Table Of Content'
s
ANATOMY
--OF THE-
EYE ORBIT
AND
Eighth edition
J.
ANTHONY BRON
BSc, FRCS, FCOphth
Professor of Ophthalmology, University of Oxford, Oxford, UK
c.
RAMESH TRIPA T ill
MD, PhD, FACS, MS Ophth, DORCP&S,
FRCPath, FICS, FNAS(I)
Professor and Chairman, Department of Ophthalmology, University of South Carolina
School of Medicine, South Carolina Eye Institute, Columbia, SC, USA
J.
BRENDA TRIPATHI
PhD
Professor of Pathology and Adjunct Professor of Ophthalmology, University of South
Carolina School of Medicine, Columbia, SC, USA
CHAPMAN & HALL MEDICAL
London · Weinheim ·New York · Tokyo · Melbourne · Madras
Published by Chapman & Hall, 2-6 Boundary Row, London SEl 8HN, UK
Chapman & Hall, 2-6 Boundary Row, London SE1 8HN, UK
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First edition 1933
Eighth edition 1997
© 1997 Anthony J. Bron, Ramesh C. Tripathi and Brenda J. Tripathi
Typeset in 10/12 Palatino by Keyset Composition, Colchester, Essex
Printed in Spain
ISBN 0 412 41010 9 (HB)
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A catalogue record for this book is available from the British Library
Library of Congress Catalog Card Number: 96 84205
Contents
Prefaces to the seventh and first editions
X
Preface
xi
1 The bony orbit and paranasal sinuses
1.1 The bony orbit 1
1.2 Age and sex changes 13
1.3 The periorbita 14
1.4 Surface anatomy of the orbital region 15
1.5 The paranasal sinuses 17
1.6 Nerve supply to the sinuses 20
1.7 Lymph drainage of the sinuses 22
1.8 Development of the sinuses 22
1.9 The cranial cavity 22
1.10 Injury to the face and orbit 28
2 The ocular appendages: eyelids, conjunctiva and
lacrimal apparatus
2.1 The eyelids or palpebrae 30
2.2 The palpebral glands 39
2.3 The palpebral blood vessels 44
2.4 Muscles of the palpebral region 46
2.5 The eyebrows (supercilii) 50
2.6 The conjunctiva 51
2.7 The caruncle 70
2.8 The plica semilunaris 71
2.9 The lacrimal apparatus and tears 72
3 The orbital and cerebral vessels
3.1 The orbital vessels 85
3.2 The arteries 85
3.3 The veins of the orbit 98
3.4 The cavernous sinuses 102
ONTENTS
The extraocular muscles and ocular movements
4.1 Gross structure 107
4.2 Orbital and global zones 108
4.3 General features 109
4.4 Connective tissue and blood supply 109
4.5 Nerve supply 110
4.6 Motor apparatus 110
4.7 Classification of extraocular muscle fibres 118
4.8 Features of extraocular muscle fibres 122
4.9 Sensory apparatus of extraocular muscle 130
4.10 Actions of the eye muscles 134
4.11 The four recti 136
4.12 Superior rectus 138
4.13 Inferior rectus 138
4.14 Medial rectus 139
4.15 Lateral rectus 139
4.16 Superior oblique 140
4.17 Inferior oblique 143
4.18 Levator palpebrae superioris and superior palpebral muscle 143
4.19 Anomalous extraocular muscles 147
4.20 The connective tissue septa of the orbit 147
4.21 The smooth muscle of the orbit 150
4.22 Surgical considerations 152
4.23 The orbital fat 153
4.24 Apertures adjoining the orbital opening through which fat may 154
herniate
4.25 Ocular movements 154
4.26 Neural basis for eye movements 157
4.27 Generation of eye movements 170
4.28 Types of eye movement 172
4.29 Blood supply of mid brain centres 176
Innervation and nerves of the orbit
5.1 The oculomotor (third cranial) nerve 178
5.2 The trochlear (fourth cranial) nerve 187
5.3 The abducent (sixth cranial) nerve 189
5.4 The trigeminal (fifth cranial) nerve 191
5.5 The ophthalmic nerve (V 193
1)
5.6 The ciliary ganglion 199
5.7 The maxillary nerve (V 2) 201
5.8 The pterygopalatine (sphenopalatine) ganglion 203
5.9 The mandibular nerve (V 3) 204
5.10 Nuclei and central connections of the trigeminal nerve 204
5.11 The facial (seventh cranial) nerve 205
5.12 The vestibulocochlear (eighth cranial) nerve 209
CONTENTS vii
6 The eyeball and its dimensions
6.1 Orbital location 211
6.2 Layers and compartments of the eyeball 212
6.3 Descriptive terminology 213
6.4 Topographic anatomy 216
6.5 Surface anatomy 228
7 The cornea and sclera
7.1 The cornea 233
7.2 The limbal transition zone 268
7.3 The episclera 270
7.4 The sclera 271
8 Anterior chamber and drainage angle
8.1 Anterior chamber 279
8.2 Corneoscleral limbus 279
8.3 Clinical features of the drainage angle 279
8.4 The outflow apparatus 282
. .
9 The trts
9.1 Gross appearance 308
9.2 Macroscopic appearance 310
9.3 Structure 313
9.4 Movement of fluid and solute across the iris 332
10 The posterior chamber and ciliary body
10.1 The posterior chamber 335
10.2 The ciliary body 336
10.3 Accommodation 367
10.4 Presbyopia 369
10.5 Ametropia 370
10.6 Aqueous secretion 370
11 The choroid and uveal vessels
11.1 Arteries of the uveal tract 371
11.2 Gross anatomy of the choroid 376
viii CONTENTS
11.3 The lamina suprachoroidea 376
11.4 The choroid 377
11.5 Arterial supply of the ciliary body and iris 398
11.6 Vasculature of ciliary muscle and pars plana 403
11.7 Vasculature of the ciliary process 403
11.8 Nerves of the ciliary body 404
11.9 Arteries of the iris 404
11.10 Innervation of the iris 405
11.11 Veins of the uveal tract 405
11.12 Choroidal circulation 407
12 The lens and zonules
12.1 The lens 411
12.2 The ciliary zonule 435
13 The vitreous
13.1 Gross appearances 443
13.2 Microscopic structure 447
13.3 Co~ position 452
13.4 Ageing and vitreous detachment 452
14 The retina
14.1 Topography of the retina 454
14.2 General architecture of the retina 458
14.3 The retinal pigment epithelium 460
14.4 The sensory (neural) retina 465
14.5 The layer of rods and cones 465
14.6 The external limiting membrane 472
14.7 The outer nuclear layer 473
14.8 The outer plexiform layer 474
14.9 The inner nuclear layer 477
14.10 The inner plexiform layer 482
14.11 The ganglion cell layer 484
14.12 The nerve fibre layer 485
14.13 The internal limiting membrane 487
15 The visual pathway
15.1 Optic nerve 489
15.2 Optic chiasma 535
15.3 Optic tracts 544
CONTENTS ix
15.4 The lateral geniculate nucleus 553
15.5 The superior colliculi 562
15.6 The thalamus 562
15.7 Optic radiation 566
15.8 Cortical gyri and sulci 571
15.9 The striate cortex (primary visual area) 573
15.10 The prestriate cortex (visual association areas) 582
15.11 Connections of the striate and prestriate cortex 584
15.12 Organization and functions of the visual cortex 587
15.13 Blood supply of the visual cortex 595
15.14 Practical considerations 595
16 Autonomic, aminergic, peptidergic and nitrergic
innervation of the eye
16.1 Autonomic nervous system 597
16.2 Parasympathetic system 601
16.3 Sympathetic system 607
16.4 Path of the light reflex 610
16.5 The dark reflex 612
16.6 Ciliospinal reflex 615
16.7 Path of the near reflex 615
16.8 Clinical syndromes involving the pupil 615
16.9 Aminergic, peptidergic and nitrergic innervation 617
17 Development of the human eye
17.1 Embryonic origins 620
17.2 Cornea 624
17.3 Sclera 628
17.4 Anterior chamber and aqueous outflow pathway 633
17.5 Uveal tract 637
17.6 Retina 646
17.7 Optic nerve 655
17.8 Vitreous 657
17.9 Lens and zonules 659
17.10 Ocular adnexae 662
References and further reading
665
Index
717
Preface to the seventh edition
Eugene Wolff's book has now passed through six editions and ten reprints in less than forty years, growing
in pages from 309 to 553 and in illustrations from 173 (initially none in colour) to 467 (56 in colour). Both
text and illustrations contain much that is of historical interest, and - like my predecessor - I have wished
to avoid tampering unnecessarily with the author's creation. However, very considerable changes have been
necessary which have entailed a rewriting of about a quarter of the text. Only the chapters on the osseous
orbit and comparative anatomy have required less extensive deletions and replacement by new writing. In
all sections many old citations (limited in interest and often undocumented) have been omitted; and yet the
Bibliography has almost doubled in length, a measure of the injection of new contributions. The
accumulations of knowledge, particularly in such fields as the ultrastructural detail of ocular tissues, analysis
of ocular movements, and organization in the visual pathways, have demanded particular attention; and
it is to these that revision has been deliberately directed. These and other fields of study have evoked many
highly specialized monographs and a countless legion of original papers, many of which can only be quoted
briefly. But it is my belief that readers of such a generalized textbook as this will thus find useful signposts
by which to look elsewhere for further detail.
There are 75 new illustrations in this edition, the majority being replacements. In this regard I am much
indebted to my friend, Mr Richard E. M. Moore, DFA(London), MMAA, FRSA, who works in my own
department; he has contributed 28 new illustrations and diagrams. I am also most grateful to Dr John Marshall
and his assistant, Mr P. L. Ansell (both of the Institute of Ophthalmology, University of London), who have
provided much improved substitutes for 40 electron- and photo-micrographs. I must also thank Dr N. A.
Locket (of the same Institute) for the loan of preparations for photomicrography. My colleagues, Mr Kevin
Fitzpatrick and Mr Joe Curtis, have also helped in the replacement of several illustrations. Dr Gordon Ruskell
(The City University, London) has helped with much useful criticism. From the publishing staff, and
particularly Mr John Goodhall, I have received most efficient and patient support. Despite all this help I
am solely responsible for any inaccuracies and omissions in this text. While hoping that readers will find
it improved in its usefulness, I hope equally that they will volunteer their criticisms and suggestions.
Roger Warwick
Guy's Hospital Medical School,
University of London
February 1976
Extracts from.
Preface to the first edition
This Anatomy of the Eye and Orbit is based mainly on lectures and demonstrations which I have had the honour
to give during ten years as Demonstrator of Anatomy at University College, and for the last three years as
Pathologist and Lecturer in Anatomy to the Royal Westminster Ophthalmic Hospital.
It is an attempt to present to the Student and Ophthalmic Surgeon the essentials of the structure,
development, and comparative anatomy of the visual apparatus in conjunction with some of their clinical
applications. The motor nerves to the eye muscles have received special attention, as have also the
illustrations, many of which are from my own preparations.
Eugene Wolff
Harley Street, London
1933
Preface
Revision of Eugene Wolff's Anatomy of the Eye and Orbit has been a very considerable task and one which
we have enjoyed. This new edition builds on the strengths of its predecessors while reflecting the increase
·in our knowledge since the seventh edition was published over twenty years ago.
The larger format of this edition permits the use of double columns, and gives far greater flexibility to
the display of illustrations. The text is now over 600 pages long, despite the omission of the chapter on
comparative anatomy. The number of illustrations, many of them with multiple parts, has been increased
to 667, of which 570 are new or have been redrawn. Many of the old figures have been reannotated where
possible, to give a consistency of style.
In order to do justice to the expansion of knowledge of the anatomy of the eye and its related structures,
seven new chapters have been added: the cornea and sclera, the iris, the ciliary body and choroid, the
drainage angle and the lens and the retina have each been given independent status. Although we have
retained parts of the old text, most has been extensively revised. In many respects the book is entirely new;
new topics include: the innervation and classification of the extraocular muscles, the ocular mucins, the
collagens and proteoglycans of the ocular coats, the properties of the trabecular cells, stereology of the lens,
the detailed anatomy of the ocular circulations, the morphology and connectivity of the retinal cells, the
functions of the retinal pigment epithelium and current views on the topography of the visual pathway and
the role of the visual and prestriate cortices.
We are indebted to the many scientists who have provided illustrations for this book and would like to
thank the following individuals, in particular, who were most generous with material and with their time
and advice. They include: M. P. Bergen; M. van Buskirk; M. B. Carpenter; 0. Earley; G. Eisner; A. W.
Fryckowski; T. F. Freddo; I. K. Gipson; I. Grierson; J. Jonas; H. Kolb; L. Koornneef; J. R. Kuszak; D. Landon;
E. Liitjen-Drecoll; N. R. Miller; J. M. Olver; Y. Pouliquen; A. C. Rhoton; G. L. Ruskell; J. Sebag; K. Sellheyer;
B. W. Streeten; E. R. Tamm; G. Vrensen; S. Zeki and E. van der Zypen.
From the inception of this new edition of Wolff's Anatomy, until his death, Roger Warwick, who revised
several previous editions, was a constant source of encouragement and inspiration. We hope that we did
not stray too far from his wishes. We would like to thank our publishers, Chapman and Hall, in particular
Nick Dunton, for their support and forebearance, and also Jane Bryant and Sue Deeley for the copy editing
and project management, respectively.
We are aware that, despite our best efforts, this book has many deficiencies and we welcome the comments
and criticisms of our readers.
Anthony J. Bron
Ramesh C. Tripathi
Brenda J. Tripathi
Oxford, UK and Columbia, SC
March 1997
