1. 成大醫院 眼科部 張義昇 主治醫師 助理教授 視網膜科代主任
Anatomy of Eyeball and Orbit
成大醫院 眼科部 張義昇
主治醫師 助理教授 視網膜科代主任

2. Textbooks of Ophthalmology
Clinical Ophthalmology, Kanski,
　Butterworth-Heinemann, 6th edition. (紅皮）
(中文: 5th edition)
General Ophthalmology, Daniel Vaughan,
APPLETON & LANCE, 16th edition. (黃皮）
(中文: 合記, 14th edition)

3. Surface anatomy Eyeball (2.5 cm) Eyelid = lid (眼皮；眼瞼) Eyelash (睫毛)
Puntum (淚點)
Medial & lateral canthus (眥；眼角)
Fornix (穹窿)
Iris (虹彩) & pupil (瞳孔)
Cornea (角膜) (1 cm)
Limbus (輪部)
(Bulbar) conjunctiva (結膜)
Sclera (鞏膜)

4. Eyeball (globe) Cornea (角膜) Limbus (輪部) Conjunctiva (結膜)
Anterior chamber (前房)
Iris (虹彩；虹膜)
Posterior chamber (後房)
Lens (水晶體)
Vitreous (玻璃體)
Iridocorneal angle (隅角)
Ciliary body (睫狀體)
Retina (視網膜)
Choroid (脈絡膜)
Sclera (鞏膜)
Tenon’s capsule
(= fascial sheath)

5. Cornea
5 layers

6. Ciliary body Ciliary process: zonule (lens suspension)
Ciliary epithelium: aqueous secretion
(Trabecular meshwork: absorption)
Ciliary muscle: lens thickening (accommodation; near vision)
Ciliary vessels: nutrition

7. Aqueous (humor) flow Anterior chamber Iridocorneal angle
Trabecular meshwork
Posterior chamber
Ciliary epithelium
Vitreous

8. Retina Cup / Disc 10 layers Foveola Fovea (centralis) Macula (lutea) 12
Foveola Fovea (centralis) 3 4 5 6 7 8
Macula (lutea) 9 10

9. 3 basic layers Outer layer -- structural portion
Cornea, sclera
Middle layer -- nutritive portion
Uvea (葡萄膜): iris, ciliary body, choroid
Inner layer -- functional portion
Retina

10. Optical system Lens (鏡頭) Aperture Film Dark room Cornea Lens (水晶體)
Pupil
Film
Retina
Dark room
Sclera, choroid
Iris sphincter (parasym):２進３出
Iris dilator (sympathetic)

11. Orbit

12. Orbit
Muscles
Nerves
Vessels
Lacrimal system
Orbital bones
Fat
Eyelids

13. Extraocular muscles Superior rectus (SR): elevation
Inferior rectus (IR): depression
Medial rectus (MR): adduction
Lateral rectus (LR): abduction
VI (LR6)
Superior oblique (SO): intorsion
IV (SO4)
Inferior oblique (IO): extorsion
Levator m.

14. 10, 20 functions

15. Nerves Vision: II (optic n.) Sensation: V1 (ophthalmic n.)
Frontal, lacrimal, nasocilliary
Motor: III (oculomotor), IV (trochlear),
VI (abducens)
Pupil dilation: sympathetic
Pupil constriction: parasympathetic
Motor: VII (facial) not through the orbital apex
-- orbicularis m.

17. Light reflex Ciliary ganglion Ciliary nerve Parasym (3rd) Sympathetic
Pupil constriction
Sympathetic
Pupil dilation
Sensory (5th, NC br)
Pain
Ciliary nerve
6-10 branches

18. Ocular reflexes ２進３出 (light reflex) ５進７出 ２進：vision
３出：pupil constriction (parasym)
５進７出
５進：(corneal) sensation
７出：orbicularis m blinking (motor)
lacrimal tearing (parasym)

19. Oculomotor nerve Superior division Inferior division Levator m SR
MR, IR, IO
Parasympathetic → ciliary ggl → ciliary n.

22. Blood supply Internal carotic a  ophthalmic a.
 7 anterior ciliary a. (ACA)
(4 rectus m., anterior segment)
20 short posterior ciliary a. (SPCA)
(choroid, outer 1/3 retina, anterior segment)
2 long posterior ciliary a. (LPCA)
(the same as above)
1 central retinal a.  4 branches
(inner 2/3 retina)

26. Venous drainage Internal jugular v.  Cavernous sinus  Ophthalmic v.
 4 ~ 7 vorticose (vortex) v.
1 central retinal v.  4 branches

28. Lymphatic drainage (eyelid)
Upper eyelid:
preauricular LN
Lower eyelid:
submaxillary LN
(submandibular LN)
No lymphatic drainage within the eye or orbit

29. Lacrimal secretary system
(Main) lacrimal gland: superolateral orbit
Orbital lobe
Palpebral lobe
Excretory ducts

30. Accessory lacrimal glands
Glands of Krause
Glands of Wolfring

31. Prevent evaporation
Adhesion
Lubrication

32. Lacrimal drainage system
Puntum (punta; 淚點)
Upper & lower calaniculus (canaliculi; 淚小管)
Common calaniculus (90%)
Lacrimal sac (淚囊)
Nasolacrimal duct (鼻淚管)

33. Orbital bones

34. Orbital bones Frontal Zygomatic Maxillary Sphenoid Ethmoidal Lacrimal
Palatine
Orbital roof
Orbital floor
Medial orbital wall
Lateral orbital wall
Orbital apex

36. Superior orbital fissure
Optic foramen
Sphenoid (lesser wing)
Optic n., ophthalmic a., sympathetic n.
Superior orbital fissure
Sphenoid (lesser & greater wings)
III, IV, VI, V1 (3 br), SOV (superior ophthalmic v.)
Inferior orbital fissure
V2 , IOV (inferior ophthalmic v.)
Nasolacrimal duct  inferior meatus

38. Blowout fracture

39. Orbital fat
Cushion

40. Eyelid Double eyelid Meibomian glands How many eyelashes (cilia)?
Upper?
Lower?

41. Single eyelid
Double eyelid

42. Open the eye Close the eye Levator m. (10-15 mm): oculomotor n.
Muller’s m. (2 mm): sympathetic n.
Horner’s syndrome
Sympathetic disorder
Mild ptosis, miosis, anhydrosis
Close the eye
Orbicularis m.: facial n.