External layer: the fibrous tunic

Structure Characteristics Function

s

Cornea   Anterior, transparent part  Refracts the

light
 Has no vasculature:
requires aqueous humor for nutrients

Sclera  Posterior, opaque, and fibrous part  Protects and

stabilizes the eye

Episclera  Outermost layer of the sclera  Protects and

stabilizes the eye
 Scleral vascular
supply

Middle layer: the uvea (vascular tunic)

Structures Characteristics Function

Iris  A pigmented diaphragm with a central  Regulates the

opening (the pupil) that adjusts its size in response amount of light
to light. that impinges on
the retina
 Contains radial and circular smooth
muscle fibers  Determines
the color of the eye
o Radial fibers arranged in parallel (iris
dilator muscle)
→ sympathetic stimulation → dilation → myd
riasis
o Circular fibers arranged around the
pupil (iris sphincter muscle)
→ parasympathetic stimulation → contraction 
→ miosis 

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 Structures Characteristics Function

Ciliary  Located behind the iris  Anchors

the lens
body  Composed of the ciliary ring, epithelium with
ciliary processes, and ciliary muscle  Accommodati
on: adjusts
o Ciliary epithelium
the lens for seeing
 Outer layer: pigmented at different
 Inner layer: not pigmented distances 

 Ciliary processes: fibers that  

encircle the border of the lens  Produces aqu
o Ciliary muscle: smooth eous humor
muscle innervated by parasympathetic fibers

Choroid  Formed by two layers  Nourishes

the retina
o Outer: pigmented
o Inner: highly vascularized

Internal layer: the retina (nervous tunic)

The retina is the innermost layer of the eye. It is composed of:

 One outer layer of pigmented epithelial cells

 Three types of neural cells (photoreceptor cells, bipolar cells, and ganglion cells)
that:
o Form nine layers connected by synapses
o Perceive and transform light into neuronal signals that travel to the brain
via the optic nerve.
 Two notable structures: optic disc and macula

Layers of the retina

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Layers: from outside to Characteristics
inside (towards the vitreous
body)

1. Pigment epithelium  Outermost layer → closest to the choroid

 Contains melanin granules
 Aids in the formation of rhodopsin and storage
of vitamin A
 Provides nutrition to photoreceptors
 Absorbs light and prevents reflection
 Site of detachment for the retina (in retinal
detachment)

2. Layer of rods and cones  Rods: first-order receptors of slender, and cylindrical

cells that contain rhodopsin
o Achromatic → photoreceptors specialized
for night vision (dim light) and motion
o Primarily located around the fovea centralis
 Cones: first-order receptors of flask-shaped cells
that lack rhodopsin but contain photopsin/iodopsin
o Chromatic (contain pigments for blue, red,
and green light) → photoreceptor specialized for
color vision, bright light, object recognition, and visual
acuity
o Primarily located within the fovea centralis
 Both rods and cones use glutamate as
a neurotransmitter

3. External limiting  Supports photoreceptor cells

membrane

4. Outer nuclear membrane  Contains the nuclei of rods and cones

5. Outer plexiform layer  Contains the synapses between bipolar cells on the

one hand and cones and rods on the other hand

6. Inner nuclear layer  Contains the cell bodies of bipolar neurons

o Second-order neurons
o Transmit information from cones and rods
to ganglion cells
 Contains Muller cells (supporting glial cells)

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Layers: from outside to Characteristics
inside (towards the vitreous
body)

o Extend from the inner limiting layer to the

outer limiting layer

7. Inner plexiform layer  Contains the synapses between ganglionic cells and

bipolar neurons

8. Ganglion cell layer  Contains nuclei and cell bodies of ganglion cells

o Third-order neurons → Form the optic
nerve (CN II)
o Project to the hypothalamus,
pretectal nucleus, lateral geniculate body,
and superior colliculus
 Contain neuroglia

9. Optic nerve fibers  Formed by axons of ganglion cells

10. Internal limiting  Innermost layer → closest to the vitreous humor

membrane

Special structures of the retina

Structure Characteristics
s

Optic disc  Formed by axons of ganglion cells that leave the eye to form the optic
nerve
 Located medial to the fovea centralis
 Lack of photoreceptors → insensitive to light → blind spot (physiologic
scotoma)
o The optic nerve passes through the retina and exits the eye at
15° temporally (optic papilla)
 Has a central depression called the optic cup

Macula  An oval-shaped yellow spot on the lateral side of the optic disk, near

the center of the posterior wall of the retina

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 Structure Characteristics
s

 Lacks blood vessels

 Contains the fovea centralis
o A central depression in the macula (foveola)
o Only has cones, each of which is connected to one
singular ganglion cell
o Point of sharpest vision (100% visual acuity)

The fovea centralis contains only cones, whereas the peripheral retina contains mainly rods!

Chambers of the eye

The eye is divided into three chambers

 Anterior chamber: between cornea and iris 
o Boundaries
 Anterior: posterior surface of the cornea
 Posterior: anterior surface of the lens, iris, and ciliary body
 Lateral: trabecular meshwork and the canal of Schlemm
 Posterior chamber: between iris and lens
o Boundaries
 Anterior: posterior surface of the iris
 Posterior: zonular fibers of the lens and the lens
 Lateral: ciliary processes
 Vitreous chamber: between lens and retina
Refractory media
The refractory media of the eye comprise the cornea, lens, aqueous humor, and vitreous
body. These structures function to direct and refract light to the posterior region of
the retina, where photoreceptors perceive and transform light into neuronal signals that
travel to the brain via the optic nerve.

Structures Characteristics Function

Aqueous  Watery fluid that fills  Maintains intraoc

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 Structures Characteristics Function

humor  the anterior and posterior chambers of the ular pressure

eye
 Provides
 Synthesized by the ciliary body from nutrients to
blood plasma. the lens and cornea 
 Pathway of flow: ciliary
body (nonpigmented epithelium)
→ posterior chamber → through the pupil
→ anterior chamber → trabecular
meshwork with spaces of Fontana (in the
iridocorneal angle) 
 → Schlemm's canal → episcleral vessels

Vitreous  Transparent gelatinous substance that  Provides support

humor fills the eyeball posterior to the lens to the lens and holds
the retina in place

Lens   Transparent and flexible biconvex  Accommodation

structure
o Distant
 Maintained in position by the vision →
suspensory ligaments of the lens decreased
convexity
o Radially arranged fibers that
connect the lens to the ciliary o Near
body (zonular fibers) vision → increased
convexity
o Attachments of the
suspensory ligaments
 Medial: lens capsule
 Lateral: ciliary
processes
 Has no vasculature: requires aqueous
humor for nutrients

Vasculature and innervation of the eye

Arteries 
The blood supply to the eye is primarily derived from the ophthalmic artery, a branch of
the internal carotid artery that reaches the eye via the optic canal. The following arteries are
the major branches of the ophthalmic artery:

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 Artery Characteristics

Central artery of the  Main branch of the ophthalmic artery

retina  Supplies the retina and parts of the optic nerve
 A terminal artery (no anastomosis) → occlusion causes
blindness
 Travels in the optic nerve
 Divides into superior, inferior, nasal, and temporal
branches

Supraorbital artery  Supplies the forehead and the scalp

 Passes through the supraorbital foramen

Frontal artery  Supplies the forehead and the scalp

Dorsal nasal artery  Supplies the lacrimal sac

Veins 

 Ophthalmic veins

o Superior ophthalmic vein: travels parallel to the ophthalmic artery

o Inferior ophthalmic vein: divides into two branches

 One branch passes through the inferior orbital fissure

 The other branch passes through the superior orbital fissure

o Drains into the cavernous sinus

Nerves 
Nerve Characteristics

Ophthalmic  Supplies sensation to the forehead, anterior scalp, upper eyelid, and

nerve (V1) eyeball. Also contains sympathetic and parasympathetic nerve fibers that
facilitate pupil dilation and innervate the ciliary body, iris, lacrimal
 Part of gland, conjunctiva, and cornea.
the trigeminal
nerve  Branches

Enters o Lacrimal nerve

7
Nerve Characteristics

the orbit throug  Enters the orbit through the superior orbital fissure

h the superior
 Innervates the lacrimal gland, the skin of the
orbital fissure
upper eyelid, and the conjunctiva
o Frontal nerve
 Enters the orbit through the superior orbital fissure
 Divides into
 Supraorbital nerve
 Innervates the frontal sinus, scalp,
forehead, and upper eyelid
 Supratrochlear nerve
 Innervates the forehead, scalp, and
upper eyelid
o Nasociliary nerve
 Enters the orbit through the superior orbital fissure
 Sensory limb (afferent limb) of the corneal reflex
 Branches
 Communicating branch to the ciliary ganglion
 Long ciliary nerves
 Afferent fibers from
the iris and cornea
 Postganglionic sympathetic fibers to
the iris dilator muscle
 Short ciliary nerves
 Afferent fibers from
the iris and cornea
 Postganglionic parasympathetic fiber
s to the ciliary muscle and iris sphincter muscle
 Postganglionic sympathetic fibers to
the iris dilator muscle
 Anterior ethmoidal nerve
 Posterior ethmoidal nerve
 Infratrochlear nerve

Optic nerve  Leaves the orbit through the optic canal

 Meets its counterpart 
 to form the optic chiasm

8
 Nerve Characteristics

Maxillary  Part of the trigeminal nerve

nerve (V2)  Sensory innervation of the lower eye lid

Ciliary ganglion  Parasympathetic ganglion

 Located behind the eyeball, between the lateral rectus muscle and
the optic nerve

The lacrimal system

Lacrimal apparatus
The lacrimal apparatus supplies tear fluid for the surface of the eyeball and the eyelid, minimizing
friction and cleaning the eye (“tear film”).

 Lacrimal gland

o Located on the upper lateral part of the orbit, on the surface of the levator

palpebrae superioris and the lateral rectus muscle

o Serous gland with tubuloalveolar secretory elements → secretes the aqueous

layer of the tear fluid

o Drains via 12 lacrimal ducts into the superior conjunctival fornix

o Innervated by parasympathetic fibers of the facial nerve (VII) via

the pterygopalatine ganglion

 Tarsal glands

o Sebaceous glands

o Located within the tarsal plate with orifices at the rim of the marginal zone of
the conjunctiva

o Produce a lipid layer that protects against dehydration of the cornea

 Lacrimal sac

o Dilated portion of the nasolacrimal duct

o Gathers tear fluid

 Nasolacrimal duct: drains into the inferior meatus of the nose

 Composition of tears: isotonic fluid (of Na+, K+,

Cl-, HCO3-), proteins (lysozyme, lactoferrin, defensins), EGF, IgA

9
 Pathway of tears
 Produced in the lacrimal gland (below lateral eyebrow) → lacrimal ducts →
superior conjunctival fornix → anterior eyeball → lacus lacrimalis → lacrimal canaliculi (at
the inner canthus) → lacrimal sac → nasolacrimal duct → inferior nasal meatus

Eyelid
The eyelid protects the eyeball from excessive light, dryness, and foreign bodies. It receives sensory
innervation from the maxillary (V2) branch of the trigeminal nerve (CN V). The palpebral
fissure (aperture) is formed by the upper and lower eyelid, which meet in
the lateral and medial canthi.

Structure Characteristics

Skin and subcutaneous  Thinnest skin of the body

tissue  Very low amount of fat tissue
 Subcutaneous tissue is absent over
the lateral and medial palpebral ligaments

Orbicularis oculi  Innervated by the facial nerve (CN VII)

muscle  Closes the eye

Orbital septum  Connective tissue that forms the anterior boundary of

the orbit
 Runs from the margin of the eyelids to the periosteum of
the orbital margin
 Within the eyelid, the orbital septum thickens and forms
the tarsal plates, which provide stability to the eyelid

Tarsal plates  Thick, densely packed part of the orbital septum

 Contain tarsal glands

Levator palpebrae  Originates from the roof of the orbit and inserts into the
superioris muscle upper eyelid, on the superior border of the tarsal plate
 Innervated by the oculomotor (CN III) nerve
 Elevates the upper eyelid → opens the eye

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 Structure Characteristics

Conjunctiva  Highly vascularized mucus membrane that lines the inside

of the eyelids and the sclera
 Divided into two distinct layers
o Palpebral (tarsal) conjunctiva: lines the inner
surface of the eyelid
o Bulbar conjunctiva: lines the anterior surface of
the eyeball
o Transition from palpebral conjunctiva to
bulbar conjunctiva: in the superior and inferior fornices
 Accessory glands in the conjunctiva produce tear fluid
(smaller volume than the lacrimal apparatus)
 For clinical significance, see conjunctivitis

Orbit
The orbit is a bony structure formed by the frontal, maxillary, ethmoid, sphenoid, lacrimal,
and zygomatic bones. It contains the eyeball and openings for the passage of the optic nerve,
vessels, and lymphatics that interact with the eye.

Walls of the orbit

 Superior (roof): lesser wing of the sphenoid bone and the orbital portion of the frontal
bone

 Inferior (floor): orbital surfaces of the maxilla, zygomatic, and palatine bones

 Medial: orbital plate of the ethmoid bone, body of the sphenoid bone, frontal

bone, lacrimal bone, and the maxilla

 Lateral: greater wing of the sphenoid, orbital plate of the frontal bone, and the frontal
process of the zygomatic bone
Openings of the orbit
Opening Anatomy Content

Superior  Between the greater  Inside the common tendinous

orbital fissure and lesser wings of ring
the sphenoid
o Nasociliary nerve
o Oculomotor nerve
o Abducens nerve
 Outside the common tendinous

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 Opening Anatomy Content

ring
o Frontal nerve
o Lacrimalis nerve
o Trochlear nerve
o Superior ophthalmic
vein

Inferior  Formed by the  Zygomatic nerve and

orbital fissure greater wing of infraorbital nerve (branches
the sphenoid of maxillary nerve)
bone superiorly and the
 Infraorbital vein and artery
palatine and maxillary
bone inferiorly  Inferior ophthalmic vein

Optic canal  Formed by the two  Optic nerve (CN II)

origins on the lesser wing
 Ophthalmic artery
of the sphenoid bone

Nasolacrimal  Formed by  Connects the lacrimal sac and

duct the lacrimal bone, maxilla, the inferior nasal meatus, where
and inferior nasal concha the nasolacrimal duct drains

Infraorbital  In the maxillary  Infraorbital nerves and vessels

foramen bone, lower orbit

Supraorbital  In the frontal bone,  Supraorbital nerves and vessels

notch upper orbit

Ethmoidal  In the ethmoid  Anterior: anterior ethmoidal

foramina bone, lateral to olfactory nerves and vessels
groove
 Posterior: posterior ethmoidal
nerves and vessels

Muscles of the eye

The orbit contains 6 muscles that are attached to the eyeball. There is an additional muscle in
the orbit that attaches to the upper eyelid, the levator palpebrae superioris, which functions to
elevate the eyelid.

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 Muscle Function Attachments Innervation

Superior  Elevation, intor  Origin: common  Oculo

rectus sion, tendinous ring motor
muscle and adduction of the nerve (CN
 Insertion: upper globe
eyeball III)

Inferior  Depression  Origin: common  Oculo

rectus and extorsion of the tendinous ring motor
muscle eyeball nerve (CN
 Insertion: lower globe
III)

Medial  Adduction of  Origin: common  Oculo

rectus the eyeball tendinous ring motor
muscle nerve (CN
 Insertion: medial glob
III)
e

Lateral  Abduction of  Origin: common  Abduc

rectus the eyeball tendinous ring ens
muscle nerve (CN
 Insertion: lateral glob
VI)
e

Superior  Abduction,  Origin: above  Trochl

oblique depression, the optic canal, on the ear
muscle and intorsion of the body of sphenoid nerve (CN
eyeball bone (and common IV)
tendinous ring); travels
through trochlea of
superior oblique
 Insertion:
upper posterior globe

Inferior  Extorsion,  Origin: lateral to the  Oculo

oblique elevation, lacrimal groove; on the motor
muscle and abduction of the floor of the orbit nerve (CN
eyeball III)
 Insertion:
lower posterior globe

Clinical significance
Refractive errors
Emmetropia

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 Physiologic state of vision in which the eye is in a relaxed state and rays of
light are relayed to the retina with a physiologic refraction 

Myopia (near-sightedness)

 Pathophysiology: axial length of the eye is too long for its refraction 

 → focal point anterior to the retina

 Symptoms: near vision clear, far vision unclear

 Complications: rare; myopic fundus with retinal detachment

 Therapy: concave lenses

Hyperopia (far-sightedness) and presbyopia (long-sightedness)

 Pathophysiology: axial length of the eye too short for its refraction
(hyperopia) or decreased lens accommodation (presbyopia) → focal
point posterior to the retina

 Symptoms: near vision unclear, far vision clear ; Myopia can

improve presbyopia temporarily (second sight)

 Complications: increased risk for closed-angle glaucoma

 Therapy: convex lenses

Astigmatism

 Pathophysiology: curvature of cornea hinders even refraction 

 → focal point can be anterior or posterior to the retina

 Symptoms: unclear vision at all distances

 Complications: early onset increases risk for amblyopia

 Therapy

14
 o Regular astigmatism: cylindric lenses

o Irregular astigmatism: corrective contact lenses and refractive

surgery 

Coloboma 

 Description: A unilateral or bilateral developmental disorder of the eye in

which the choroid fissure fails to close by the 7th week of development.

 Clinical features
o Defect in one of the structures of the eye (e.g., retina, optic disc, iris)

o Most common: a keyhole-shaped defect of the iris

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