BY
Dr. S.DILEEP KUMAR
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The crystalline lens
Epithelium of the cornea
Epithelium of the conjunctiva
Lacrimal gland
Epithelium lining the lacrimal apparatus
Skin of eyelids and its derivatives viz.,cilia,
tarsal glands and conjucntival glands.
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Retina with its pigment epithelium
Epithelial layers fo the ciliary body
Epithelial layers of the iris
Sphincter and dilator pupillae muscles
Optic nerve (neuroglia and nervous elements
only)
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It is the periocular mesenchyme derived from the
neural crest and paraxial mesoderm.
Blood vessels of iris,choroid,ciliary vessels,central
retinal artery and other ocular vessels
Substantia propria,descemet’s membrane and
endothelium of cornea.
Sclera
Stroma of iris
Ciliary muscle and stroma of ciliary body
Sheaths of optic nerve
Extra ocular muscles
Fat ligaments and other connective tissues.
Superior and medial walls of the orbit
Connective tissue of the upper eyelid
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Inferior and lateral walls of the orbit
Connective tissue of the lower eyelid
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1.SHAPE : Not a sphere but Ablate spheroid
Contains two spheres cornea(ant) and
sclera(post).
2.Dimensions:
3.Poles : Maximal convexities anterior and
posterior
4.Equators:geometric,anatomical,surgical.
5.Axes: Optical,Visual and Fixation axis.
6.Visual angles:Alpha,Gamma,Kappa angles
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1.Fibrous coat: ant one-sixth called cornea
transparent. Posterior five-sixth opaque-sclera.
Junction of cornea and sclera- LIMBUS
Conjunctiva is firmly attached to the limbus
2.Vascular coat: Nutrition to eye ball consists of
iris, ciliary body and the choroid
3.Nervous coat: Visual functions(Retina)
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1.ANTERIOR SEGMENT: This is again divided
into two by the lens and zonules.
Contains iris, cornea and two aqueous humour
chambers.
A. Anterior chamber: Depth is 3mm (range 2.54mm) .25ml of aqueous humour.
B.Posterior chamber: triangular space contains
0.06ml of aqueous humour.
2.POSTERIOR SEGMENT: Includes viterous,
Retina,choroid and optic disc.
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OPTIC NERVE
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OPTIC CHIASMA
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OPTIC TRACT
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LAT GENICULATE BODY
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OPTIC RADIATIONS
This will ultimaltely end up in the visual cortex
in the Occipital lobe.
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1.The eyelids, eyebrows,conjunctiva and the
lacrimal apparatus.
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1.Forms the post 5/6th of the fibrous coat.Its whole
outer surface is covered by the TENON’S
CAPSULE.
2.Its ant 1/3rd is covered by bulbar conjunctiva.
3.Inner surface contact- potential suprachoroidal
space in between.
4.Canal of schelm
5.Thinner in children than adults and females than
the males.
6. Thickest posteriorly (1mm) and becomes thin
anteriorly.thinnest at the insetion of the
EOM.(0.3mm).
7. Thickness of the sclera at the equator is 0.4to
0.6mm and adjacent to limbus is about 0.8mm
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1.POSTERIOR: Optic nerve(lamina cribrosa),
Long and short ciliary vessels and nerves.
2.MIDDLE: Slightly posterior to the equator
pass 4 vortex veins(vena vericosae)
3.ANTERIOR: 3-4mm away from limbusAnterior ciliary vessels.
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1.EPISCLERAL:Dense, vascularised. Anteriroly
gets continuous with the Tenon’s capsule.
2.SCLERA PROPER: Avascular – dense
collagen fibres
3.LAMINA FUSCA: Blends with the supra
choroidal and supraciliary laminae of the uveal
tract.
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1.Supplied by the long ciliary nerves
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1.Transparent avascular watch glass like
structure forms 1/6th of the outer fibrous coat.
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1.Epithelium: Stratified squamous type
5-6layers are present.In injury regenerates
in 6-8 days. Diameter 50—90um
A. Basal layer: tall collumar
B. Wing cells: 2-3layers polyhedral shaped
C. Flattned cells: upper 2 layers superficial.
2.Bowmans membrane: Acellular mass of
condensed collagen fibrils. Destroyed cannot
be regenrated. Diameter 8—14um.
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3.Stroma: Collagen fibrils(lamallae) cells in
hydrated matrix of proteoglycans(ground
substance) dia 0.5mm
4.Descements membrane: Collagen and
glycoproteins. Ant 1/3rd having vertically
banded pattern and post 2/3rd amorphous and
granular. Dia at birth 3um in young 10—2um
-Hassel Hanle bodies at posterior surface
round wort like excrescences
-Similar central excrescences known as guttatae
are seen in FUCH’s dystropy.
5.Endothelium: Flat polygonal cells present.
Diameter vary from 18—20um.
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BLOOD SUPPLY: It is AVASCULAR. But small
loops of ant ciliary vessels invade 1mm and
provide nutrition, but these are not in the
cornea but in subconjuctival tissue which
overlap the cornea.
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NERVE SUPPLY:
Trigeminal nerve
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Ophtalmic branch
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Naso ciliary nerve
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Long ciliary nerve
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Sensory nerve endings
1.These are highest in the centre and gradually
decreases peripherly.
2.No nerve supply – central posterior,
Descements membrane & endothelium.
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PARTS:
1.PALPEBRAL
a . Marginal
b . Tarsal
c . Orbital
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2.BULBAR
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3.CONJUNCTIVAL FORNIX
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Three in number
1.Epithelium:
a. Marginal
b. Tarsal
c. Fornix & Bulbar
d. Limbal
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2.Adenoid layer
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3.Fibrous layer
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1.Mucin secretory glands
a. Goblet cells : in epithelium.
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b. Crypts of Henle: in tarsal conjunctiva.
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c. Manz: In limbal conjunctiva.
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BLOOD SUPPLY:
1.PERIPHERAL & MARGINAL arterial arcade
of the lids – palpebral and fornix
2.Anterior ciliary arteries
VEINS drain into plexus of the eyelids and
some into the cornea into ant ciliary veins.
LYMPHATICS drain into preauicular(lat) and
submandibular(medial) lymph nodes.
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NERVE SUPPLY:
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Long ciliary nerves to the cornea
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Rest of conjunctiva is supplied by the branches
from the Lacrimal, Supratrochlear,
infratrochlear, supraorbital, frontal nerves.
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This constitutes middle vascular layer of the
eyeball.
From anterior to posterior it consists of
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1.IRIS
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2.CILILARY BODY
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3.CHOROID
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1.Anterior most, thin circular acts as a
diaphargm of the camera
2.In centre there is pupil which regulates the
light reaching the retina.
3.ATTACHMENTS- Periphery to the ant
surface of the ciliary body.
This iris divides into anterior and posterior
chambers between cornea and lens.
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Divided into ciliary zone and pupillary zone by
zig zag line called COLLARETTE.
1.CILIARY ZONE: Radial streaks due to blood
vessels & crpts. Superficial layer is not present
2.PUPILLARY ZONE: present betn collaratte
and pigmented pupillary frill which is smooth
and flat.
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Consists of 4 layers:
1.Anterior limiting layer: Colour of
iris,deficient in crypts,
2.Iris stroma:
Sphincter pupillae-1mm broad circular,
supplied by parasympathetic fibres of 3rd
nerve. CONSTRICTS THE PUPIL
Dilator pupillae lies posterior supplied by the
cervical sympathetic nerve DILATES THE
PUPIL
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3.Anterior epithelial layer: It is continuation of
the pigment epi of the retina. Gives rise to
dilator pupillae.
4.Posterior epithelial layer: Conti of the non
pigmented epi of the retina.
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1.Continuation of choroid at Ora serrata.
2.Cut section it is triangular in shape.
Ant part- forms angle of the ant and post
chambers. In its middle iris is attached.
Outer side – lies against the sclera.
Inner side – Divided into 2 parts
1.Pars plicata(2mm)
2.Pars plana (4mm)
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Ciliary body consists of 5 layers:
1.Supra ciliary lamina
2.Stroma of the ciliary body
3.Layer of pigmented epithelium
4.Layer of non pigmented epithelium
5.Internal limiting membrane
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1.Finger like projections from pars plicata part
of ciliary body
2.No-70 – 80
3.Each process 2mm long 0.5mm in diameter.
4.Colour white
5. 2 layers of epithelial cells
6.These process contain blood vessels and
connective tissue. SITE for AQUEOUS
production
7.Fucnctions: 1.Formation of aqueous.2.Ciliary
muscles help in accomidation.
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Ciliary processes
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A.H on posterior chamber(pupil)
Anterior chamber
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Trabecular meshwork
Ciliary body
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Schlemm’s canal
Suprachoidal space
Collectors channels
venous circulation of
ciliary body
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Episcleral veins
Trabecular 90%
Uveo sleral 10%
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1.Posterior most part of the vascular coat
Extends from the optic disc to ora serrata
2.Inner surface smooth brown and lies in
contact with pigment epithelium of retina
3.Outer surface rough lies in contact with the
sclera.
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1.Supra choroid lamina(lamina fusca)contains short and long posterior ciliary vessels
and nerves(10-34um)
2.Stroma of choroid- Pigment cells and plasma
cells. Main bulk is formed by the vessels
arranged in 3 layers.
a. Large vessels – HALLER’S LAYER
b. Medium vessels – SATTLER’S LAYER
3.Layer of chorio cappillaries which nourishes
the outer layers of retina.(18-50um)
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ARTERIAL SUPPLY:
1.Short posterior ciliary artery from ophtalmic
artery. Supply – Choroid in segmental manner.
2.Long posterior ciliary art: 2 in number Nasal
and Temporal. Supply – ciliary body.
3.Anterior ciliary arteries arise from muscular
branches of the ophtalmic artery.
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VENOUS DRAINAGE:
Drain blood from the Iris ciliary body and
choriod form the VORTEX VEINS. These are 4
in number.
They are :
1.Superior temporal
2.Inferior temporal
3.Superior nasal
4.Inferior nasal.
These all drain into the superior & inferior
ophthalmic veins, these drain into the
Cavernous sinus.
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1.It is a transparent biconvex crystalline
structure place between the iris and vitreous.
2.Diameter is 9-10mm
thickness at birth 3.5mm and extreme age
5mm.
Wt- 0-9 yrs 135mg to 225mg in 40-80yrs.
3.Two surfaces
a. ant surface- less convex(radius 10mm)
b. post surface- more convex(radius 6mm)
These 2 surfaces meet at the equator.
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4.Refractive index is 1.39 and total power is
15-16D.
This accommodative power varies with age
At birth 14-1 6D
At 25yrs 7-8D
At 50yrs 1-2D.
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1.Lens capsule: Thin transparent hyaline
membrane surrounding the lens.
Thicker over the anterior than posterior
surface.
Thickest at the pre-equator regions and
thinnest at the posterior pole.
2.Anterior Epithelium: Single layer of cuboidal
cells lie beneath the andterior capsule.
In the equator these cells become columnar
these are actively dividing and elongating to
form new lens fibres throughout the life.
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3.Lens fibres :The epithelial cells elongate to
form lens fibres which have complicated structure
form.
These are formed through out the life and
arranged compactly as nucleus and cortex of the
lens.
A. Nucleus: It is central part containing the oldest
fibres. It consists of different zones
From inside out the layers are:
a.Embryonic-1-3mnts of gestation
b.Fetal nucleus 3months of gestation till birth
c. From the birth to puberty infertile.
d. From then Adult nucleus.
B. Cortex: It is the periphery part which
compromises the youngest lens fibres.
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4.Suspensory ligaments of zonules :
Also called Zonules of Zinn OR Ciliary
zonules.
Series of fibres passing from the ciliary body to
the lens. These may be 9-10 lakhs in number
approximately.
These hold the lens in position and enable the
ciliary muscle to act on it.
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These are arranged in 3 groups:
1.From pars plana and anterior part of oraserrata
pass ant to get inserted to the equator.
2.Fibres from anteriorly placed ciliary processes
pass posteriorly to be inserted posterior to the
equator.
3.Fibres passes from the summits of the ciliary
processes, almost directly inward to be inserted at
the equator.
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1.V.H is a inert, transparent, colourless, jelly
like hydrophillic.
FUNC: Optical functions and supporting the
structural integirty of the eyeball.
2.Anteriorly bound by the lens.ciliary body &
posteriorly by Retina.
3.Wt-4gm Volume-4cc constitutes 2/3rd of
globe.
4.Contains extracellular material(1%) and
water(99%)
5.RI 1.3349
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3 PARTS:
1.Hyaloid layer: Outermost
a.Anterior hyloid or Ant limiting memb
It is covers the vitreous body starting app
1.5mm from oraserrata. Lies in contact with the
part of pars plana ciliary processes, ciliary
zonules & post lens capsule.
In the centre area of behind the lens lies the
BERGERS SPACE or Patellar fossa.
From centre of this space the ant hyloid memb
turns backward to form the ant portion of
CLOQUET’S CANAL.
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b. Posterior hyaloid membrane :
It is in contact with the Internal limiting
membrane of the retina.
2.Cortical vitreous:
It refers to the entire periphery zone app
100um.
It consists if more of the condensed collagen
fibrillar vitreous.
3.Medullary vitreous:
It has less fibrillar structure. It is cell free.
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1.It is the innermost tunic of the eyeball, thin
delicate and transparent membrane.
2.Thickness at the posterior pole in
peripapillary region is app 0.56mm,at the
equator 0.18mm, and at ora serrata app
is0.1mm
3.It appears purplish-red (due to purple of
rods). After death- white opaque.
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4.It extends from the optic disc to the ora
serrata has surface area about 266mm2
On Ophthalmoscope it is diveded into
1.Optic disc
2.Macula lutea.
3.Peripheral retina.
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1.Pale pink , diameter 1.5mm,uniformly pink.
2.All the retinal layers terminate except the
nerve fibres(which pass through the lamina
cribrosa)
3.The optic disc appears white due to the
lamina cribrosa and medullated nerve fibres
behind it and absence of vascular choroid.
4.In the centre where the nerve fibres are
thinnest,the white lamina shines brighltly.
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1.It is ayellow spot, dark 5.5mm in diameter situate
at the posterior pole of the eyeball,temporal to the
optic disc.
2.Fovea centralis is the central depressed part of
macula. Diameter 1.85mm and 0.25mm in
thickness
-Fovea(0.35mm in dia) situated about 2 disc
diameter (3mm) away from the temporal egde.
-Umbo is tiny depression in the very centre of the
fovea.
-Foveal avascular zone located inside the fovea but
outside the foveola.
3.Surrounding the fovea are the parafoveal and
perifoveal areas about 0.5mm and 1.5mm in dia.
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1.There are no rods, cones are larger, tighly
packed and other layers of retina are thin.
2.Its central part largely consists of cones and
their nuclei covered by thin internal limitin
membrane.All other retinal layers are absent in
the foveolar region.
3.In the foveal region surrounding the foveola
the cone axons are arranged
obliquuely(Hanle’s layer) to reach the margin
of the fovea.
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Divided into 4 regions:
1.Near periphery: Refers to a circumscribed region
about 1.5mm around area centralis.
2.Mid periphery: Occupies a 3mm wide zone
around the the near periphery.
3.Far periphery: Extends from the optic disc 910mm on the temporal side and 16mm on the nasal
side in horizontal meridian.
4.Ora serrata: It is the serrated peripheral margin
where the retina ends and ciliary body starts.
2.1mm wide temporally, 0.7-0.8mm wide nasally.
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Its distance from the limbus is 6mm nasally
and 7mm temporally.
It is located 6-8mm away from the equator and
25mm from the optic nerve on the nasal side.
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Consists of the 3 types of cells and their
synapses arranged in the following layers:
1.Retinal pigment layer
2.Layer of rods and cones
3.External limiting membrane
4.Outer nuclear layer
5.Outer plexiform layer(Molecular)
6.Inner nuclear layer
7.Inner plexiform layer(Molecular)
8.Ganglion cell layer
9.Nerve fibre layer
10.Internal limiting membrane
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1.Outer four layers – choriocapillaris
2.Six inner layers – central retinal artery
3.The outer plexiform layer – party from the
central retinal artery and partly from
choriocapillaris by diffusion.
4.Fovea is a avascular structure –
choriocapillaris.
5. Macular – small twigs from superior and
inferior temporal branches of central retinal
artery. Sometimes cilioretinal artery – its helps
in the vision in occulsion of the central retinal
artery.
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1.Six muscles assist in the movements of the
eye in the vision.
2.They are
A. Superior rectus (42mm)
B. Inferior rectus (40mm)
C. Medial rectus (40mm)
D. Lateral rectus (48mm)
E. Superior oblique. (60mm)
F. Inferior oblique (37mm)
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ORIGINAll the four recti muscles arise from the
common tendinous ring called the Annulus of
Zinn which is attached at the apex of the orbit
encircling the the orbital fissure.
All the recti muscles arise from their respective
sides, but lateral rectus has got 2 heads by
origin which join as “V” form.
The SR and the MR are closely attached to the
dural sheathof the optic nerve at their origin.
This attachment for the charasteristic pain in
case of retrobulbar neuritis felt during upward
and inwardmovts of the eye
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COURSE:
All the four recti run forward around the
eyeball along their respective sides.
The inferior rectus remains in contact with the
orbital floor only half its length.
The superior rectus is seperated from the
orbital roof by LPS muscle
These starting from the apex is diverging
,however,somewhat in front of they turn
equator they turn towards the eyeball in a
gentle curve to get inserted on the sclera.
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INSERTION:
All the four muscles are inserted into the sclera at
different distances from the limbus
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Medial rectus
Inferior rectus
Lateral rectus
Superior rectus
Fushs1884
5.5mm
6.5mm
6.9mm
7.7mm
Apt1980
5.3mm
6.8mm
6.9mm
7.9mm
The insertions being not equidistant from the
limbus do not form a circle , rather a spiral The
spiral of tillaux
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OBLIQUE MUSCLES:
SUPERIOR OBLIQUE MUSCLE:
Origin– from the bone of the sphenoid above
and medial to the optic foramen, partially
overlapping the LPS muscle.
Course– moves forward between the roof and
medial wall of the orbit to reach trochlea of
SOM. This trochlea is acts as a pulley attache
dto the spina trachlearis. After passing the
trochlea it turns posterolaterally. At the distal
3rd portion(10mm behind the trochlea) it
becomes tendinous so it is reflected part.
The reflected part pass under the SR and gets
inserted into the sclera.
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Insertion:
The fanned out reflected tendon is inserted on
to the upper and outer part of the sclera behind
the equator.
The SO is the longest and thinnest of all EOM.
The length of the direct part is 40mm and that
of the reflected part is 19.5mm.
From the physiological and kinematic stand
point the trochlea is the origin of the muscle.
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INFERIOR OBLIQUE MUSCLE;
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Origin:
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Rounded tendon from ashallow depression on
the orbital palte of the maxilla just lateral to the
orrifice of the nasolacrimal duct. Some fibres
arise from the lacrimal fascia.
It is the only muscle which takes origin from
the front of the orbit
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Course:
It passes laterally and backward between the
IR and floor of the orbit.
It is almost wholly muscular with a short
tendon at the origin and insertion.
It is the shortest of all the eye muscles being
only 37mm.
Insertion:
It is inserted by ashort tenton in the lower and
outer part of the sclera behind the equator.
The insertion line is curved with the concavity
facing the origin.
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ARTERIAL SUPPLY:Two supply the EOM –
medial and lateral branches of the ophthalmic
artery.
The medial muscular branch larger of two
supplies the medial rectus, inferior rectus and
inferior oblique muscles. The medial rectus also
receives branch from the lacrimal artery and IR
and IO from infraorbital artery.
The lateral muscular branch supplies the lateral
rectus, superior rectus,the levator muscle and
the superior oblique muscle.
VEINOUS DRAINGE: Veins from all EOM
empty into the superior and inferior ophtalmic
veins.
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The oculomotor (3rd cranial nerve) supplies the
medial rectus, superior rectus, inferior oblique,
inferior rectus.
The trochelear (4th cranial nerve) supplies the
superior oblique muscle.
The abducens (6th cranial nerve) supplies the
lateral rectus muscle.
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MUSCLE
PRIM
MR
LR
SR
IR
SO
IO
ADD
ABD
ELEV
DEP
INT
EXT
SECOND
--INT
EXT
DEP
ELEV
TERI
--ADD
ADD
ABD
ABD