Gross Anatomy: Orbit, Eyelids, and Cranial Nerves III, IV, and VI March 12, 2010 1.

List the neighboring anatomical regions and structures related to each wall of the orbit. a. Superior: frontal sinus and frontal lobes (anterior cranial fossa) b. Posterior: temporal lobes of brain (middle cranial fossa) c. Apex: cavernous sinus and sphenoid air sinus (middle cranial fossa) d. Medial: ethmoid air cells (sinuses) e. Inferior: maxillary sinus 2. Describe the fascial structures of the orbit, their arrangement, and their relationship to the bones, eyelids, and eyeball a. Periorbita i. Periosteum that lines the orbital walls continuous w/ periosteum outside of the orbit, orbital septum, and periosteal layer of the dura through the optic canal and superior orbital fissure b. Orbital septum i. Between periosteum to the tarsal plates of the eyelid c. Tarsal plates i. Dense CT w/in upper and lower eyelids ii. Joined medially and laterally by the palpebral ligaments d. Optic sheath i. Continuation of the meningeal layer of the intracranial dura into the orbit around the optic nerve e. Sclera i. Tough whitish outer layer of the eyeball ii. Where extraocular muscles attach f. Bulbar sheath i. Thin fascia that separates the eyeball and the muscles from other orbital contents ii. Allows the eye to rotate and muscles to move independently

g.

3. List the five layers of the eyelids, discuss the primary structures that comprise each layer, describe the continuity of conjunctiva from eyelid onto the eyeball, and name the nerves that provide sensory innervations to the skin of the lids and their related mucous membranes a. Layers of eyelids i. Skin 1. Somatosensory innervation: V1 (upper eyelid) and V2 (lower eyelid) ii. Subcutaneous layer 1. Subcutaneous fat; eyelashes; sebaceous glands iii. Muscular layer 1. Levator palpebrae superioris a. Innervation: CN III (SM) b. Action: lifts upper eyelid iv. Tarsofascial layer 1. Orbital septum inserting into the tarsal plates

2. Contains tarsal glands that empty into free margins of the eyelids v. Conjunctival layer 1. Thin, transparent epithelium covering the inside of the eyelids 2. Palpebral conjunctiva: continuous skin on free edge of eyelid and bulbar conjunctiva at the inferior and superior fornices b. Conjunctival Sac i. Made of bulbar layer (closest to eyeball) and palpebral layer which meet at fornices to create the sac ii. Prevent tears and foreign objects from going to the back of the eyeball c. Superior Tarsal Muscle i. Smooth muscle ii. Origin: levator palpebrae superioris iii. Insertion: tarsal plate iv. Function: keeps upper eyelid open against gravity v. Innervation: symp/post axons from superior cervical ganglion

vi. 4. Describe the muscles of the eyelids involved in blinking

a. Closing eyelids: orbicularis oris mm i. Innervation: zygomatic branch of CN VII b. Opening eyelids: levator palpabrae superioris mm i. Innervation: CN III c. Maintains eyelid open: superior tarsal mm i. Innervation: symp/post from superior cervical ganglion 5. Diagram the arrangement of the extraocular muscles within the orbit and around the eyeball, give their innervations, and describe their anatomical actions

a. Muscle
Superior Rectus Inferior Rectus Medial Rectus Lateral Rectus Superior Oblique Inferior Oblique

Innervation
CN CN CN CN CN CN III III III VI IV III

Function
Elevates/Adducts Depresses/Adducts Adducts Abducts Depresses/Abducts Elevates/Abducts

6. Perform a basic clinical examination to test the function and innervations of the extraocular muscles and explain why you are doing each step a. Medial rectus: adduct b. Lateral rectus: abduct c. Superior rectus: abduct and elevate d. Inferior rectus: abduct and depress e. Superior oblique: adduct and depress f. Inferior oblique: adduct and elevate g. *The key is to line up the movement with the direction of the muscle fibers

h. The latter four are opposite of their direction of action 7. Trace the pathways of the motor neurons that course through the oculomotor, trochlear, and abducent nerves
Oculomotor (III) SM: oculomotor nucleus CN III all extraocular muscles (w/ levator palpabrae superioris) except LR and SO Para: Edinger-Westphal nucleus (para/pre) CN III ciliary ganglion (para/post) short ciliiary nerves pupil sphincter & ciliary muscles Trochlear (IV) Abducent (VI) Trochlear nucleus middle cranial fossa superior orbital fissure orbit superior oblique mm Abducent nucleus posterior cranial fossa superior orbital fissure orbit lateral rectus mm

8. Trace the pathways of the sensory neurons that innervate bulbar conjunctiva as opposed to the palpebral conjunctiva and skin of the eyelids
Ophthalmic (V1) Cell bodies: Trigeminal ganglion Upper eyelid: inside (conjunctiva) and outside (skin) nasociliary branch of V1 Bulbar conjunctiva: on sclera of eyeball nasociliary branch gives off ciliary nerves bulbar conjunctiva Maxillary (V2) Cell bodies: Trigeminal ganglion Lower eyelid: conjunctiva and skin infraorbital branch of V2

9. Discuss the function and describe the pathways for sympathetic and parasympathetic innervations of the superior tarsal muscle, the ciliary muscle, and the dilator and sphincter of the pupil Division
Parasympathe tic

Nerve
Facial (VII)

Pathway
Superior salivary nucleus (para/pre) CN VII geniculate ganglion greater petrosal nerve pterygoid canal pterygopalatine ganglion (para/post) V1/V2 branches orbit lacrimal

gland Oculomotor (III) Edinger-Westphal nucleus (para/pre) CN III ciliary ganglion (para/post) short ciliary nerves sphincter papillae mm (constricts pupil) and ciliary body (lens focusing) T1-T4 lateral gray horns sympathetic trunk superior cervical ganglion travel w/ internal carotid artery as carotid plexus two pathways: one branches to join CN III to go to superior tarsal muscle other join either nasociliary (V1) or CN III to reach dilator papillae mm (dilates pupil)

Sympathetic

Superior cervical ganglion

From superior cervical sympathetic ganglion

Notes from Lab 1. Ophthalmic artery: crosses over the optic nerve from lateral to medial a. First branch off of internal carotid artery as it curves upward in the cavernous sinus b. Gives off the central retinal artery that pierces optic sheath to travel with the optic nerve towards the retina i. This artery is checked w/ an ophthalmoscope 2. Superior ophthalmic vein: runs lateral to the superior rectus muscle a. Tributary to the cavernous sinus (posteriorly) b. Receives tiny central vein of the retina i. Blockage of superior ophthalmic vein could thus cause blindness (e.g. cavernous thrombosis, increased CSF pressure) 3. Branches of the ophthalmic nerve (V1) = NFL (medial to lateral) a. Nasociliary: accompanies ophthalmic artery over the optic nerve i. Gives off long ciliary nerves and a branch that goes to ciliary ganglion b. Frontal c. Lacrimal 4. Lacrimal Apparatus a. Lacrimal sac: reservoir for excess tears i. Located medial to inner eye ii. Drains into nasal cavity via nasolacrimal duct

b. Lacrimal gland: lateral and superior to front of eye i. Tears thus travel from lateral to medial ii. Blinking spreads the tears across the eye