Lecture 19 / slide 9

The eye and orbit

Done by: Farah Hanisah, Nurul Ashikin, Nur Aieshah

Regarding the grooves and the foramina in the orbit, at about the medial third of the
supraorbital margin you can see the supraorbital notch and foramen through which the
supraorbital nerves and vessels pass.

Then here, between the two roots of the lesser wing of sphenoid bone, you can see the optic
canal. It is where the optic nerve and the ophthalmic artery pass.

Then you have the superior orbital fissure between the greater wings and the lesser wing of
sphenoid bone. Through the superior orbital fissure, many structures pass, which are

 lacrimal nerve
 frontal nerve
 oculamotor nerve
 throchlear nerve
 abduscense nerve
 nasociliary nerve
 the superior ophthalmic vein

Here is the inferior orbital fissure between the greater wing of sphenoid bone and the maxilla
and it transmits the inferior ophthalmic vein. In addition to that it also transmits the
maxillary nerves and its zygomatic branch.

Then you have the infraorbital groove and the infraorbital canal which transmits the
infraorbital nerves and vessels; and here is the infraorbital foramen. There is the fossa of the
lacrimal sac or the groove of the lacrimal sac or the nasolacrimal canal which transmits the
nasolacrimal duct.

So what are the contents of the orbit?

You have the eyelids. There are the upper and the lower eyelids and in between there is a
palpebral fissure. The eyelids consist of three structures making up the skeleton. So first,
you have 2 tarsal plates. There is the orbital septum and there are the medial and lateral
palpebral ligaments.

The orbital septum is attached to the orbital rim, to tarsal plates and to the lateral and medial
palpebral ligaments. Now palpebral ligaments laterally and medially attached the tarsal
plates to the orbital rim. If you can see, there is a muscle. One of the extrinsic muscles of the
eye, it is called levator palpebrea superioris muscle. This muscle is attached to the
upper/superior tarsal plate by smooth muscle called tarsal muscle which is supplied by
sympathetic fibers.
Here the eyelids are covered superficially on the outside by the skin but internally by mucous
membrane called conjunctiva. The conjunctiva has two portions. The one that is attached to
the endo-surface of the eyelids is called palpebral conjunctiva. Where as the one that is
present in the globe of the eye is called the bulbar conjunctiva.

Now you can see there is some like brightness or shining through the conjunctiva of the
eyelid that would be because of the tarsal glands which secretes oily material to prevent the
spoil of the tears on the rim of the eye. Medially, this is of course the medial angle of the
eye, lateral angle of the eye, this is called canthus. Now in the medial angle of the eye, there
is a space where the tears accumulate that is known as the lacus lacrimalis or lacrimal lake.

In the centre of the lacrimal lake is the body that is called lacrimal caruncle (appears as a
round like structure). Now the medial end of each eyelid there is lacrimal papilla and a hole
on it that is punctum.

These are eyelashes, which are hair exiting on the anterior surface or aspect of the eyelid and
posterior to them you can see hosts. Those are the openings for the tarsal glands. The
lacrum end of the lacrimal lake is called semilunar fold or the plica semilunaris.

Muscles of the eye

So there are extrinsic and intrinsic muscles of the eye. Now remember that the extrinsic
muscles of the eye are supplied by the motor nerves, whereas the intrinsic muscles are
supplied by the phrenic nervous system; Sympathetic and parasympathetic depending on the
type of the muscle. The first four muscles are the recti muscles which arise from the
tendinous ring on the posterior wall of the orbital cavity.

Regarding the extrinsic muscle of the eye you have the:

  Superior rectus: inserts to the superior surface of the eyeball, just posterior to the
corneoscleral junction
 Inferior rectus: inserts in the inferior surface of the eyeball
 Medial rectus: inserts in the medial surface of the eyeball
 lateral rectus: inserts in the lateral surface of the eyeball
 Superior oblique: it arises from the posterior wall of the orbital cavity and passes
through pulley and is attached to superior surface of the eyeball beneath superior
rectus.
 inferior oblique: arises from the floor of the orbital cavity and insert in the lateral
surface of the eyeball into lateral rectus.

All of these extrinsic muscles are involved in movement of the eyes. Here are the actions for
each of them (refer to the slides). R e m e m b e r that, all the extrinsic muscles are supplied
by the oculomotor nerves except:

1. lateral rectus which is supplied by the abducent nerve, cranial nerve number 6, and
2. Superior oblique muscle which is supplied by the trochlear nerve, cranial nerve
number 4.

For the intrinsic muscles of the eye you have the

 sphincter pupillae of iris: involves in constriction of the pupil, supplied by

parasympathetic
 dilator papillae of iris: is for dilation and is the ONLY one supplied by the
sympathetic
 ciliary muscle: is for the accommodation of the eye and lens, supplied by
parasympathetic
You have muscles of the eyelid; which are orbicularis oculi and levator palpebrae
superioris both of which arise from the back of orbital cavity and insert into the anterior
surface and upper margin of superior tarsal plate. Again, there is a part of levator palpebrae
superioris that is a smooth muscle supplied by the sympathetic fibres.

Lateral view of the orbit

This is the eyeball, here is the optic nerve exiting the eyeball and being enclosed by a sheath
of meninges. Here is the superior rectus and remember that ‘rectus’ means ‘straight’ so, it’s
a ‘straight muscle’ as it appears, so superior rectus and then the most superior muscle is the
levator palpabrae superioris muscle. This muscle which has a pulley near fibrocartilagenous
pulley is the superior oblique muscle. Then, here is another straight muscle which is present
laterally, so this is the lateral rectus. Opposite of it in the medial side is medial rectus and
you have the inferior oblique muscle and finally you have the inferior rectus muscle.

Superior view of the orbit

By looking superiorly at the orbit you can see the superior rectus muscle. Superior to it is the
levator palpebrae superioris muscle which has been cut. Here is a pulley, the trochlea pulley
which is a pulley for superior oblique muscle and this is superior oblique muscle. Remember
that, it is present medially and then you have medial rectus muscle. This is the inferior rectus
muscle and this is lateral rectus muscle. Of course, you cannot see the inferior oblique
muscle. Here the orbital plate of frontal bone has been removed.

Anterior view of the orbit

Anteriorly, you can see the superior rectus; here are the transverse fibres of the longitudinal
view of levator palpebrae superioris muscle. And then, here is the superior oblique. You
know this is medial side; this should be the medial rectus. Opposite to it is the lateral rectus,
inferiorly is the inferior rectus and finally you have the inferior oblique muscle.

The ophthalmic artery and veins

Now, the orbit and its contents are supplied by the ophthalmic artery. The ophthalmic artery
is a branch of the internal carotid artery and so, here you can see the ophthalmic artery and
here it shows the internal carotid artery.
Now, the ophthalmic artery gives off many structures which supply the contents of the orbit.
First, you have the central artery of the retina. The central artery of the retina is the
artery that pierces the meningeal sheaths of the optic nerve and runs within the substances
of the optic nerve. Then, you have the muscular branches of the ophthalmic artery which
supply different extrinsic muscles of the eye. Then, you have ciliary arteries which appear
and enter the eyeball and supplying it and then you have the supratrochlear artery and
there is the orbital artery which is lateral to it and finally, you have the lacrimal artery which
is most lateral supplying the lacrimal gland.

There are 2 ophthalmic veins, the superior ophthalmic vein and inferior ophthalmic vein.
The superior ophthalmic vein communicates with the facial vein, whereas the inferior
ophthalmic vein communicates with the pterygoid venous plexus through the inferior orbital
fissure. All these things exit or pass through the superior orbital fissure to drain into the
cavernous sinus.

The Lacrimal apparatus

There is something called the lacrimal apparatus that is composed of the different
structures. The first is called the lacrimal gland. Here you can see 2 parts because lacrimal
gland is divided by aponeurosis of the levator palpebrae superioris muscle into a larger
palpebral portion and a smaller palpebral portion. Now there are the lacrimal ducts that drain
both portions passing through the inferior part of the lacrimal gland. Those ducts open so
that the tears pass through the capillary punctum or the lacrimal punctum to their lacrimal
lake accumulating and then going to the lacrimal canaliculi which empty and open into the
lacrimal sac. Now, remember that the lacrimal sac is the expanding of the portion of the
nasolacrimal duct that opens into the inferior meatus which is lateral to the oral space
inferior to the inferior concha.
Nerves of the orbit
 There are many nerves of the orbit. First you can see the optic nerve here. The optic
nerve exits from the eyeball as I mentioned previously; and is enclosed by sheath or
the meninges then it exits the orbit through the optic canal with one of the ophthalmic
artery that enters through the same canal.
 Now remember that the optic nerve mediates the special sense of sight. ** This is the
optic chiasma where the station of the fibers in the median half of the optical tract
perquisite here. Then you have the branches of the ophthalmic division of the
trigeminal nerve. Now the ophthalmic division of the trigeminal nerve enters the orbit
as 3 branches which are;
o frontal nerve: it is the largest branches of the ophthalmic nerve and it divides
into supraorbital nerve laterally and supratrochlear nerve medially
o lacrimal nerve: goes to the lacrimal gland and if you remember it carries
postganglionic parasympathethic fibers deliver to it by the zygomatic branches
of maxillary nerve particularly by zygomaticotemporal branch
o nasociliary nerve: also termed as the mesociliary nerve branches of the
ophthalmic nerve and it has many branches. First, this is the ciliary ganglion
which is parasympathetic ganglion it receives a sensory fibers from the
ophthalmic nerves. Those fibers do not synapse in this ganglion they just pass
by it. Then you have the long ciliary nerves which carry postganglionic
sympathetic fibers from the internal carotid plexus to the pupillae dilator muscle
and then you have posterior ethmoidal nerve which innervates the sphenoidal
and ethmoidal air sinuses. Then you have the anterior ethmoidal nerve which
appears on the face as external nasal nerve and finally you have the
infratrochlear nerve.
 You can see here is the trochlear nerve. In fact, the trochlear nerve passes through the
superior orbital fissure as 2 divisions or rami which are superior ramus and inferior
ramus. The superior ramus innervates the levator palpabrae superioris muscle and
superior rectus whereas the inferior ramus or divisions innervates rest of the muscles
as in the inferior rectus, inferior oblique and medial rectus muscles.
 Now the nerve inferior to oblique muscle give some preganglionic parasympathetic
fibers to the ciliary ganglion where they innervate. Then you have the trochlear nerve
here as you can see the trochlear nerve passes to the superior orbital fissure running
medially and superiorly so that it can reach the superior oblique muscle which it
supplies. Then you have the abducens muscle here which supplies the lateral rectus
muscle.
 The last nerve is the ciliary ganglion. Again the ciliary ganglion is parasympathetic
ganglion receiving preganglionic parasympathetic fibers from the oculomotor nerve
via the nerve to inferior oblique muscle. Those preganglionic parasympathetic fibers
synapse here in the ciliary ganglion and then nerves called short ciliary nerves exit
the ciliary ganglion carrying postganglionic parasympathetic fibers so that they enter
the eyeball to reach the ciliary muscle and the pupillary sphincter muscle innervating
them.