Orbital wall and margins

Medial wall (thinnest): Feature:

1. Frontal process of maxilla. o Lacrimal fossa
2. Lacrimal process of maxilla. o Anterior and posterior ethmoidal foramina
3. Orbital plate of ethmoid.
4. Body of sphenoid.

4 3 2 1
Lateral wall (strongest):
1. Orbital surface of the zygomatic bone in front.
2. Orbital surface of greater wing of sphenoid behind.

1 2
Features
o Zygomatic foramen
o Whitnall’s tubercle
Floor: Features
1. Orbital surface of the body of maxilla. o Infraorbital groove and canal
2. Orbital surface of the zygomatic bone, anterolaterally.
3. Orbital process of the palatine bone, posteromedially

1
2
Roof:
1. Orbital plate of the frontal bone in front.
2. Lesser wing of the sphenoid behind.

Features:
1. Fossa for lacrimal gland
1 2. Trochlear notch
2
3. Optic canal
 Orbital margin
Supraorbital margin: by frontal bone
-Presents supraorbital notch/foramen
Infraorbital margin- by zygomatic & maxilla
Medial orbital margin: formed by frontal bone, frontal process of maxilla
Lateral orbital margin- frontal process of zygomatic bone, zygomatic process of frontal bone
 Tendinous ring of Zinn

L
F
T

36 N
Superior orbital fissure L III
F N
1. Lacrimal nerve (V1) T III
2. Frontal nerve (V1) SOV
3. Trochlear nerve
4. Superior ophthalmic vein VI
5. Superior division of the oculomotor nerve
IOV
6. Nasociliary nerve (CN V1)
7. Inferior division of the oculomotor nerve
8. Abducens nerve
9. Inferior ophthalmic vein
 Inferior orbital fissure
1. A branch of the inferior ophthalmic vein
2. Infra-orbital nerve (V2)
3. Infra-orbital artery (maxillary artery) and vein
4. Zygomatic nerve (V2)

IOV

Infraorbital NAV
ZN
Contents of orbit

1. Eyeball
2. Fasciae- orbital and bulbar
3. Muscles of orbit (extraocular muscles)
4. Nerves: optic nerve, oculomotor nerve with ciliary ganglion, trochlear nerve, abducent
nerve, branches of ophthalmic & maxillary nerve
5. Vessels: ophthalmic artery, superior & inferior ophthalmic veins
6. Lacrimal gland
7. Orbital fat
 Fascia in relation with orbit

The dura mater of middle cranial fossa

optic canal

Divide

Outer layer forms Inner layer forms dural

periosteum of orbit sheath for optic nerve
Periorbita Fascia bulbi
Periorbita (orbital fascia)
 Posteriorly – continuous with dura mater and the sheath of the optic nerve
 Anteriorly- lines the orbital margin
- projects into eyelid as orbital septum
 Forms lacrimal fascia- bridges the lacrimal groove
 Contributes for fibrous pulley for superior oblique muscle
Bulbar fascia (fascia bulbi / Tenon’s capsule) Fascia bulbi is pierced by ciliary vessels & nerves,
• Forms the membranous sheath around the eyeball tendons of extraocular (recti & oblique) muscles
• Separates eyeball from orbital fat
• Extends from optic nerve to sclero-corneal junction (limbus)
• Separated from sclera by episcleral space
Expansions : for each orbital muscles
❑ Lateral check ligament – sheath for lateral rectus muscle – attached to Whitnall’s tubercle
❑ Medial check ligament: sheath for medial rectus muscle – attached to lacrimal bone
❑ Both the ligaments are connected below the eyeball – by suspensory ligament of Lockwood- which blends
with sheaths of Inferior rectus and inferior oblique muscles
 EXTRAOCULAR MUSCLES

VOLUNTARY MUSCLES INVOLUNTARY MUSCLES (smooth muscles)

Four recti muscles Superior tarsal (Muller's muscle)

(a) Superior rectus, Inferior tarsal
(b) Inferior rectus, Orbitalis
(c) Medial rectus,
(d) Lateral rectus.
Two oblique muscles
(a) Superior oblique,
(b) Inferior oblique
One levator palpebrae superioris
The common tendinous ring (Annulus of Zinn)
• Encloses the optic canal and middle part of the superior
orbital fissure.
• It is attached medially to apex of the orbit and laterally to
a small tubercle (tubercle of Zinn) on the lower border of
superior orbital fissure.
• It provides origin to Recti muscles
Recti muscles
Origin
All the recti arise from the
corresponding margins of the
common tendinous ring.
(The lateral rectus arises by two
heads)
Superior rectus
Insertion
Into sclera little posterior to
the limbus (corneoscleral Lateral rectus
Medial rectus
junction) in front of the
equator of the eyeball.
Average distance from limbus is:
Medial rectus, 5 mm Inferior rectus
Inferior rectus, 6 mm
Lateral rectus, 7 mm
Superior rectus, 8 mm
Oblique muscles
Muscle Origin Insertion
SUPERIOR Body of sphenoid Into sclera behind equator in the posterior
OBLIQUE (superomedial to superior quadrant of the eyeball, between SR
optic canal) & MR
(tendon passes through a pulley attached to
trochlear notch)
INFERIOR From rough Into sclera behind equator in the posterior
OBLIQUE impression in the superior quadrant of the eyeball (little below
anteromedial insertion of SO)
angle of the roof
of orbit,
 IO SR

LR MR

SO IR

Muscles Action
Superior rectus (SR) Elevation, adduction, and intorsion.
Medial rectus (MR) Adduction
Inferior rectus (IR) Depression, adduction, and extorsion
Lateral rectus (LR) Abduction
Superior oblique (SO) Depression, abduction, and intorsion
Inferior oblique (IO) Elevation, abduction, and extorsion.
Levator palpebrae superioris

Levator palpebrae superioris

Superior Tarsus
 Origin Insertion Nerve supply Action
Lesser wing of Upper lamella (skeletal muscle) into Striped (skeletal muscle) part is Elevation of the
sphenoid at the the skin of upper eyelid supplied by the upper upper eyelid
apex of the division of oculomotor nerve.
orbit, above Intermediate lamella (smooth
the common muscle)/superior tarsal muscle is Unstriped (smooth muscle) part is
tendinous ring inserted on to the upper supplied by the postganglionic
border of the superior tarsal plate. sympathetic fibres from the superior
cervical ganglion.
Lower lamella (connective tissue) is
inserted on to the superior fornix of
the conjunctiva.
III NERVE (OCCULOMOTOR NERVE)

III nu LPS

UD SR

MR

Cavernous sinus LD IR
EW IO

SR
Ciliary ganglion
SR

• Sphincter Pupillae
• Ciliaris muscle

▪ Content of interpeduncular fossa

▪ Most commonly involved in intracranial aneurysm
 Superior orbital fissure
Interpeduncular fossa
Posterior cerebral artery
Upper division
LPS
SR

MR
Midbrain
IR
Cavernous sinus IO

lower division
Superior cerebellar arteries
CILIARY GANGLION
Short ciliary nerves
Sphincter pupillae
Ciliaris muscle
Course & relations Midbrain

Interpeduncular fossa

Forward and laterally between the posterior cerebral and superior cerebellar arteries

Through the tentorial notch

Middle cranial fossa

Oculomotor triangle (Between the free and attached margins of tentorium cerebelli)

Enters the lateral wall of the Cavernous sinus

Divides into upper and lower divisions

Superior orbital fissure

 Upper division Lower division

• Superior rectus • Medial rectus

• Levator palpebrae superioris • Inferior rectus
• Inferior oblique

Nerve to inferior oblique gives motor root

(parasympathetic root)

Ciliary ganglion

Short ciliary nerves

Sphincter pupillae
Ciliaris muscle
 Clinical correlation

The damage of oculomotor nerve clinically presents as:

• Ptosis (drooping of the upper eyelid), due to paralysis of the
levator palpebrae superioris.
• Lateral strabismus (lateral squint), due to unopposed action of
the lateral rectus muscle.
• Dilated and fixed pupil, due to paralysis of the sphincter
pupillae and consequent unopposed action of the dilator pupillae.
• Loss of accommodation, due to paralysis of the medial rectus,
sphincter pupillae, and ciliaris muscles.
• Double vision or diplopia occurs on looking medially, inferiorly,
and superiorly, due to paralysis of the medial rectus, inferior
rectus, and inferior oblique muscles.
• Proptosis (prominence of the eyeball) due to relaxation of the
muscles of the eyeball.
TROCHLEAR NERVE
IV NERVE (TROCHLEAR)

SO

Cavernous sinus

• Only nerve from the dorsal aspect of brainstem

• Longest intracranial course
• LMN Decussate within brainstem
• Most slender (thinnest/smallest)
 Superior orbital fissure

Posterior cerebral artery

SO

Midbrain

Cavernous sinus

Superior cerebellar arteries

 Course & relations Midbrain

Dorsal aspect of the midbrain

Winds round the superior cerebellar peduncle and cerebral peduncle

Passes between the posterior cerebral and superior cerebellar arteries

Forward in its lateral wall of cavernous sinus

Superior orbital fissure superolateral to the tendinous ring

Medially above the levator palpebrae superioris

Superior oblique
Clinical correlation
1. Extorsion of the eyeball and weakness of downward gaze.
2. Diplopia (double vision), which occurs when the patient looks laterally and in glances on looking downward
→There is compensatory head-tilting to the opposite side.
ABDUCENT NERVE
VI NERVE (ABDUCENT)

Dorello’s canal
Cavernous sinus

LR

Petrous temporal bone

• Longest intradural course

• Most commonly affected in increased cranial pressure
Course & relations Lower border of the pons

Pierces the dura mater over the clivus inferolateral to the dorsum sellae

Passes through the medial wall of the inferior petrosal sinus

Over the sharp ridge of the petrous temporal bone

Under the petroclinoid ligament and enters the fibro-osseous canal (Dorello’s canal)

Runs through cavernous sinus, inferolateral to internal carotid artery

Superior orbital fissure (within the tendinous ring)

Lateral rectus muscle

 Clinical correlation

Increased intracranial pressure

The nerve is stretched due to the descent of brainstem

The nerve is cut by the sharp bony edge of the petrous temporal bone

Paralysis of lateral rectus

• Convergent squint due to the unopposed action of medial rectus,

• Diplopia (double vision) with maximum separation of two images while
looking toward the paralyzed side.
OPTHALMIC NERVE
Course & relations
Trigeminal ganglion

Pierces the dura mater of the trigeminal cave

Lateral wall of the cavernous sinus

Superior orbital fissure

Lacrimal nerve Frontal nerve Nasociliary nerve

Lateral wall of the orbit

LACRIMAL GLAND
 Frontal nerve (largest branch)

Between LPS and periosteum lining the roof of the orbit

Supraorbital nerve (lateral) Supratrochlear nerve (medial)

Supraorbital notch Upwards along the superior orbital margin

Divides into medial and Skin of the lower part of the forehead
lateral branches

Supply the scalp as far

back as the vertex
 Nasociliary nerve

Lateral to medial above optic nerve

Medial wall of the orbit

Sensory root 2-3 long ciliary nerves Posterior ethmoidal nerve Anterior ethmoidal nerve
to the ciliary
ganglion Infratrochlear nerve Anterior ethmoidal foramen

Postganglionic sympathetic Posterior ethmoidal foramen

Sensory fibres Anterior cranial fossa
to the ciliary fibres to the dilator pupillae
body, iris and
Ethmoidal and sphenoidal Nasal slit at the side of crista galli
cornea
air sinuses

Internal nasal branches to the nasal septum

Skin of upper eyelid
and lateral wall of the nose

Leaves the nasal cavity as external nasal nerve

CILIARY GANGLION
 Ciliary Ganglion
• Type: Peripheral parasympathetic ganglion
• Size: 2 mm in diameter
• Location: near the apex of orbit between the optic nerve and lateral rectus muscle
• Topographical connection: Nasociliary nerve
• Functional connection: Oculomotor nerve
 Roots
• Motor (parasympathetic) root: It consists of preganglionic parasympathetic fibres from Edinger–Westphal
nucleus
• Sensory root: It is derived from nasociliary nerve. It consists of sensory fibres (for pain, touch, and
temperature) from eyeball
• Sympathetic root: It is derived from sympathetic plexus around internal carotid artery.

Branches

• The branches of ciliary ganglion are short ciliary nerves (8–10).

• On reaching the eyeball they pierce the sclera around the attachment of the optic nerve and pass
forwards in the space between the sclera and choroid to reach the target organs.
OPTHALMIC ARTERY AND VEIN
 Ophthalmic artery

ICA

Ophthalmic artery

Optic canal (inferolateral to optic nerve)

Crosses optic nerve lateral to medial

(accompanied by nasociliary nerve)

Runs along medial wall of orbit

 Branches
1. Central artery of the retina
2. Lacrimal artery
▪ Glandular branches to lacrimal gland.
▪ Two lateral palpebral arteries—one to each eyelid.
▪ Two zygomatic branches: zygomaticofacial and
zygomaticotemporal
▪ Recurrent meningeal branch
▪ Muscular branches
3. Posterior ciliary arteries
4. Supraorbital artery
5. Posterior ethmoidal artery
6. Anterior ethmoidal artery
7. Dorsal nasal artery
8. Supratrochlear artery
9. Medial palpebral branches
 Ophthalmic veins
Superior ophthalmic vein
Accompanies the ophthalmic artery
Runs backwards above the optic nerve
Superior orbital fissure
Cavernous sinus
It communicates anteriorly
at its commencement
With the supraorbital and
angular veins
Inferior ophthalmic vein
Below the optic nerve
Joins superior ophthalmic
vein or drain directly into
the cavernous sinus.
Communicates with
pterygoid venous plexus by
Small veins passing through
the inferior orbital fissure
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