1. Visual system Oculus et structurae pertinentes
© David Kachlík

2. © David Kachlík
Odilo Redon

3. Orbita = Orbit tetrahedral pyramid tilted dorsally aditus x apex
10 openings + their contetnt
m. orbitalis Mülleri – smooth muscle in the fissura orbitalis inferior
content: eyeball, oculomotor muscles, fat pad and related structures
© David Kachlík

4. Orbita – osseous walls
cranially: pars orbitalis o. frontalis (fovea trochlearis + spina trochlearis, incisura/foramen frontalis/supraorbitalis, fossa glandulae lacrimalis), ala minor o. sphenoidalis (fissura orbitalis sup.)
medially: processus frontalis maxillae (fossa sacci lacrimalis), os lacrimale, lamina orbitalis o. ethmoidalis (foramen ethmoidale ant. et post.), ala minor o. sphenoidalis
laterally: facies orbitalis o. zygomatici (foramen zygomaticoorbitale), facies orbitalis alae majoris o. sphenoidalis
© David Kachlík

5. Orbita – osseous walls
caudally: facies orbitalis o. zygomatici, facies orbitalis corporis maxillae (sulcus et canalis infraorbitalis, fissura orbitalis inf.), processus orbitalis o. palatini
aditus orbitae → apex orbitae
orbita is divided by theoretical planes into 3 levels
© David Kachlík

6. Orbita – related structures
medially: cellulae ethmoidales (via very thin lamina orbitalis ossis ethmoidalis)
caudally: sinus maxillaris
cranially: fossa cerebri anterior
dorsally: sinus cavernosus + fossa pterygopalatina
© David Kachlík

7. Visual system bulbus oculi = eyeball
structurae pertinentes oculi = related structures of the eye
topography: regio orbitalis
development
© David Kachlík

8. Eyeball tunica fibrosa (externa) tunica vasculosa (media)
tunica interna (nervosa)
corpus vitreum (vitreous body) + lens
© David Kachlík

9. Eyeball polus anterior, posterior equator x meriadiani
axis bulbi externus, internus
axis opticus (= „linea visus“)
© David Kachlík

10. Tunica fibrosa (externa)
sclera
cornea
© David Kachlík

11. Tunica fibrosa (externa) Sclera
dense connective tissue (= reticulum trabeculare), collagen fibres, fibroblasts, ground substance
lamina episcleralis, substantia propria, lamina fusca
lamina cribrosa (entrance of n. II.)
5/6th of the eyeball surface, ø 2,2 cm
sinus venosus sclerae (canalis Schlemmi s. Lauthi)
sulcus sclerae – sclerocorneal junction = limbus corneae (angulus sclerocornealis)
© David Kachlík

12. Tunica fibrosa (externa) Cornea
perfectly transparent, non-vascular
limbus, vertex
5 layers
epithelium anterius cornae (stratified squamous ep.)
lamina limitans anterior (Bowman´s membrane)
substantia propria corneae
lamina limitans posterior (Descement´s membrane)
epithelium posterius corneae („endothelium“)
11 x 12 mm - physiological astigmatism
© David Kachlík

13. Tunica vasculosa (media) = Uvea
choroidea
corpus ciliare (ciliary body)
iris
© David Kachlík

14. Tunica vasculosa (media) = Choroidea
lamina suprachoroidea (= lamina fusca sclerae)
spatium perichoroideum
lamina vasculosa (choroideal stroma)
larger vessels, connective tissue, smooth muscle cells, nerves
lamina choriocapillaris
capillaries
lamina basalis = Bruch´s membrane
BM of pigment epithelium and capillaries + connective tissue
© David Kachlík

15. Tunica vasculosa (media) = Corpus ciliare
annular shape, triangular profile
processus + plicae ciliares
orbiculus (external part), corona (internal part)
smooth musculus ciliaris
fibrae meridionales, radiales, circulares, longitudinales
© David Kachlík

16. Tunica vasculosa (media) = Corpus ciliare
stroma
m. ciliaris: parasympathetic  accomodation  focus at near
(focus at far is assured with the elastic choroidea)
capillaries and nerves supplying the muscle
epithelial cover – production of humor aquosus
BL – continuation of Bruch´s membrane
pigment epithelium – (continuation of pigm. epith. of retina)
cilliary canal
nonpigment epithelium (continuation of sensory epith. of retina) BL
fibrae zonulares – fixation of lens
© David Kachlík

17. Tunica vasculosa (media) = Iris
annular and flat shape
function of photograph stop (shutter)
margo ciliaris (external), m. pupillaris (internal)
pupilla
anulus iridis major + minor (containing circulus arteriosus iridis major + minor)
m. sphincter pupillae (parasymp.) – miosis (circular)
m. dilatator pupillae (symp.) – mydriasis (radiate)
© David Kachlík

18. Tunica vasculosa (media) = Iris
plicae iridis, stroma iridis
anterior surface
no epithelium cover
fibroblasts and melanocytes (colour)
dentate line – remnant of membrana pupillaris Wachendorfi
posterior surface
2 layers of pigment epithelium
internal pigment
external myoepithelial
m. sphincter pupillae
m. dilatator pupillae
© David Kachlík

19. Lens polus anterior, posterior
axis, equator, radii (seams in shape of Y and inverted-Y)
capsula lentis
substantia lentis – cortex, nucleus
zonula ciliaris Zinni
fibrae zonulares
spatia zonularia
catharact - replacement
© David Kachlík

20. Lens transparen biconvex nonvascular structure
capsula lentis – similar to BL
epithelium lentis – unilayered cubic
anterior surface only
substantia lentis
cortical – contains oblong cells (fibres) with organels and nucleus
nuclear – cellular fibres without organels and nucleus
cells contain specific proteins (filensin, crystallins)
© David Kachlík

21. Accomodation focus at near focus at far contraction of m. ciliaris
fibrae zonulares relax
lens bulges
parallel contraction of m. sphincter pupillae (= miosis)
focus at far
vessels tonus keeps fibrae zonulares tightened
lens is flatened
contraction of m. dilatator pupillae (= mydriasis)
© David Kachlík

22. Corpus vitreum = Vitreous body
membrana, stroma, humor vitreus
99% of water
hyaluronic acid, collagen fibres
cells – hyalocytes – during development only!
no regeneration ! – in trauma flows out and replaced with aqueous humor
canalis hyaloideus Cloqueti – remnant of fetal arteria hylaloidea
fossa hyaloidea
maintains the internal eyeball pressure, compress retina to the choroidea
© David Kachlík

23. Humor aquosus = Aqeous humor
produced by corpus ciliare
absorbed in angulus iridocornealis
0,2-0,3 ml of pellucid and colourless fluid
daily production - 3 ml
content: 0,7-1,2% NaCl, glucose and urea traces (0,1%), no proteins!
corresponds to the lymph inside the eyeball
intraocular pressure: mmHg
 intraocular pressure  compression of retina  glaucoma
© David Kachlík

24. Camerae bulbi = Chambers of eyeball
camera postrema s. vitrea
between corpus ciliare, lens and retina
contains corpus vitreum
spatium retrozonulare
camera posterior
between iris, lens and corpus ciliare
contains and produces humor aquosus
camera anterior
between cornea and iris
angulus iridocornealis
contains and absorbs humor aquosus
© David Kachlík

25. Angulus iridocornealis = Iridocorneal angle
in site of sclerocorneal junction
trabecular net in the posterior wall = spatia anguli i.c. = Fontana´s spaces
no direct connection to Schlemm´s canal
reabsorption of humor aquosus
maintains the intraocular pressure
!!! no application of parasympatheticolytics in patient with glaucoma !!!
© David Kachlík

26. OCT Optic coherent tomography measurements of light reflexion
© David Kachlík

27. Break
© David Kachlík

28. Tunica interna (nervosa) = Retina
pars caeca
pars iridica
pars ciliaris
ora serrata
pars optica – 11 layers
pigment part
sensory part
© David Kachlík

29. Tunica interna (nervosa) Retina – pigment part
unilayered cubic epithelium
cells with thight junctions
apical cell parts contain melanin granules
encompass the external segments of sensory cells
interfotoreceptor matrix
nutrition of cells, regeneratin of fotopigment, degradation of membranous discs
© David Kachlík

30. Tunica interna (nervosa) Retina – sensory part
light-sensitive neurons (transducers)
rods and cones
trasmission neurons (integraters)
bipolar and ganglionic cells
association neurons
horizontal and amacrinne cells
suppoting cells (glia)
Müller´s cells
© David Kachlík

31. Tunica sensoria (interna) Rods = Bacilli
synaptic disc
axon
nucleus
internal segment
GA, ER, MIT; synthesis of ATP and rhodopsin
external segment
membranous discs with fotopigment
migrate externally until the separate
black and white vision
© David Kachlík

32. Tunica sensoria (interna) Rods = Coni
synaptic foot
fotopigment - iodopsin
external segment
membranous discs with fotopigment
communicate with environment
colour vision– 3 types of cones
„blue“ – 420 nm
„green“ – 535 nm
„red“ – 565 nm
© David Kachlík

33. Tunica sensoria (interna) Transmisison neurons (Integraters)
Bipolar cells
rod-like bipolar cells
cone-like bipolar cells – dwarf x diffused
contacts with ganglionic cells
Ganglionic cells
diffused type – contact with more bipolare cells
dwarf type – contact with dwarf bipolare cell
axons of ganglionic cells form nervus opticus
© David Kachlík

34. Tunica sensoria (interna) Association neurons
only neuritic processes – in both directions
horizontal cells
contacts with rods and cones
amacrinne cells
contacts with bipolar and ganglionic cells
modification and synchronization of signal
© David Kachlík

35. Tunica sensoria (interna) Supporting cells
Müller´s cells
macroglia
their BL = membrana limitans interna
zonulae adherentes with rods and cones
= membrana limitans externa
© David Kachlík

36. Tunica sensoria (interna) Layers of optic part of retina
!!!  do not be frightened  !!!
© David Kachlík

37. Tunica sensoria (interna) Layers of optic part of retina
stratum pigmentosum (1.)
stratum nervosum (2.-10.)
stratum segmentorum externorum et internorum(2.)
stratum limitans externum (3.)
stratum nucleare externum (4.)
stratum plexiforme externum (5.)
stratum nucleare internum (6.)
stratum plexiforme internum (7.)
stratum ganglionicum (8.)
stratum neurofibrarum (9.)
stratum limitans internum (10.)
© David Kachlík

38. Tunica interna (nervosa) Specific spots of retina
discus n. optici (= blind spot)
n. II leaves the eyeball
no light-sensitive cells
 excavatio disci
© David Kachlík

39. Tunica sensoria (interna) Specific spots of retina
fovea centralis („macula lutea; yellow spot“)
distant layers diverted laterally
sharpest and most brilliant colour vision spot
cones only ( cones)
 foveola (2500 cones)
© David Kachlík

40. OCT Optic coherent tomography
© David Kachlík

41. OCT
© David Kachlík

42. OCT
ABRUPTIO RETINAE
© David Kachlík

43. Arterial supply of the eye
a. carotis interna  a. ophtalmica 
aa. ciliares posteriores breves  choroidea
aa. ciliares longae (24)  corpus ciliare + iris
aa. musculares  aa. ciliares ant., a. epiclerales, aa. conjuctivales lat.
a. centralis retinae  retina
a. lacrimalis  aa. palpebrales lat.
aa. palpebrales med.  aa. conjuctivales med.
© David Kachlík

44. © David Kachlík

45. Vasa sanguinea retinae – fundus oculi
a. centralis retinae  arteriolae
a. temporalis sup.+inf.
a. nasalis sup.+inf.
a. macularis sup.+inf. (+ media)
veins correspond to arteries, they often cross
© David Kachlík

46. A. cilioretinalis (cilioretinal a.)
present in 10-33% of eyes
branches from the a. ciliaris posterior brevis
exits the discus n.II separately from a. centralis retinae
additional supply to macula lutea from choroidal circulation
provide a small amount of blood supply to the retina when a. centralis retinae is occluded
90% located temporally, 10% nasally
occlusion of a. cilioretinalis → central visual loss
occlusion of a. centralis retinae → spare central vision and macula lutea
© David Kachlík

47. A. cilioretinalis (cilioretinal a.)
© David Kachlík

48. Venous drainage of eye – 3 directions
vv. episclerales
vv. ciliares ant.  vv. sclerales  sinus venosus sclerae Schlemmi s. Lauthi
vv. vorticosae (4 in quadrants of eyeball)
v. centralis retinae
v. ophthalmica sup.  sinus cavernosus
v. ophthalmica inf.  plexus pterygoideus
v. angularis  v. facialis  v. jugularis int.
! danger of inflammation spreading !
© David Kachlík

49. Nervous supply of eye n. opticus – special sensory
pars intraocularis, canalis, itracranialis
vagina interna, externa
n. ophthalmicus  nn. ciliares longi – somatosensory
n. lacrimalis, n. frontalis, n. nasociliaris – for surrounding structures
nn. ciliares breves  ganglion ciliare – autonomic (visceromotor)
(sympathetic fibres non-interpolated, parasympathetic interpolated)
n.III., n. IV., n.VI – somatomotor
© David Kachlík

50. © David Kachlík

51. Nervus opticus evagination of diencephalon (thalamus opticus)
axons separated with endoneurium
covered with meninges
a. et v. centralis retinea runs inside the nerve
© David Kachlík

52. VISUAL PATHWAY Projection → Ascendent → Sensoric
4 - neuronal, partially crossed
neuron: rod and cones of retine
neuron: bipolar cells
neuron: ganglional cells  n. II  chiasma opticum  corpus geniculatum laterale
neuron: cells in corpus geniculatum laterale  tractus geniculocorticalis (= radiatio optica Gratioleti)  lobus occipitalis, area 17 (around sulcus calcarinus)
Meyer´s loop into temporal lobe
© David Kachlík

53. VSIUAL PATHWAY branches from 3rd neuron
to hypothalamus (nucleus suprachiasmaticus) – converts optical signals to highest vegetativ centres (seeing meal = salivation)
pathways of pupillar reflex - through area pretectalis
to nucleus accessorius dorsalis n. III /Edinger-Westphal/ - parasymphatetic pathway with n. III  ganglion ciliare  nn. ciliares breves  m. ciliaris et m. sphincter pupillae /miosis + accomodation/
to reticular formation  tractus reticulospinalis  centrum ciliospinale /Budge/ C8-Th1  sympathetic pathway in truncus symphaticus  ganglion cervicale superius  plexus caroticus internus et ophtalmicus  nn. ciliares breves  m. dilatator pupillae /mydriasis/
pathway for convergence  nucleus interstitialis /Cajal/  fasciculus longitudinalis medialis  nuclei of all ophtalmogyric nerves
tectal optic circuit - tractus tectospinalis (control of synkinesis of eyes, head, neck to visual stimuli and for coordination with gross movements of body)
© David Kachlík

54. © David Kachlík

55. Structurae oculi accessoriae = Related strctures of eye
Apparatus ligamentosus
Palpebrae = Eyelids
Conjunctiva
Apparatus lacrimalis
Apparatus muscularis
Supercilium
© David Kachlík

56. Apparatus ligamentosus
periorbit
vagina bulbi (= capsula Tenoni)
lig. suspensorium bulbi
spatium episclerale
corpus adiposum orbitae
fasciae musculares
© David Kachlík

57. Tunica conjunctiva t.c. bulbi x t.c. palpebrarum
fornix superior, inferior
continuation of epithelium of cornea, dorsally to the eyelid, covers anterior surface of the eyeball
stratified cylindric epithelium
contains goblet cells
glanduale conjuctivales Wolfringi
caruncula lacrimalis
© David Kachlík

58. Víčka = Palpebrae palpebra superior, inferior
tarsus superior (10 mm), inferior (5 mm)
lig. palpebrale med. (2 pruhy) + lat.
facies ant.+post., rima palpebrarum, commissura palp. med.+lat., limbus ant.+ post.
angulus oculi med.+ lat.
m. tarsalis sup. (Mülleri) + inf. – smooth muscles
pars palpebralis m. orbicularis oculi - n. VII
m. levator palpebrae superioris - n. III
cilia
© David Kachlík

59. Palpebrae = Eyelids palpebra superior, inferior
tarsus superior (10 mm), inferior (5 mm)
lig. palpebrale med. (2 bands) + lat.
facies ant.+post., rima palpebrarum, commissura palp. med.+lat., limbus ant.+ post.
angulus oculi med.+ lat.
m. tarsalis sup. (Mülleri) + inf. – smooth muscles
pars palpebralis m. orbicularis oculi - n. VII
m. levator palpebrae superioris - n. III
cilia
© David Kachlík

60. Palpebrae = Eyelids external cutaneous part m. orbicularis oculi
keratinizing stratified squamous epithelium
gl. sebaceae Zeissi
inflammation - hordeolum
cilia + gl. ciliares Molli
apocrinne glands
m. orbicularis oculi
tarsus
fibroelastic plate
gl. tarsales Meibomi
sebaceous glands - chalazion
internal conjunctival part
sulcus et epithelial transition
© David Kachlík

61. Apparatus lacrimalis = Lacrimal apparatus
glandula lacrimalis
pars orbitalis + palpebralis
12-15 separate ductuli excretorii
glandulae lacrimales accessoriae Krausei
rivus lacrimalis
lacus, papilla, caruncula lacrimalis
puctum, canaliculus lacrimalis
saccus lacrimalis  ductus nasolacrimalis (plica lacrimalis Hasneri)  meatus nasi inf.
© David Kachlík

62. tubuloacinar serous glands with myoepithelial cells
Glandula lacrimalis
tubuloacinar serous glands with myoepithelial cells
© David Kachlík

63. Muscular apparatus mm. recti bulbi: sup., inf., med., lat. (VI.)
mm. obliqui bulbi: inf., sup.(IV.)
/fovea trochlearis, spina trochlearis, trochlea, vagina m.o.b.s./
m. levator palpebrae sup. (pars spf.+prof.)
n. III – other 5 muscles
smooth svaly: m. orbitalis Mülleri, m. tarsalis sup. Mülleri + inf.
© David Kachlík

64. Movements of the eye-ball I.
movements around axis = ductions
around vertical axis:
adduction (internal)
abduction (external)
around horizontal axis:
elevation (sursumduction; supraduction): up
depression (deorsumduction; infraduction): down
around sagittal (antero-posterior) axis:
intorsion (incykloduction): tilted internally
extorsion (excykloduction): tilted externally
© David Kachlík

65. Movements of the eye-ball II.
paired movements (both eyes working together)
simultaneous movement of both eyes in the same direction = version (conjugate movements)
dextroversion (to the right) + levoversion (to the left)
supraversion (sursumversion) + infra/deorsumversion (up + down)
dextro/levoelevation + dextro/levodepression (up/down and to side)
dextro/levocykloversion (rotation to the right/left)
simultaneous movement of both eyes in opposite directions = vergence (disconjugate movements), convergence = both eyes moving nasally or inward , divergence = both eyes moving temporally or outward
strabismus; heterotropia; squint = one eye constantly is turned inward (“crossed-eye”), outward (“wall-eye”), upward, or downward.
© David Kachlík

66. Movements of the eye-ball
© David Kachlík

67. Strabismus concomitans
esotropia (s. convergens)
exotropia (s. divergens)
hypertropia (s. sursumvergens)
hypotropia (s. deosumvergens)
© David Kachlík

68. Development of visual system
neuroectoderm of the forebrain
superficial ectoderm of head
mesoderm in between
cells from neural crest
© David Kachlík

69. Development of visual system
primordia from beginning of 4th week (22nd day)
formation of optic grooves in the region of forebrain
grooves deepen in optic vesicles
formation of optic peduncle
induction of ectoderm = thickening
formation of lens (optic) placode
© David Kachlík

70. Development of visual system
envagination of lens (optic) placode
formation of hollow lens vesicle without connection to the external surface
optic vesicles envaginate = optic cup
envagiantion of optic pedicle and cup + migration of vascular mesenchyme = formation of vitreous vessels
© David Kachlík

71. Development of retina origin from optic cup
external layer – pigment epithelium
internal layer – proliferates into pars nervosa
intraretinal space – successively fades out
inversion of retina
© David Kachlík

72. Development of n. II
fibres from ganglionic cells growth through the optic pedicle
fissure (evagiantion) fades out
© David Kachlík

73. Development of corpus ciliare
protrusion of both layers of optic cup
pigment epithelium – from external layer
non-pigment epithelium – from internal layer
ciliary canal – from optic cup cavity
m. ciliaris and connective tissue – from mesenchyme
© David Kachlík

74. Development of iris margin of eye cup external layer – smooth muscles
internal layer –pigment epithelium
© David Kachlík

75. Development of lens from lens (optic) vesicle a. hyaloidea – fades out
anterior surface – no change = epithelium anterius
posterior surface – cells elongate as far as lumen disappers
formation of primary fibres
secondary fibres – derived from epitheliuum anterius cells
capsula lentis – thickened BL of epitheliuum anterius
a. hyaloidea – fades out
pupillary membrane – covering lens – fades out
© David Kachlík

76. Development of camere bulbi
camera anterior
fissure between primordial lens and cornea
camera posterior
fissure in optic cup on sides of lens vesicle
© David Kachlík

77. Development of cornea, choroidea and sclera
superficial ectoderm
mesenchyme
cells of neural crest
choroidea and sclera
surronding mesenchyme
© David Kachlík

78. Development of palpebrae
6th week: cutaneous folds across cornea
10th week: both folds fuse
28th week: folds separate again
inbetween: conjunctina adheres internally
muscles: IInd branchial arch
tarsus and glands from mesenchyme
© David Kachlík

79. Development of lacrimal glands
evaginations of superficial ectoderm
non-functionnal until 6th week
newborn does not water in eyes
© David Kachlík

80. finally…END ! 
© David Kachlík