Clinical Anatomy of the Eye SECOND EDITION, ~
Clinical Anatomy of he Eye SECOND EDITION RichardS. Snell, M.D., Ph.D. Emeritus Professor of Anatomy, The George Washington School of Medicine and Health Sciences, Washington, D. C. Michael A. Lemp, M.D. Clinical Professor of Ophthalmology, Georgetown University Medical Center, President, University of Ophthalmic Consultants ofwashington, Washington, D. C. Illustrations by Ira Grunther, B.S., A.M.I. Blackwell Science
1998 by Blackwell Science, Inc. Blackwell Science Ltd, a Blackwell Publishing company Editorial offices: Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Tel: +44 (0) 1865 776868 Blackwell Publishing Inc., 350 Main Street, Malden, MA 02148-5020, USA Tel: + 1 781 388 8250 Blackwell Science Asia Pty, 550 Swanston Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 8359 1011 The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. First edition published 1989 (ISBN 978-0-865-42053-3) Second edition first published 1998 11 2012 ISBN 978-0-6320-4344-6 Library of Congress Cataloging-in-Publication Data Snell, Richard S. Clinical anatomy of the eye I RichardS. Snell, Michael A. Lemp.-2nd ed. p. em. Includes bibliographical references and index. ISBN 978-0-6320-4344-6 1. Eye-Anatomy 2. Eye-sockets-Anatomy. I. Lemp, Michael A. II. Title. (DNLM: 1. Eye-anatomy & histology. 2. Orbit-anatomy & histology. 3. Cranial Nerves-anatomy & histology. 4. Eye Diseases-diagnosis. WW 101671c 1997] QM51l.S64 1997 611'.84-dc21 DNLM/DLC for Library of Congress 97-39908 CIP A catalogue record for this title is available from the British Library Typeset by Publication Services, WG, Inc Printed and bound in Malaysia by Vivar Printing Sdn Bhd The publisher's policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. For further information on Blackwell Publishing, visit our website: www.blackwellpublishing.com
Contents Preface vii 1 the 2 the Development of the Eye and Ocular Appendages An Overview of the Anatomy of Skull 21 The Orbital Cavity 59 3 The Paranasal Sinuses 78 4 The Ocular Appendages 90 5 The Eyeball 132 G v
vi Clinical Anatomy of the Eye. ~ ~... 7 The Anatomy of the Eyeball as Seen with the Ophthalmoscope, Slit Lamp, and Gonioscope 214 8 Movements of the Eyeball and the Extraocular Muscles 231 9 The Orbital Blood Vessels 277 10 Cranial Nerves- Part 1: Those Nerves Directly Associated with the Eye and Orbit 294 11 Cranial Nerves- Part II: The Nerves Not Directly Associated with the Eye and Orbit 329 12 The Autonomic Nervous System 351 13 The Visual Pathway Index 379 413
Preface Clinical Anatomy of the Eye has proved to be a very popular textbook for ophthalmologists and optometrists in training both in the United States and in many other parts of the world. We wish to thank the many colleagues and students who have provided us with suggestions to improve the second edition. The objective of the book remains unchanged: to provide the reader with the basic knowledge of anatomy necessary to practice ophthalmology. It is recognized that this medical specialty requires a detailed knowledge of the anatomy ofthe eyeball and the surrounding structures. The specialist's knowledge should include not only gross anatomic features and their development, but also the microscopic anatomy of the eyeball and the ocular appendages. The nerve and blood supply to the orbit, the autonomic innervation of the orbital structures, the visual pathway, and associated visual reflexes should receive great emphasis. The practical application of anatomic facts to ophthalmology is emphasized throughout this book in the form of Clinical Notes in each chapter. Clinical Problems requiring anatomic knowledge for their solution are presented at the end of each chapter. Most of the illustrations have been kept simple, and many are in color. Overview drawings of the distribution ofthe cranial and autonomic nerves have been included. In this edition, a new chapter on the cranial nerves other than those present vvithin the orbit has been added for completeness. Many new tables have been included to aid the learning process. The clinical material has been brought up-to-date and the anatomy involved with new clinical techniques has been introduced. The radiographs, CT scans, and MRis have been updated and a PET scan has been added. Again, the surface anatomy and surface landmarks have been emphasized, with photographs ofliving subjects added to assist this study. We extend grateful thanks to Drs. Geva E. Mannor, Douglas E. Gaasterland, and John E O'Neill who carefully read chapters of the manuscript and made valuable suggestions, many of which have been incorporated into the final text. We are greatly indebted to Dr. David 0. Davis of the Department of Radiology at the George Washington University School of Medicine for the loan of radiographs and CT scans that have been reproduced in different vii
viii Clinical Anatomy of the Eye sections of this book. We are also grateful to Dr. Gordon Sze of the Department of Radiology at Yale University Medical Center for examples of CT scans and MRis of the brain. We once again give our sincere thanks to Ira Alan Grunther for the very fine art. To the staff of Blackwell Science, we express our appreciation for guiding this book through every phase of its production. Richard S. Snell Michael A. Lemp 1997