Ophthalmology

Basic Anatomy

Ophthalmology Staff Meeting

SGUHMC
Prepared by: Haytham El-Ballouz PGYII
 Embryology of the human
eye
 The eye is derived from three of the primitive embryonic layers:
 Surface ectoderm
 Gives rise to the lens, the lacrimal gland, the epithelium of the cornea, conjunctiva, and
adnexal glands, and the epidermis of the eyelids
 Mesoderm
 The vitreous, Extraocular and lid muscles, and the orbital and ocular vascular endothelium
 The neural ectoderm
 Retina and retinal pigment epithelium, layers of ciliary epithelium, the dilator and
sphincter muscles of the iris, and the optic nerve fibers and glia
 The neural crest
 Responsible for formation of the corneal keratocytes, the endothelium of the cornea and the
trabecular meshwork, the stroma of the iris and choroid, the ciliary muscle, the fibroblasts
of the sclera, the vitreous, and the optic nerve meninges.
 Involved in formation of the orbital cartilage and bone, the orbital connective tissues and
nerves, the extraocular muscles, and the subepidermal layers of the eyelids.
 GROWTH & DEVELOPMENT OF THE EYE

 Eyeball
 Short antero-posterior diameter at birth
 Ultimate size is reached at 7–8 years
 Cornea
 Large at birth and reaches adult size by the age of 2 years.
 It is flatter than the adult cornea, and its curvature is greater at the periphery
than in the center
 Lens
 At birth, the lens is more nearly spherical in shape than later in life, producing a
greater refractive power that helps to compensate for the short anteroposterior
diameter of the eye.
 The lens grows throughout life as new fibers are added to the periphery, making it
flatter.
 Iris
 At birth, there is little or no pigment on the anterior surface of the iris
 Pigment begins to appear on the anterior surface, the iris assumes its definitive
 Orbital cavity

 The eyes lies within the orbital

cavity

 The bony cavity represents

quadrangular pyramid with their
base directed anterolaterally and
their apices directed
posteromedially

 Volume of each orbit is 30 cm3

 Orbital cavity

 The orbit is related to

 Frontal sinus superiorly
 Maxillary sinus
inferiorly
 Ethmoid and sphenoid
sinus medially
 Orbital Margin
 Orbital margin forms a
quadrilateral spiral
 It is outlined by
 Frontal bone superiorly
 Maxillary and zygomatic bone
inferiorly
 Zygomatic and frontal bone
laterally
 Frontal bone, posterior lacrimal
crest of lacrimal bone, and
anterior lacrimal crest of
maxillary bone medially
 Orbital Apex

 Formed by the optic canal in

the lesser wing of the sphenoid
bone
 Orbital Roof

 Formed by
 Orbital plate of frontal bone
 Lesser wing of the sphenoid
 Contains
 Fossa for lacrimal gland
anterolaterally
 Trochlear fossa medially (site of
SOM pulley)
 Orbital Floor

 Orbital floor is made up of:

 Maxilla
 Palatine
 Orbital plate of zygomatic
bone
 Lateral Wall

 Formed by
 Zygomatic bone
 Greater wing of the sphenoid bone
 Contains the Whitnall tubercle
 LRM ligament
 Suspensory ligament of the eye ball
(Lockwood)
 Lateral palpebral ligament
 Whitnall ligament
 Aponeurosis of levator muscle
 Medial Wall

 Formed by
 Frontal process of maxilla
 Lacrimal bone
 Orbital plate of ethmoid
 Lesser wing of sphenoid
Topographic features of the eye
Topographic features of the eye
 Eye lids

 Movable folds that are covered externally

by thin skin and internally by transparent
mucous membrane, the palpebral
conjunctiva.
 The exposed surface between the upper and
lower eyelid is called the palpebral fissure
 The palpebral fissure is 30mm long, and
11mm wide
 The fissure terminates at
 Lateral canthus which forms an acute angle.
 Medial canthus is more elliptical and
surrounds the lacrimal lake
 Eye lids

 Two structures are identified

in the lacrimal lake:
 Lacrimal caruncle containing
large modified sweat glands
and sebaceous glands that
open into hair follicles
 Plica semilunaris a vestigial
remnant of the third eyelid of
lower animal species.
Organization of the eye lid

 The eyelids consist of several principal

planes of tissues
 The skin layer
 Thinnest and contain no subcutaneous fat
 Hair follicles, sebaceous glands, sweat glands
 Organization of the eye lid
 Protractors
 Orbicularis oculi
 Orbital part (voluntary, tightly
closes the eyelid)
 Palpebral part (both voluntary
and involuntary, gently closes
the eye)
 Lacrimal part( draws eye lid
medially aiding in tears
drainage)
 Muscle of Riolan
 Meibomian glandular
discharge , blinking , and
position of eyelashes
 Horner muscle
 Formed by fusion of deep
 Organization of the eye lid

 Orbital septum
 Thin multilayered sheet of fibrous
tissue
 Arises from periosteum over superior
and inferior orbital rim
 Fuse with levator aponeurosis
superiorly, and capsulopalpebral fascia
inferiorly
 Orbital fat
 2 fat pockets in upper eyelid (nasal and
central)
 3 fat pockets in lower eyelid(nasal,
central, temporal
 Lies
 posterior to orbital septum and
 anterior to levator aponeurosis (upper
eyelid) and capsulopalpebral fascia(lower
 Organization of the eyelid

 Retractors
 Lower eyelid
 Capsulopalpebral fascia
 Originates from attachments to
terminal muscle fibers of IRM
 Inserts into inferior tarsal border
 Form Lockwood suspensory
ligament anterior to inferior
oblique muscle
 Inferior tarsal muscle
 Runs posterior to
capsulopalpebral fascia
 Organization of the eye
lid
 Upper eyelid
 Levator muscle and its
aponeurosis
 Originate in apex of the orbit
 Whitnall ligament is a sleeve of
elastic fibers
 Function as suspensory support
 Aponeurosis divide into anterior
and posterior portion
 Insert on septa between
orbicularis muscle and skin, and
anterior surface of tarsus
respectively
 Superior tarsal muscle(Muller
muscle)
 Originate in undersurface of
levator aponeurosis
 Insert in upper eyelid superior
 Organization of the eyelid

 Fibrous tissue (tarsal plates)

 Dense connective tissue
 Attached to the orbital margin
by medial and lateral canthal
tendons
 Mucous membrane (palpebral
conjunctiva)
 Transparent vascularized
membrane
 Merges with the bulbar
conjunctiva
 Terminates at the limbus
Organization of the eye lid

 Levator palpebrae superioris

 Originates from lesser wing of sphenoid bone
 Divides
 anteriorly into Aponeurosis
 posteriorly into superior tarsal muscle(Muller
muscle)
 Its function is to elevate the upper eyelid
 Glands of the eye lid

 Sebaceous glands
 Meibomian: modified
sebaceous glands
 Zeis: modified sebaceous
associated with lash follicles
 Moll: modified apocrine
sweat glands
 Sweat glands
 Lacrimal apparatus
 Consists of
 Lacrimal gland
 Accessory lacrimal glands
 Lacrimal canaliculi
 Lacrimal sac
 Nasolacrimal duct
 Lacrimal system

 Lacrimal gland
 Located in lacrimal fossa in the orbital part of the frontal
bone
 Divided into two parts orbital and palpebral by the lateral
expansion of levator aponeurosis
 Contains acinar and myoepithelial cells
 Accessory glands
 Gland of krause and wolfring
 Located in proximal lid boarder and/or fornices
 Lacrimal system

 Includes
 Lacrimal puncta
 Lacrimal canaliculi
 Lacrimal sac
 Nasolacrimal duct
 Tear flow along upper and lower lid margins
 Lacrimal fluid accumulate in lacrimal lake
 Eye open canaliculi and sac expands
Negative pressure draws tear into the sac
 Lacrimal part of orbicularis oculi contracts
compress the sac positive pressure force
tears into nasolacrimal duct
 Conjunctiva

 Thin, transparent mucous membrane that covers

 posterior surface of the lids
 anterior surface of the sclera as far as the limbus
 Arteries are derived from the anterior ciliary and palpebral
arteries.
 Lymphatics are arranged in superficial and deep layers
 Preauricular and Submandibular nodes
 Nerve supply from the first (ophthalmic) division of the fifth
nerve.
 Conjunctiva
 Divided into three zone
 Palpebral
 Cover the eye lid inner surface
 Firmly attaches to the tarsus
 Forniceal conjunctiva
 Redundant and freely movable
 Reflected at the cul-de-sac and attaches
to the globe
 Bulbar
 loosely attached to the orbital septum in
the fornices and is folded many times.
 Freely movable, fuses with tenon capsule
and inserts into the limbus
 Tenon capsule
 Envelops the eyeball from
the optic nerve posteriorly
till the intramuscular
septum anteriorly
 Forms the actual socket for
the eyeball
 The fascial sheath is pierced
by the tendons of the extra
ocular muscles and is
reflected onto each of them
as a tubular muscle sheath.
 Help to stabilize the muscle
during eye movement
 Tenon capsule

 Connected to each other and to tenon fascia

by connective tissue bands
 Suspensory ligament of Lockwood
 Check ligaments of medial and lateral rectus
muscle
 Extra ocular muscles

 The recti
 The obliques
 Levator palpebrae superioris
Extra ocular muscles
 The recti

 Arise from a fibrous cuff, the common

tendinous ring, that surrounds the optic
canal and part of the superior orbital fissure
 Named according to their insertion into the
sclera on the medial, lateral, inferior, and
superior surfaces of the eye
 The lateral and medial recti lie in the same
horizontal plane, and the superior and
inferior recti lie in the same vertical plane
The recti
The obliques
 The eye ball
 Consists of three layers

 Fibrous layer (outer

coat), consisting of the
sclera and cornea.

 Vascular layer (middle

coat), consisting of the
choroid, ciliary body,
and iris.

 Inner layer (inner

coat), consisting of the
retina that has both
optic and non-visual
parts.
 The sclera

 covers the posterior five sixths of the eyeball.

 It is the fibrous skeleton of the eyeball providing
 shape and resistance
 attachment for both the extrinsic (extra ocular) and the intrinsic muscles
of the eye.
 The anterior part of the sclera is visible through the transparent bulbar
conjunctiva as the white of the eye
 Thinnest at insertion of the rectus muscles, and thickest posteriorly
around the optic nerve
 Avascular and nourishes from episcleral vessels, and intrascleral
vascular plexus through
 The cornea

 Transparent tissue connected to

the sclera at the limbus
 Constitute the main refractive
element of the eye
 Forms a positive lens of 43D
 Around 550 m thinnest in the
center and thickens at periphery
 Avascular, metabolic waste and
nutrients are derived and removed
through aqueous humor and tears
 The cornea
 Five distinct layers
 Epithelium
 stratified squamous, no keratinized
 Healthy corneal surface
 Junctional barrier
 Bowman's layer:
 clear acellular layer, a modified portion of the stroma.
 Stroma:
 90% corneal thickness
 Collagen fibrils, proteoglycans, fibroblasts
 Orientation is important o maintain optical clarity
 Cannot regenerate after trauma
 Descemet's membrane:
 serve as a modified BM
 Regenerative potential
 Endothelium:
 Uveal tract

 The vascular layer of the eyeball also called

the uvea or uveal tract consists of
 Choroid
 ciliary body
 Iris
 Iris
 Anterior extension of the ciliary body
 Flat surface with a centrally situated
round aperture, the pupil that controls
the amount of light entering the eye.
 Divides the anterior chamber from the
posterior chamber
 The blood supply to the iris is from the
major circle of the iris
 Sensory nerve supply to the iris is via
fibers in the ciliary nerves.
 Pupillary size determined by a balance
between
 constriction due to parasympathetic
activity via the third cranial nerve
 dilation due to sympathetic activity
 Ciliary body

 extends forward from the

anterior end of the choroid to
the root of the iris
 Has 2 principal function
 Aqueous humor formation
 Lens accommodation
 It consists of
 corrugated anterior zone, the
pars plicata
 flattened posterior zone, the
pars plana
 Ciliary body

 Three muscular layers

 Longitudinal outer layer
attaches to scleral spur
 Radial mid portion layer
 influence the pore size of
the trabecular meshwork.
 Circular innermost layer
attach to zonular fibers of
the lens capsule and alter
its shape
 Choroid
 Noriches the outer portion of the
retina
 Made up of 3 layers of vessels
 Innermost: choriocapillaries
 Small vessels
 Outer: large vessels
 Continues anteriorly with cilliary
body
 Attaches firmly to pigment
epithelium of retina
 Easily separated from the sclera
 Responsible for red eye reflection
 RETINA

 Lines the posterior 2/3 of the

choroid
 Extend anteriorly to reach the
ora serrata
 Part of the fundus oculi that’s
visible on ophthalmoscopy
 Optic disk:
 region where optic nerve and
retinal blood vessels exit the
globe
 Contains no visual receptors
 Retina

 Macula lutea
 5-6 mm in diameter
 Area responsible for color
vision and highest visual
acuity
 Known as the yellow spot,
area within temporal
vascular arcade
 Characterizes histologically
by more than one layer of
ganglion cell nuclei
 Retina
macula lutea
 Divided into
 Perifoveal area
 1.5mm, characterized by several
layers of ganglion cells and 6 layers
of bipolar cells
 Parafoveal area
 0.5 mm, characterized by 4-6 layers
of G cells, 7-11 layers of B cells
 Fovea
 Excavation in retinal center, consist
of margin, declivity, bottom
 Foveola
 Center of fovea
 Umbo
 Center of Foveola, highest visual
acuity
 Retina

 Thin transparent membrane

 Retina is divided into
 Retinal pigment epithelium
 Neurosensory retina and its elements
 Neurosensory Retinal
Elements
 Photoreceptors
 Composed of neuroepithelial
cells called rods and cones
 Divided into
 Outer segment
 Inner segment (nuclear region)
 Synaptic zone
 Rods outer segment made up
of flattened saccules which are
discrete structures from cell
membrane
 Cones outer segment saccules
are formed by enfolding of cell
membrane
 Neurosensory retinal elements
photoreceptors
 In extra foveal region of
retina, rods predominate
 In foveal region cones
prevail
 Visual pigment:
 each is formed by an
Opsin, and Retinene (Vit
A1 aldehyde)
 In rods its rhodopsin
which has peak
sensitivity to light at
wave length 505 nm
Neurosensory retinal elements
photoreceptors

 cones have 3 opsins

 Short wavelength
 Contain cyanolabe
 Sensitive to blue at wavelength 445
 Medium wave length
 Contain chlorolabe
 Sensitive to green at wavelength 540nm
 Long wavelength
 Contain erythrolabe
 Sensitive to yellow at wavelength 565 nm
Neurosensory retinal elements
photoreceptors

 Some photoreceptors contain melanopsin

 Axons project to suprachiasmatic nuclei and
LGN
 Controls circadian photo entrainment
 Also aids in papillary light reflex
 Neurosensory retinal elements
neuron
 Made up of 4 types of cells
 Bipolar cells :
 synapse with either rods or cones, and
make synaptic contact with ganglion and
amacrine cells
 Horizontal cells:
 make synaptic connections with many rods
and cones
 Amacrine cells :
 connect ganglion cells, and bipolar with
ganglion cells
 Ganglion cells :
 form nerve fiber layer and optic nerve
fibers
 Made up of
 M cells : luminance, contrast and motion
Neurosensory retinal elements
glial cells

 Made up of Muller, astrocytes and microglial

cells
 Function
 Structural support
 Nutrition
 Retinal development and metabolism
 Blood supply
 Central retinal artery:
 Terminal branch of ophthalmic
artery, derived from internal
carotid artery
 Divides into superior and
inferior arcades
 Cilioretinal artery from ciliary
circulation
 Venous drainage :
 Retinal arcade veins
central retinal veins , joined by
choroidal veins both empty into
superior ophthalmic vein
cavernous sinus petrosal sinus
internal jugular
Stratification of the retina

 Retinal pigment epithelium

 monolayer of hexagonal cells, extend to ora serrata
 Attached by lateral intracellular junctions
 Its separation from neurosensory retina is named retinal
detachment
 Drusen bodies: accumulation of incompletely digested
extracellular matrix between BM of RPE and Bruch's
membrane
 Function: Vit A metabolism, phagocytosis, reduction of
light scatter, heat exchange, active transport,
mucopolysaccharide matrix production
 Stratification of the retina
 External limiting membrane :
 Formed by the attachment
sites of photoreceptor and
Muller cells
 Outer nuclear layer:
 Made up of nuclei of
photoreceptor cells
 Outer plexiform layer
 Interconnection between
photoreceptor synaptic bodies
and horizontal and bipolar cells
 Inner nuclear layer
 Nuclei of bipolar, Müller,
horizontal and amacrine cells
 Stratification of the retina
 Inner plexiform layer
 Axons of bipolar and amacrine
cells and dendrites of ganglion
cells and their synapses
 Ganglion cell layer
 Cell bodies of ganglion cells
 Nerve fiber layer
 Formed by axons of ganglion
cells, non myelinated
 Internal limiting membrane
 Formed by foot plates of Muller
cells and attachment to basal
lamina
 Lens

 Biconcave, avascular, colorless

 Contains no pain fibers
 Encapsulated and anchored by
zonular fibers to ciliary body
 Fine tune the focus of near/far
objects on the retina
 Contraction of ciliary muscle
moves the proximal attachment
of zonules forward and inward ,
lens become globular, adjust for
near vision
 Chambers
 Anterior chamber
 The space between the cornea
anteriorly and posteriorly by the
iris and pupil
 Depth =3mm, volume of 200 micro
L
 Filled with aqueous humor, that
drains through trabecular
meshwork into schlem canal

 Posterior chamber
 Bounded by the iris anteriorly and
posteriorly by suspensory ligament
of the lens and the cilliary
processes
 Site of aqueous humor production
by cilliary epithelium
 Chambers

 Vitreous
 Constitute four fifth of the globe volume
 Volume=4ml, gel like structure
 99% water
 Mucopolysaccharide hyaluronic acid
 Provide route for metabolites used by lens,
Ciliary body, and the retina
 Ciliary ganglion

 Located 1cm in front of

annulus of Zinn
 Supply iris sphincter, ciliary
muscle, and short ciliary
nerves(cornea, ciliary body,
iris)
 Receive three roots
 Sensory from nasociliary
branch of CNV1
 Motor from inferior division of
CNIII
 Sympathetic from plexus
around internal carotid artery
 Oculomotor nerve

 Supply SR, IR, MR, IO

 Carries cholinergic innervation to
pupillary sphincter and ciliary
muscle (light reflex)
 Near reflex includes
accommodation, pupil
constriction, and convergence
 Starts in occipital association
cortex, cortico-fugal pathway,
Edinger-Westphal nucleus, motor
nuclei of MR
 Trochlear and Abducens

 Trochlear nerve
 Originate in caudal mesencephalon
at the level of inferior colliculus
 Longest intracranial course, enter
trough superior orbital fissure
 Innervate SOM
 Abducens nerve
 Nucleus situated in floor of forth
ventricle
 Pass through superior orbital
fissure within annulus of Zinn
 Innervate LRM
 THE TRIGEMINAL NERVE (V)
 Originates from the pons
 The first (ophthalmic) divides into the
 Lacrimal: terminate in the lacrimal gland, providing
its sensory innervation
 Frontal: divides into the supraorbital and
supratrochlear nerves to provide sensation to the
brow and forehead
 nasociliary nerves: provide sensory supply to the
cornea, iris, and ciliary body
 The terminal branches are
 Infratrochlear nerve: supply the medial portion of the
conjunctiva and eyelids
 Anterior ethmoidal nerve: provide sensation to the tip
of the nose
 The second (maxillary) division
 Enters the orbit through the inferior orbital fissure
 It passes through the infraorbital canal, becoming
the infraorbital nerve
 supply sensation to the lower lid and adjacent
cheek
 Pathway of light
 Light passes through the
optical component of the eye
 Cornea anterior chamber
papillary opening of the iris
lens vitreous humor
 Light then reaches the retina
which transform it into
electrical impulses
 Electrical impulses are
transported to central visual
areas for interpretation and
response
 Pathway light
 Light travels through the entire
span of the retina to reach the
photoreceptors (first order
sensory neuron)
 Light signal is changed to
electrical signal, then
transduced to bipolar cells
( second order neurons)
 Transduction continues to retinal
ganglion cells (third order
neurons)
 Signal is modified by horizontal
and amacrine cells
 Photoreceptor potential

 Na channels are open in the

dark
 Current flows from inner to
outer segment
 Ionic equilibrium is
maintained by Na-K pump
 Light close Na channels
resulting in
hyperpolarization
Retinene 11- • All-trans
light
cis formation isomer

Meta-
rhodopsin II

Response in neurotransmit

n a l on
Sig cati
p lifi
am hyperpolarization
Closure of Na channels

Hydrolize C-
Transducin phosphodiest
GMP to non
activated erase
cyclic GMP
 Optic nerve
 Signal travel by nerve fibers
of optic nerve
 through lamina cribrosa of
the sclera, through optic
canal.
 Conserve retinotopic
representation
 Macular bundles temporally
and increase in the center
 Peripheral retinal receptors at
its periphery
 Pathway to LGN

 Optic chiasm
 At optic chiasm, nerve fibers from
nasal half decussate to separate
the left and right visual world
 Macular fibers cross posteriorly
 Superior visual field fibers are
first to cross
 This anatomic rearrangement
permits left hemisphere to
receive right sided visual
information
 Optic track
 Prior to LGN pupillary pathway
fibers exit to pretectal nuclei and
superior colliculus
 Lateral Geniculate Nucleus
 Meaning knee shaped
 6 layered structure
 2 levels of organization
 Crossed fibers terminate in lamina
1,4,6
 Uncrossed fibers terminate in
lamina 2,3,5
 Layers 1-2 have magnocellular cells
 Respond to movement, depth, and
flicker
 Layers 3-6 have parvocellular
component
 Color vision, texture, shape, and fine
details
 Preserve retinotopic map with 90
degrees of rotation
 Optic radiation carry impulses from
LGN to visual cortex
 Meyers loop geniculocalcarine fibers
that curve around lateral
ventricle(represent upper part of
contralateral visual cortex)
 Some project to superior colliculus,
then project to spinal cord to control
reflex movements in response to
visual stimuli
 Some project to edinger-westphal
nucleus, parasympathetic neurons
via oculomotor nerve, ciliary ganglia,
control pupillary light reflex
 Primary visual cortex

 Also called calcarine or

brodmann area 17
 Located at medial surface
of occipital lobe above and
below calcarine fissure
 6 layered structure
 Layer 2-3 organized into
blob and interblob regions
 Parvocellular input about
color project to blob
regions
 Input concerned with shape
 Primary visual cortex

 Optic radiations terminate in

layer 4
 Layer 4 is further sub divided into
 4Ca input from M cells
 4Cb receive input from P cells
 4Cc
 Macular fibers terminate
posteriorly
 Fibers originating from
contralateral side terminate
anteriorly
 Receive input in a retinotopic
distribution
 Primary visual cortex

 3 types of cells
 Simple cells: respond to specifically oriented
dark-light border
 Complex cells : respond to orientation of light-
dark interface
 End stopped cells : decrease firing when
stimulus reaches the end of the cell receptive
field
 Primary visual cortex

 Preference of information coming from

one eye creates the ocular dominance
columns
 Contain cells that receive input from only
one eye
 These cells alternate with cells receiving
inputs from the other eye
 The various types of ocular dominance
tasks may be divided into three broad
sub-categories, each of which suggests a
different way to measure the dominance.
 Sensory dominance
 Oculomotor dominance
 Directional dominance
 Cortical areas

V2,V3  Other cortical areas

Continued
processing, larger
visual field, sensitive
to direction, motion

V4 Sensitive to color

V5 Speed, direction

V6 Extrapersonal space

V7 Unknown

V8 Color vision
 Color vision

 Attributes of color
 Hue, intensity, saturation
 Perception of color depends on the color of
other objects in the visual field
 Young-helmholtz theory:
 Three types of cones that are sensitive to one
of the three primary color
 Sensation of any color determined by relative
frequency of impulses from each cone system
 Color vision

 Ganglion cells alter inputs from photoreceptors

 3 neural pathway project from LGN and
ganglion cells to V1
 Red-green pathway
 Signal difference between L-M cone response
 Blue-yellow pathway
 Difference between S and sum of L-M response
 luminance pathway
 Sum of L-M pathway
 Binocular vision

 Visual fields are cut by the nose medially

and orbit roof superiorly
 Central fields of two eyes coincide
 The impulses are fused at cortical level
 Fusion Failure produces diplopia
 Binocular vision plays an important role in
depth perception
 Binocular vision

 To establish clear stable binocular vision,

oculomotor system must perform 7 functional
tasks
 Vestibular
 Fixation
 Optokinetic
 Smooth pursuit
 Saccadic
 Vergence
 Nystagmus Quick phases
 References

 Basic and clinical science course, section 2, fundamentals

and principles of ophthalmology
 Basic and clinical science course , section 12, retina and
vitreous
 Basic and clinical science course , section 7, orbit, eyelid,
and lacrimal system
 Clinically oriented anatomy, section 7, the head
 Vaughan and Asbury general ophthalmology, chapter one,
anatomy and embryology of the eye
 Yanoff & Duker: Ophthalmology, 3rd ed, part 6, section
one, structure and function of the neural retina