Colin S. Poon Michael Abrahams James Abrahams
The sot tissue structures o the orbit are contained withina bony cavity. These sot tissue structures include the globe,the extraocular muscles, the optic nerve–sheath complex,the lacrimal apparatus, and various vascular and nervestructures.
The bony orbit is a conical structure with the apex pointing posteriorly. The orbital roo is composed o the rontalbone and is thinner anteriorly. The medial wall is com-posed o the rontal process o the maxillary bone anteri-orly, the lamina papyracea o the ethmoid air cells at themidportion, and the sphenoid bone posteriorly. Thelamina papyracea is very thin, and not surprisingly it is acommon site o orbital blowout racture and spontaneousdehiscence o orbital at. The lateral orbital wall is ormedby the orbital surace o the zygomatic bone. The orbitaloor is ormed by the orbital plate o the maxilla, theorbital process o the palatine bone, and the orbital suraceo the zygomatic bone. The orbital plate o the maxilla isthin and a common site o inerior blowout racture.Multiple oramina and canals go through the bony orbits (Box 11-1). The optic canal (also called
)is located at the orbital apex. It is bordered by two bony spikes o the lesser wing o the sphenoid bone, commonly reerred as the
. The canal contains the optic nerve and the ophthalmic artery, both o which are con-tained within a dural sheath. The superior orbital fssure is located at the marginbetween the lateral wall and the orbital roo. The greater wing o the sphenoid bone orms its lateral boundary, while the lesser wing orms its medial boundary. The supe-rior orbital fssure contains the superior ophthalmic vein;the oculomotor (III), trochlear (IV), and abducens (VI)nerves; and the ophthalmic division o trigeminal nerve(V
). The superior orbital fssure orms the largest com-munication between the orbit and intracranial structuresand thereore orms a conduit or inectious or neoplastic processes between the orbital apex and the cavernoussinus. The inerior orbital fssure is located at the marginbetween the lateral wall and the orbital oor. It containsthe inraorbital (branch o V
) and zygomatic nerves, thenerve branches rom the pterygopalatine ganglion, and venous connection between the inerior ophthalmic veinand the pterygoid plexus. The inerior orbital fssure con-nects with the pterygopalatine ossa and the masticator space/inratemporal ossa, allowing the spread o deepacial inection and neoplasm to the orbital apex. The globe is essentially a spherical structure, with the wall consisting o three layers: retina (innermost), choroids(middle), and sclera (outermost). These layers cannot beresolved with current clinical imaging technology, unlessthey are separated by pathologic processes (e.g., retinaldetachment). The globe is divided into three uid-flledcavities: anterior chamber, posterior chamber, and vitreouscavity.
The anterior chamber and posterior chamber constitute the anterior segment, while the vitreous cavity constitutes the posterior segment. The anterior chamber extends rom the cornea to the iris. The posterior chamber extends rom the posterior surace o the iris to the anterior surace o the vitreous. The vitreous cavity is posterior tothe posterior chamber. The anterior border o the orbit is ormed by theorbital septum, a fbrous structure adherent to the inner margin o the orbital rim with central portions that extend
Major Foramina o the Orbit and Their NeurovascularContents
Optic nerveOphthalmic artery
Superior Orbital Fissure
Cranial nerves: III, IV, VI, V
Lacrimal and rontal nervesSuperior and inerior ophthalmic veins
Inerior Orbital Fissure
Cranial nerve: V
Zygomatic nerveInraorbital vessels