This document discusses important clinical tips related to applied eye anatomy. It covers various topics including orbital fractures, extraconal vs intraconal lesions, third nerve palsy, eyelid anatomy, conjunctiva, corneal anatomy and transplantation, the anterior chamber angle, lens anatomy and cataracts, vitreous anatomy, and posterior vitreous detachment. The presenter provides brief explanations of anatomical structures and clinical correlations to help with management of eye diseases.

1. Applied eye anatomy
Clinical tips
By
Amr Mounir, MD, PHD

2. This video presentation discusses
important clinical tips of applied eye
anatomy
Understanding the eye anatomy and
its clinical importance will help in
management of various eye diseases
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

3. The Orbital floor fracture is the
commonest orbital wall fracture.
Followed by the medial wall It
caused by a blowout fracture,
both floor and medial wall are
formed of thin bones.
The bony orbit
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

4. Floor fracture
 enophthalmos
 diplopia
Medial wall fracture
 enophthalmos
 diplopia
 orbital emphysema
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

5. Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Intraconal or Extraconal??

6. Proptosis:
Forward protrusion
of the eyeball.
It is a common
manifestation of
lesions inside the
orbital cone
Intraconal lesions
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

7. Non axial proptosis (Orbital dystopia):
Non axial protrusion of the eyeball.
Displacement can occur in eccentric or vertical planes
It is a common manifestation of lesions outside the
orbital cone
Extraconal lesions
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

8. Lacrimal gland secretes the watery
layer of the tear film
So, in Sjögren syndrome → severe
dry eye (keratoconjunctivitis sicca)
Lacrimal gland
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

9. The ducts of both the orbital
and palpebral lobes drain into
the superotemporal
conjunctival fornix
Damage to the excretory ducts
in the superior conjunctiva
occurs in chronic conjunctivitis
with Keratinization
Lacrimal gland ducts
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

10. Epiphora which is decreased drainage
of tears caused by any disease
affecting the lacrimal drainage system
e.g: Ch. Dacryocystitis
Lacrimal drainage system
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

11. Ptosis: drooping of the upper
eyelid
Due to muscle problem
Or Aponeurotic problem
Or 3rd n. palsy
The levator palpebrae superioris
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

12. The superior tarsal
muscle, known as Muller’s
muscle, is a muscle which
maintains the elevation of
the upper eyelid.
It is supplied by a
sympathetic innervation
Müllers muscle
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

13. Sympathetic overactivity
→ Lid retraction → thyroid
eye disease
Müllers muscle
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Sympathetic hypo activity
→ Ptosis → Horner
syndrome

14. Superior division:→
Levator muscle + SR
3rd nerve ( oculomotor nerve)
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Inferior division:→
MR, LR, IO + motor
to ciliary ganglion

15. Complete 3rd nerve palsy →The eye
will be displaced outward "exotropia"
and displaced downward "hypotropia“
with ptosis and mydriasis
3rd nerve palsy
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Partial 3rd nerve palsy →Variable
duction limitation of the affected
extraocular muscles and with variable
degree of ptosis +- pupillary
dysfunction.

16. Medical 3rd nerve palsy → Pupillary
fibers occupy a peripheral
location so, it is not affected in
ischemic neuropathy (pupil-sparing)
3rd nerve ( oculomotor nerve)
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Surgical 3rd nerve palsy → Pupillary
fibers occupy a peripheral location
so, it is affected in compressive
neuropathy as in aneurysm (pupil-
involving)

17. Trochlear nerve 4th nerve
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

18. Trochlear nerve palsy
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Weakness or paralysis of the superior
oblique muscle (hypertropia)
Head tilt down and to the side
opposite

19. Abducens nerve: 6th nerve
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

20. Abducens nerve: 6th nerve
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Weakness or paralysis of the lateral rectus
muscle (esotropia)

21. Eyelids
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Gray line: Gray line is an eyelid margin projection of the
Orbicularis Muscle known as Riolan Muscle

22. Eyelids
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Gray line: is important landmark in repair of lacerations
involving the lid margin

23. Eyelids
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Meibomian glands: They are exocrine glands along the
rims of the eyelid inside the tarsal plate. It secrets the oil
layer of the tear film.

24. Meibomian glands:
inflammation or blockage →
chalazion.
Eyelids
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Meibomian glands
dysfunction → posterior
blepharitis

25. Zeis glands: They are
sebaceous glands located
on the margin of the
eyelid. The glands of Zeis
in relation to eyelashes.
Bacterial infection of Zeis
glands → stye
Eyelids
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

26.  Unkeratinized stratified
squamous epithelium
 Goblet cells are present
within the stratified
epithelium.
 Goblet cells secret the
mucous layer of the tear
film which is important for
conjunctival lubrication
Conjunctiva
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

27.  Keratinization of the
conjunctiva in dry eye , chronic
ocular irritation and cicatrizing
conjunctivitis
 Cicatrizing conjunctivitis
causes destruction of goblet
cells and severe dry eye.
Conjunctiva
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

28. Follicle
They are lymphoid hyperplasia.
White or greyish elevations in
tarsal conjunctiva
Caused by viral, chlamydial
infection and toxic effect
Conjunctiva
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

29. Papillae
They are fibrovascular mounds
with central vascular core.
Flat topped elevations in tarsal
conjunctiva
Caused by allergic, bacterial
effect
Conjunctiva
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

30. Epithelium:
Stratified squamous, nonkeratinized
of 5 layers
Fast-growing and easily regenerated
cells
Kept moist with tears
Irregularity or edema of the corneal
epithelium disrupts the smoothness of
the air/tear-film interface
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

31. Epithelium:
Rapid regeneration in
cases of corneal ulcer
Dry eye causes minute
erosions called PEE
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

32. Irregularity or edema of
the corneal epithelium
disrupts the smoothness
of the corneal tear-film
interface.
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

33. Corneal stroma:
Consists of regularly arranged collagen
fibers along with sparsely distributed
interconnected keratocytes.
Collagen fibers are parallel and are
superimposed.
The corneal stroma consists of 200
layers of mainly type I collagen fibrils.
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

34. Keratoconus:
It is disorder of the eye which
results in progressive thinning
of the cornea.
Caused by weakening of the
corneal tissue by disruption of
the regular arrangement of
the collagen layers and
collagen fibril orientation.
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

35. Corneal endothelium:
a cuboidal monolayer layer of cells.
These cells are responsible for
regulating fluid and solute transport
between the aqueous and corneal
stromal compartments.
The endothelium has both barrier and
pump functions, which are important
for the maintenance of corneal clarity.
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

36. Endothelial cell dysfunction:
Caused by endothelial injury by
surgery or due to hereditary
dystrophy like Fuchs’ endothelial
corneal dystrophy
Cornea
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

37. Penetrating Keratoplasty:
Is a full-thickness resection
of the patient's cornea,
followed by placement of a
full-thickness donor
corneal graft.
Corneal anatomy and Keratoplasty
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

38. Lamellar Keratoplasty:
A) Deep anterior lamellar
keratoplasty (DALK)
→ done by removing the
corneal stroma down to
Descemet’s membrane and
replaced by donor cornea
Corneal anatomy and Keratoplasty
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

39. Lamellar Keratoplasty:
B) Endothelial keratoplasty
→ done by replacement of
Descemet's membrane and
the endothelium, with or
without a varying amount
of corneal stroma
Corneal anatomy and Keratoplasty
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

40. The anterior chamber
angle is a part of the eye
located between the
cornea and iris which
contains the trabecular
meshwork.
Angle of the anterior chamber
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

41. Angle closure:
is caused by blocked
drainage canals in the eye
due to narrow angle.
Angle of the anterior chamber and glaucoma
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD
Open angle
Is caused by blockage of
drainage at level beyond
the angle

42. It is biconvex transparent
crystalline structure.
The lens lacks nerves,
blood vessels, or
connective tissue.
Lens is totally
transparent.
Lens
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

43. Cataract:
is a clouding of the normally
clear lens due lens
opacification.
May be:
1. Cortical
2. Nuclear
3. Ant. Polar
4. Post. Polar
5. Post. Subcapsular
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

44. • Clear gel
• Fills the space between the lens
and the retina of the eyeball
• The vitreous is firmly attached to:
a) Ora serrata
b) Optic disc
c) Back of the lens
d) Foveal region
Vitreous
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

45. A posterior vitreous
detachment (PVD):
is a condition of the eye in
which the vitreous
membrane separates from
the retina posterior to the
vitreous base
Posterior vitreous detachment
Applied eye anatomy - Clinical tips, by Amr Mounir, MD, PHD

46. ThankYou