OPHTHALMOLOGY

3B THE EYE
OP-01 Dr. Eliseo George A. Ave Jr. | August 26, 2017

Topic Outline
I. Orbit
II. Topographic Features of the Globe • Frontal
III. Conjunctiva • Ethmoid
IV. Tenon’s capsule • Lacrimal
V. Sclera • Sphenoid
VI. Episclera • Maxillary
VII. Cornea • Zygomatic
VIII. Limbus • Palatine
IX. Anterior Chamber
X. Trabecular Meshwork
XI. Uveal Tract
a. Iris Orbital Walls
b. Ciliary body • Roof
c. Choroid  Orbital plate of the Frontal Bone
XII. Bruch’s Membrane  Lesser wing of the sphenoid
XIII.Lens
 Landmarks
XIV. Retina
 Lacrimal gland fossa
a. Macula
b. Fovea  Superior orbital notch
XV. Ora serrata  Remember: FrontLess
XVI. Vitreous • Lateral
XVII. Extraocular Muscles  Zygomatic bone
XVIII. Eyelids  Greater wing of the sphenoid
XIX. Lid retractors  Landmarks
XX. Lacrimal Apparatus  Lateral orbital tubercle
XXI. Optic Nerve
 Strongest part of the orbit since it
XXII. Visual Pathway
protects the posterior half of the globe
* must know highlighted in red*
from trauma
• Medial
ORBIT
 Lesser wing of the Sphenoid
• Pear shaped bony cavity
 Maxillary bone
• Contains the following:
 Ethmoid bone (Lamina Papyracea)
 Globe
 Lacrimal bone
 Extra-ocular Muscles
 Remember: SMEL
 Nerve
 Lamina Papyracea – thinnest orbital
 Fat
bone
 Blood vessels
• Floor
Orbital Dimensions*
 Zygomatic bone
• Total Volume: 30cc
 Maxillary bone
• Entrance Height: 35mm
 Palatine bone
• Entrance Width: 45mm
 Landmarks:
Sinuses
 Infraorbital groove and canal

Orbital Apex
Frontal sinus (green)
- Entry of portal for nerves and vessels to the eye
Ethmoid (violet)
- Site of Origin of EOMS (except IO)
Sphenoid (red)
• Optic Foramen
Maxillary sinus (blue)
 Opening of the optic canal to the orbit
 Transmits the optic nerve, ophthalmic
artery and sympathetic nerves

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• Superior Orbital Fissure
 Infero-lateral to the optic foramen
 Divides the sphenoid bone
 Transmits the CN III, IV, and VI,
ophthalmic division of CN
sympathetic nerve fibers and superior
ophthalmic vein
• Annulus of Zinn
 Fibrous ring formed by common origin
of the 4 recti muscles
 Separates the SOF into two
compartments
• CN IV
 Only nerve that innervates an EOM and
does not pass thru the ring
• Arterial Supply: Ophthalmic Artery
Branches:
 Central retinal artery (2/3 Inner Retina)
 Lacrimal artery (Lacrimal gland, upper
eyelid)
 Muscular branches (EOMS)
 Long Post. Ciliary arteries (Ciliary body)
 Short Post. Ciliary arteries (Choroid &
ON)
 Medial palpebral artery (Eyelids)
• Venous Drainage: Sup. & Inf. Ophthalmic Vein
TOPOGRAPHIC FEATURES OF THE GLOBE
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The eyeball is not a sphere. The radius of curvature of the
cornea (8mm) smaller than that of the sclera (12mm),
making the shape of the globe an oblate spheroid. The
anteroposterior diameter of the adult eye is approx. 23-
V, 25mm. Myopic eyes tend to be longer, hyperopic eyes
tend to be shorter. The average transverse diameter of the
adult eye is 24mm.
CONJUNCTIVA
- Thin, transparent mucous membrane
- Covers the eyes and turns red when irritated
(Conjunctivitis/Sore eyes)
- 2 parts:
▪ Palpebral: lines post. surface of the
eyelid and adherent to tarsus
▪ Bulbar: covers the eyeball
- Functions:
▪ Reservoir for tears
▪ Contribute to tears by producing the
goblet-cell mucus
▪ Actively pumps water to stabilize tear
tonicity
▪ Acts as flexible covering to the globe
▪ Contribute to maintain normal mass of
corneal epithelial cells
TENON’S CAPSULE
- Fascia Bulci
- Located underneath the conjunctiva
- Fibrous membrane covering the globe from
limbus to the ON
SCLERA
- Opaque, porcelain white
- Hydration contributes to its opaque nature
- Ensheaths eye from corneal limbus to the dural
sheath of the optic nerve
- Thinnest (0.3mm) just behind insertions of rectus
muscles, thickest (1.0mm) at posterior pole
around optic nerve head
- Provides strong structural framework to support
the inner eye; can withstand expansive force of
IOP
The opaque, porcelain-white appearance of the sclera
contrasts markedly with the transparency of the cornea
and is primarily due to 2 things. Because of the thinness of
 3B THE EYE
the sclera, strabismus and retinal detachment surgery • 43 D - main refractive element
require careful placement of sutures of the eye

EPISCLERA Layers of the Cornea

- Covers the sclera and serves to protect • Epithelium and Basal Lamina
structures of the eye • Bowman’s Layer
- Thin layer of elastic tissue that contains blood • Stroma
vessels • Descemet’s membrane
- Main source of nutrition for the sclera • Endothelium

CORNEA
- Highly specialized avascular tissue to refract and
transmit light
- Unique architecture and deturgescence accounts
for corneal transparency
- Mechanical barrier and biologic defense system
- Adult size: horizontal 11-12 mm
vertical 9-11 mm
- Central cornea- 0.5mm
- Peripheral cornea- 1mm
- Flattening is more extensive nasally and
superiorly Cellular Components of the Cornea
- Thickness increases with age - Epithelial cells
• Derived from epidermal or surface
ectoderm
- Keratocytes (fibroblasts)
• Neural crest
- Endothelial cells
• Neural crest
- Dendritic langerhan’s cell
• Only at limbus and peripheral corneal
epithelium

Corneal Epithelium
- Non-keratinized, stratified and squamous cells
- 5-6 layers of cells
- Thickness (50um or 10% of cornea) is constant
The central 3rd of the cornea is nearly spherical and over entire surface
measures about 4mm in diameter, because the posterior
surface of the cornea is more curved than the anterior Bowman’s Layer
surface, the central cornea is thinner (0.5 mm) than the - Tough layer consisting of randomly dispersed
peripheral cornea (1mm). This topography is important in collagen fibrils
contact lens fitting - Modified region of the anterior stroma 8-14 um
thick
- Optical properties: - Not restored after injury
 Transparency
 Smoothness of surface Stroma
 Contour - 90% of the cornea, 500 um thick
 Refractive index - Normal water content - 78%
• Air-tear interface at the surface - Keratocytes, ground substance, collagen
of the cornea forms a positive lamellae
lens approx. 43 diopters (D)

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- Fibrils uniform in size and separation Although not distinct anatomical structure, the limbus is
(transparency) important for 2 reasons:
- 70% dry weight is collagen type I 1. Relationship to the chamber angle
- Glycosaminoglycan (keratan sulfate) highly 2. Use as a surgical landmark
charged and account for the swelling property of The transition from opaque sclera to clear cornea occurs
the stroma gradually over 1.0-1.5 mm and difficult to define
It is composed of collagen-producing keratocytes, ground histologically. The corneoscleral junction begins centrally
substance and collagen lamellae. The fibrils are in a place connecting the end of Bowman’s layer and
remarkably uniform in size and separation, and this Schwalbe’s line, the termination of the Descemet’s
regularity helps determine transparency of the cornea. membrane. Internally, its posterior limit is the anterior tip
of the scleral spur.
Descemet’s Membrane
- PAS positive ANTERIOR CHAMBER
- True basement membrane
- Thickness increases with age
- At birth: 3-4 um thick; increases throughout life
to an adult level of 10-12 um
- Rich in type IV collagen
Hassall-Henle warts- common among elderly people
Cornea guttae- in increasing age

Endothelium
- Single layer of hexagonal cells derived from the
neural crest
- Active transport of ions leads to the transfer of
water from the corneal stroma and maintenance The anterior chamber is bordered anteriorly by the cornea
of stromal deturgescence and transparency and posteriorly by the iris diaphragm and the pupil.
- Endothelial cell dysfunction and loss
• Endothelial decompensation, stromal
edema, visual failure

LIMBUS

- Transition zone between the peripheral cornea

and anterior sclera - The anterior chamber angle which lies at the
- Importance junction of the cornea and iris consists of the
▪ Relationship to the chamber angle following structures:
▪ Surgical landmark  Scwalbe line, schlemm canal and
- Surgical limbus trabecular meshwork, scleral spur,
▪ Anterior bluish gray zone overlying clear anterior border of the ciliary body
cornea and extending from Bowman’s (where its longitudinal fibers insert into
layer to the Schwalbe line the scleral spur), iris
- The depth of the anterior chamber varies. It is
deeper in apakia, pseudophakia and myopia and

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shallower in hyperopia. In normal adult eye
emmetropic eye, the chamber is approx 3 mm
deep at its center and reaches its narrowest
point slightly central to the angle recess. The
volume of the anterior chamber is about 200 ul
in emmetropic eye.
- The internal scleral sulcus accomodates the
Schlemm canal externally and trabecular
meshwork internally. The Schwalbe line, the
periphery of the Descemet’s membrane, forms
the anterior margin of the sulcus; the scleral spur
is its posterior landmark. The scleral spur
receives the insertion of the longitudinal ciliary
muscle and contraction opens up the trabecular
spaces
The anterior chamber is filled with aqueous humor which
is produced by the ciliary epithelium in the posterior
chamber. Fluid passes through the pupil aperture and
drains chiefly by the conventional pathway through the
trabecular meshwork into the Schlemm canal then
collector channels to the aqueous, episcleral and orbital
veins and partly by the nontrabecular uveoscleral
drainage pathway, across the ciliary body into the
supraciliary space then sclera to the orbital tissues.
TRABECULAR MESHWORK
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The trabecular meshwork is a circular spongework of
connective tissue lined by trabeculocytes. The cells have
contractile properties which may influence outflow
resistance. They also have phagocytic properties.
- 3 layers:
▪ Uveal portion
▪ Corneoscleral meshwork
▪ Juxtacanalicular tissue (site of AH flow
resistance)
▪ The uveal and corneoscleral meshwork
can be divided by an imaginary line
drawn from Scwalbes line to the scleral
spur
The trabecular meshwork is roughly triangular in cross
section, with the apex of the Schwalbe line and base
formed by the scleral spur and ciliary body. The trabecular
meshwork can be divided into 3 layers: Juxtacanalicular
tissue which is directly adjacent to the Schlemm canal. The
uveal meshwork lies internal and the corneoscleral
meshwork lies external to this line.
UVEAL TRACT
- Main vascular compartment of the eye
- 3 parts:
• Iris
• Ciliary body (located in the anterior uvea)
• Choroid (located in the posterior uvea)
- Firmly attached to the sclera at only 3 sites:
 Scleral spur
 Exit points of the vortex veins
 Optic nerve
IRIS
- Most anterior extension of the uveal tract
 3B THE EYE
- Made up of blood vessels and connective tissue
- Melanocytes and pigment cells
- Mydriasis - thrown into a number of ridges and
folds
- Miosis - anterior surface appears relatively
smooth
*Physiologic cause of miosis:
1. When you shine light into the pupil, it constricts
2. When you are reading a book (you accommodate,
then you converge leading to miosis)
*Near triad: accommodation, convergence, miosis
*Melanocytes and pigment cells that are responsible for its
distinctive color.
*Mobility of the iris allows the pupil to change size
Stroma
- Composed of pigmented cells (melanocytes),
nonpigmented collagen fibrils, matrix containing
hyaluronic acid
- Aqueous humor flows freely through the loose
stroma along the anterior border of the iris
Vessels and Nerves
- Blood vessels form the bulk of the iris stroma
- Follow a radial course arising from the major
arterial circle and passing to the center of the
pupil
- COLLARETTE
 Thickest portion of the iris
 Anastomoses occur between the arterial
and venous arcades to form minor
vascular circle of the iris
Posterior pigmented layer
- Densely pigmented and velvety smooth, uniform
- Continuous with the nonpigmented epithelium
of the ciliary body (neurosensory portion of the
retina)
- Basal surface of the pigmented layer borders the
posterior chamber
- Apical surface faces the stroma and adheres to
the anterior pigmented layer, gives rise to
DILATOR MUSCLE
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Rubeosis iridis is a medical condition of the iris of the
eye in which new abnormal blood vessels (i.e.
neovascularization) are found on the surface of the iris. It
is usually associated with disease processes in the retina,
which involve the retina becoming starved of oxygen
(ischaemic). The ischemic retina releases a variety of
factors, the most important of which is VEGF. These
factors stimulate the formation of new blood vessels
(angiogenesis). Unfortunately, these new vessels do not
have the same characteristics as the blood vessels
originally formed in the eye. In addition, new blood vessels
can form in areas that do not have them. Specifically, new
blood vessels can be observed on the iris. In addition to
the blood vessels in the iris, they can grow into the angle
of the eye. These blood vessels then block fluid leaving the
eye and result in an increase in intraocular pressure. This
is called neovascular glaucoma. Treatment: Laser
Dilator muscle
- Embryologically derived from neuroectoderm
- Lies parallel and anterior to the posterior
pigmented epithelium
- Smooth muscle cells contain fine myofilaments
and melanosomes
- Sympathetic and parasympathetic innervation
- Contracts in response to sympathetic α1
adrenergic stimulation
- Inhibitory cholinergic parasymathetic stimulation
- HORNER’S SYNDROME
 miosis, ptosis, anhydrosis
 Interruption of sympathetic nerve supply
Sphincter muscle
- Derived from neuroectoderm
- Composed of circular band of smooth muscle
fibers
- Located near the pupillary margin in the deep
stroma, anterior to the pigment epithelium
- Receives primary innervation from
parasympathetic nerve fibers
CILIARY BODY
- Bridges the anterior and posterior segments
- Apex of the ciliary body is directed posteriorly
toward the ora serrate
- Base of the ciliary body gives rise to the iris
Functions:
- Aqueous humor formation
- Lens accommodation
- Trabecular and uveoscleral outflow of aqueous
humor
 3B THE EYE
The ciliary body is 6-7 mm wide and consists of 2 parts:
the pars plan and pars plicata
Pars plana
- Avascular, smooth pigmented zone
- 4 mm wide
- Extends from ora serrata to the ciliary processes
- Safest posterior surgical approach to the
vitreous cavity (bleeding is prevented) (ie
intravitreal injection, hemorrhage in diabetic
retinopathy)
- Located 3-4 mm from the corneal limbus (this is
where you are going to inject)
Pars plicata
- Richly vascularized
- 70 radial folds or ciliary processes
- Puncture to this site will cause bleeding
CHOROID
- Posterior portion of the uveal tract
- Nourishes the outer portion of the retina
- 0.25 mm thickness
3 Layers of Vessels:
- Choriocapillaries (innermost)
- Middle layer of small vessels
- Outer layer of large vessels
BRUCH’S MEMBRANE
- PAS-positive lamina resulting from the fusion of
the retinal pigment epithelium and
choriocapillaries of the choroid
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- Extends from the margin of the optic disc to the
ora serrata
- Importance: Before surgery, always check the
macula of the patient because blurred vision due
to age related macular degeneration is
irreversible.
5 Elements:
- Basal lamina of the RPE
- Inner collagenous zone
- Thicker, porous band of elastic fibers
- Outer collagenous zone
- Basal lamina of the choriocapillaries
- Consists of a series of connective tissue sheets
that are highly permeable to small molecules
(fluorescein)
TRIVIA
Why is it important to ask a patient if he/she is a smoker
before giving vitamins for the eye?
- Because vitamins given to nonsmokers contain
beta carotene. To smokers beta carotene
predisposes to increased risk of lung cancer
LENS
- Biconvex structure located directly behind the
posterior chamber and pupil
- Contributes 20 D of the 60 D of focusing power
of the average adult eye
- Equatorial diameter: 6.5 mm at birth-> 9-10mm
- AP width: 3mm at birth -> 6mm
- Lack innervation and avascular
- Depends on aqueous and vitreous for
nourishment
 3B THE EYE
If a person is myopic (e.g.- 4: high myopia), axial length
becomes longer (length of eyeball is longer). Structures
inside the eye becomes stretched which may eventually
cause retinal detachment.
If a person has a short eyeball, the structures inside the
eye becomes crowded, one might develop angle closure
glaucoma.
Zonulae occludentes & Zonulae adherents
RETINA
- Structural stability
- Thin, transparent structure that develops from
- Maintain outer blood-retina barrier
the inner and outer layers of the optic cup
MACULA
Macula - Area within temporal vascular aracades
- 5-6 mm in diameter - Region with more than one layer of ganglion cell
- Lies between the temporal vascular arcades nuclei

Fovea Macula lutea (―yellow spot‖)

- Macula’s center - Derives from the yellow color of the central
- Rich in cones retina
- Color vision, highest visual acuity - Color due to presence of carotenoid pigments
chiefly located in Henle fiber layer
- 2 major pigments: zeaxanthin, & lutein
- Lipofuscin

Fovea
Retina Pigment Epithelium
- Concave central retinal depression approx 1.5
Functions:
mm in diameter
- Vitamin A metabolism
- Comparable in size to the optic nerve head
- Maintenance of the outer blood-retina barrier
- Margins are clinically inexact
- Phagocytosis of the photoreceptor outer
- Young- elliptical light reflex that arises from the
segments
slope of the thickened ILM of the retina
- Absorption of light (reduction of scatter)
- Heat exchange Parafovea
- Formation of the basal lamina - 0.5 mm wide
- Production of the mucopolysaccharide matrix - GCL, INL, OPL are the thickest
surrounding the outer segments - Surrounding this zone is the most peripheral
- Active transport of materials in and out of the region of the macula (PERIFOVEA) 1.5 mm wide
RPE
Foveola
Retinal detachment
- Central depression within the fovea
- Separation of the RPE from the neurosensory
- Located 4.0 mm temporal and 0.8 mm inferior to
retina
the center of the optic disc
- Most common cause: trauma
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- 0.35 mm across, 0.10 mm thickness at its center - Volume- 4 ml
- 99% water
Foveal Avascular Zone (FAZ) - Fine collagen fibrils (type II)
- Capillary-free zone - Becomes more fluid with age and separates from
- Important landmark in treatment of subretinal the retina (posterior vitreous detachment)
neovascular membranes by laser - Associated peripheral retinal detachment is
photocoagulation potential cause of rhegmatogenous retinal
- Location same as foveola detachment
- Diameter 25—600 µm or more
“Patient: Doc! May nakikita akong langaw, kapag
tumingin ako dito, sumasama.
Doc: that’s what we call floaters”
Physiologically, at age 2, vitreous starts to liquefy.
Microscopic fibers within the vitreous tend to clump and
can cast tiny shadows on your retina. The shadows you
see are called floaters.
If floaters continue to multiply. One may suspect Infection,
bleeding especially in DM or trauma patients

EXTRAOCULAR MUSCLES

Anatomical macula also called area centralis

ORA SERRATA
- Boundary between the retina and the pars plana
- Distance from Schwalbe line- bet 5.75 mm
nasally and 6.50 mm temporally
- Diameter of the eye is 20 mm and circumference
is 63 mm at the equator, diameter is 24 mm and
circumference is 75 mm
- Smooth temporally and serrated nasally
- Watershed zone between anterior and posterior
vascular system (peripheral retinal degeneration
is common) Origin of the four rectus muscle: Annulus of Zinn
*For Table 1. Extraocular Muscles, please refer to the last
page.
*Please familiarize yourself with Insertion: Distance
from limbus (mm)

*MUST KNOW*

In myopia, distance is greater; In hyperopia, distance is

shorter

VITREOUS
- Occupies 4/5 of the volume of the globe
- Important to the metabolism of the intraocular
tissues for it provides route for metabolites used
by lens, ciliary body and retina
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 3B THE EYE
Horizontal muscles (e.g. Medial rectus and Lateral rectus Layers:
do not have secondary and tertiary action) - Skin and subcutaneous tissue
RAd SIn - Orbicularis Muscle
Rectus muscle – Adduct - Orbital septum
Superior Oblique – Intorts - Orbital fat
- Levator and Muller’s Muscles (Lifts the eyelid)
- Tarsus (Provides strength to the eyelids)
- Conjunctiva
-

LID RETRACTORS
- Muscles that open the eyelid
- Upper Lid
 Levator Palpebrae Superioris
 Muller’s Muscle
- Lower Lid
 Inferior Rectus Muscle
 Inferior Tarsal Muscle

MILS: 5.5, 6.5, 7.0, 11.5 LACRIMAL APPARATUS

Blood Supply comes from the Muscular Branches of the

Ophthalmic Artery
- Lateral Muscular branch: LR, SR, SO and Levator
Palpebrae Superioris (All lateral branches supply
the superiors)
- Medial Muscular branch: IR, IO and MR

Lateral Rectus
- Only muscle supplied by 1 Ciliary Artery
- Also supplied by the Lacrimal Artery

Inferior Rectus and Inferior Oblique

- Supplied by the Infraorbital Artery

Cranial Nerve Innervation - Ampulla = 2Mm

- CN VI: LR - Canaliculi = 8-12mm
- CN IV: SO (longest intracranial course) - Common canaliculi in 90%
- CN III: - Lacrimal sac = 12-15mm
 Upper Division: SR and LPS - Nasolacrimal Duct = 12-18mm
 Lower Division: MR, IR and IO
OPTIC NERVE
EYELIDS

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- Range: 35 to 55mm (Average: 40mm) VISUAL PATHWAY
- Contains 1.2 million axons

Four Divisions:
1. Intraocular
2. Intraorbital
3. Intracanalicular (most important)
4. Intracranial

Intraocular
- 1mm
- Anteriorly:
 Optic disc
 1.5mm H
 1.75mm V
 Physiologic cup
Principle site of many congenital and acquired ocular
diseases
Embryology (nice to know)
Anterior surface visible ophthalmoscopically
- Eye and Orbital tissues:
 Ectoderm
Layers of the Optic Nerve Head
 Mesoderm
- Superficial nerve fiber layer
 Neural Crest cells
- Prelaminar
Endoderm does not enter into the formation of the eye.
- Laminar
Mesenchyme, derived from mesoderm or the neural crest,
- Retrolaminar
is the term for embryonic connective tissue.
Most of the mesenchyme of the head and neck is derived
Intraorbital
from the neural crest.
- 25mm; 3-4mm
- Central retinal artery and choroid
Surface ectoderm gives rise to:
- The lens, the lacrimal gland, the epithelium of
Intracanalicular
the cornea, conjunctiva and adnexal glands, and
- 4-10mm
the epidermis of the lids.
- Within the canal
- Pial vessels
Neural crest
- Blunt trauma causes indirect traumatic optic
- Arises from the surface ectoderm in the region
neuropathy
immediately adjacent to the neural folds of
Indirect traumatic optic neuropathy- blunt trauma over neural ectoderm
the eyebrow can transmit the force of injury to the - Responsible for the formation of the corneal
intracanalicular region causing shearing and interruption keratocytes, the endothelium of the cornea and
of the blood supply to the nerve in this area the trabecular meshwork, the stroma of the iris
and choroid, the ciliary muscle, the fibroblasts of
Intracranial the sclera, the vitreous, and the optic nerve
- 10mm; 4-7mm meninges.
- Branches of the internal carotid and the - It is also involved in the formation of the orbital
ophthalmic arteries cartilage and bone, the orbital connective tissues
and nerves, the extraocular muscles, and the
subepidermal layers of the lids.

Neural ectoderm
- Gives rise to the optic vesicle and optic cup
- Responsible for the formation of the retina and
retinal pigment epithelium, the pigmented and

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 3B THE EYE
nonpigmented layers of ciliary epithelium, the
posterior epithelium, the dilator and sphincter Never think highly of yourself. That’s how you gain respect from
muscles of the iris, and the optic nerve fibers others.
and glia. -Dr. Eliseo George A Ave Jr, MD, DBPO

A failure will only become a failure if you stop trying.

Mesoderm
-Dr. Eliseo George A Ave Jr, MD, DBPO
- Contributes to the vitreous, extraocular and lid
muscles, and the orbital and ocular vascular
endothelium.

Table 1. Extraocular muscles

Muscle Approximate Origin Insertion: Tendon length Arc of contact Action from
muscle Distance from (mm) (mm) Primary
length (mm) limbus (mm) Position
Medial rectus 40 Annulus of Zinn 5.5 4 6 Adduction
Lateral rectus 40 Annulus of Zinn 7.0 8 10 Abduction
Superior 40- Annulus of Zinn 8.0 6 6.5 Elevation,
rectus Intorsion,
adduction
Inferior rectus 40 Annulus of Zinn 6.5 7 7 Depression,
extorsion,
adduction
Superior 32 Orbit apex From temporal 26 12 Intorsion,
oblique above annulus pole of depression,
of Zin superioir abduction
rectus to
within 6.5 mm
of optic nerve
Inferior 37 Lacrimal fossa Macular area 1 10 Extorsion,
oblique elevation,
abduction

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