsi -->inserts @ post lacrimal crest encircling canaliculi to facilitate tear drainage; laterally: lateral palpebral tendon attaches to lateral retinaculum --> atttaches to lateral orbital tubercle of Whitnall

Front 86

Corrugators

Back 86

pulls brow to nose -->glabellar skin creases (thytids); frontal bone periosteum-->sub-Q tissue; inferior-->fibers are continuous w/ orbital orbicularis

Front 87

Procerus

Back 87

depresses brow; interdigitates w/ inf frontalis--> horizontal lines at nasion & dorsum of nose

Front 88

Lymph drainage of eyelids

Back 88

medial upper lid-->submandibular LN;
lateral upper lid-->preauricular LN;

Front 89

Venous drainage of eyelids

Back 89

pretarsal medial upper lid-->angular V; pretarsal lateral upper lid-->superficial temporal V

Front 90

vascular supply to prelaminar region of ON

Back 90

Capillaries from Short post ciliary artery

Front 91

vascular supply to Lamina Cribrosa region of ON

Back 91

Plexus from Short post ciliary artery

Front 92

vascular supply to retrolaminar region of ON

Back 92

Ciliary (recurrant pial vessels) + retinal circulation

Front 93

Cilioretinal artery

Back 93

present in 15-25%

Front 94

Central retinal artery

Back 94

surface NFL of ON; provides centripetal branches from pial region; supplies NFL, GCL, IPL, inner 1/3 of INL