By/ Rasha Mohamed Elshinety, MD, PhD

Bony orbit
y The bony orbit is a four sided pyramidal opening with

its base opening in norma frontalis. y The apex of the orbit directs posterior. y The long axis of the orbit directs forward and laterally. y The orbit has 4 walls; roof, floor, medial wall and lateral wall

Roof of the orbit:

Is formed of: y Orbital plate of frontal bone (large anterior part). y Lesser wing of sphenoid (small posterior part). It shows the following features: y Lacrimal fossa that lodges the lacrimal gland (its main part). y Trochlear fovea that gives attachment to the trochlea of superior oblique muscle. y Optic canal that gives passage to: 1. Optic nerve. 2. Ophthalmic artery.

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Floor of the orbit:

Is formed of: y Maxilla (medially). y Zygoma (laterally).

It shows the following features: Inferior orbital fissure (between the floor and lateral wall), it gives passage to: y Infraorbital nerve. y Infraorbital vessels. y Zygomatic nerve. y Emissary vein. y Branches from the sphenopalatine ganglion. Infraorbital groove that convert into infraorbital canal that opens into the infraorbital foramen.

Medial wall of the orbit:

Is formed of: y From anterior to posterior: 1. Lacrimal bone. 2. Ethmoid bone. 3. Body of sphenoid bone.

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It shows the following features: y Lacrimal groove that lodges the lacrimal sac and is bounded by the lacrimal crests and leads inferiorly into the nasolacrimal canal that transmitts the nasolacrimal duct. y Anterior and posterior ethmoidal canals that transmit the anterior & posterior ethmoidal nerve and vessels respectively.

Lateral wall of the orbit:

Is formed of: y Zygomatic bone (anterior). y Greater wing of sphenoid (posterior).

It shows the following features: Superior orbital fissure (between the lateral wall and the roof) Transmits the following structures from lateral to medial; I- Nerves: A- Outside the common tendinous, ring: Lacrimal. Frontal. Trochlear. B- Inside the common tendinous ring: Superior division of occulomotor. Nasociliary. Inferior division of occulomotor. Abducent. II- Superior and inferior ophthalmic veins. III- meningeal branch of lacrimal artery. IV- Orbital branch of middle meningeal artery.

1. Zygomaticofacial canal that transmit the

zygomaticofacial nerve and artery. 2. Zygomaticotemporal canal that transmit the zygomaticotemporal nerve and artery.

Contents of the orbit:

1. Orbital fat. 2. Eyeball. 3. Muscles: levator palpebrae superioris & muscles of

the eyeball. 4. Nerves (sensory & motor). 5. Vessels ( ophthalmic artery & superior and inferior ophthalmic veins). 6. Ciliary ganglion. 7. Lacrimal gland. 8. Fascia. y N.B. There is no lymph nodes inside the orbit.

Muscles of the eyeball:

A- Intrinsic muscles: * Sphincter pupillae. * Dilator pupillae. * Ciliary muscle. B- Extrinsic muscles: * 4 recti (superior, inferior, medial and lateral). * 2 oblique (superior and inferior).

Extrinsic muscles:
Recti muscles: Origin: common tendinous ring. Insertion: Into the sclera. Nerve supply: All are supplied by occulomotor nerve except the lateral rectus by abducent nerve. * Action: y Medial and lateral recti produce medial and lateral deviation of the cornea respectively. y Superior and inferior recti produce superior and inferior movement of the cornea respectively accompanied with medial deviation.
y * * * y
y

y Oblique: * Origin: wall of the bony orbit. * Insertion: sclera. * Nerve supply: superior oblique by trochlear

nerve while the inferior oblique by the occulomotor. * Action: the superior and inferior oblique produce inferior and superior movement of the cornea respectively with abduction.
y

Nerves of the orbit:

1. Sensory: * Optic nerve. * Branches of

ophthalmic nerve: y Frontal. y Lacrimal. y Nasociliary. y 3. Zygomatic.

y

:2- Motor: y Occulomotor. y Trochlear. y Abducent.

Optic nerve
* It is the sensory nerve for vision. * Origin:

The ganglion cells of the retina. * Course: The nerve is 4 cm long. It pierces the sclera posteriorly medial to the center of the eyeball. The nerve is completely enclosed inside a meningeal sheath that is the extension of the 3 meninges surrounding the brain

Branches of the ophthalmic nerve:

y Lacrimal nerve; the smallest branch that supply the

lacrimal gland, adjacent conjunctiva and eyelid. y Nasociliary; the medium size one that give sensory branch to sensory ganglion. y Frontal; the largest branch that divide into supratrochlear and supraorbital. It the highest structure in the orbit.

1- Occulomotor;
the 3rd cranial nerve. * It supplies all the extraoccular muscles (recti & oblique) except SO & LR. * It also gives parasympathetic supply to the ciliary and sphincter (constrictor) pupillae muscles. * It divides into 2 branches (superior & inferior divisions).
y

2- Troclear nerve;
y the 4th cranial nerve and the smallest of all. y It supplies only the superior oblique muscle

3- Abducent nerve;
y the 6th cranial nerve. y It supplies the lateral rectus muscle.

Ciliary ganglion:
* The ciliary ganglion is the smallest of the 4

parasympathetic ganglia of the head and neck. * Roots: y Sensory: nasociliary nerve. y Sympathetic: plexus around internal carotid artery. y Parasympathetic: nerve to inferior oblique. * Branches: y Short ciliary nerves.

Ophthalmic artery:
Origin: Internal carotid artery. Course and relations: It enters the orbit through the optic canal below the optic nerve. * It passes then lateral to the nerve. * Inside the orbit it crosses above the nerve from lateral to medial. * Here the ophthalmic artery is accompanied with superior ophthalmic vein and nasociliary nerve.
* * * *
* Termination:

y By dividing into supratrochlear and dorsal nasal

arteries

y Branches: 1. Central artery of the retina. 2. Lacrimal artery. 3. Palpebral branches. 4. Muscular branches. 5. Meningeal branches. 6. Anterior ethmoidal artery. 7. Posterior ethmoidal artery. 8. Supratrochlear artery. 9. Infratrochlear artery. 10. Dorsal nasal artery. 11. Ciliary arteries; anterior and posterior. 12.

Veins of the eyeball

* Superior & inferior ophthalmic veins: * They drain the structures inside the orbit and

end into the cavernous sinus after passing through the superior orbital fissure. * Central vein of the retina: * It accompanies the central artery of the retina inside the optic nerve and ends inside the cavernous sinus.
y

Fascia & ligaments:

y Fascial sheath of the eyeball (Tenon s capsule); it is

a thin membrane that covers the eyeball from the optic nerve till the corneoscleral junction. y Check & suspensory ligaments. y Orbital septum (palpebral fascia).