ANATOMY OF ORBIT

Rajvin Samuel Ponraj

Development of orbit
Develops from mesenchyme ossification by

6 th to 7 th week laying down of bones starting with maxilla bone around the Optic vesicle During this time optic vesicle 170 degree apart rotates anteriorly

Developmental Anomalies :
Craniosynosotosis:

Brachycephaly Oxycephaly Scophocephaly Trigonocephaly

Craniosfacial dysostois / Crouzon syndrome

Oxycephaly-syndactlye / Apert syndrome

Flattened occiput , steep forehead , supra orbital ridge Midfacial hypoplasia , parrot beak nose

Bones of Orbit

Frontal Lacrimal Maxillary

Ethmoid Palatine Zygomatic

Sphenoid

Dimensions - orbit
30 ml volume 35 mm vertically , 40 mm horizontally 45 degree between lateral wall and sagital plane 23 degree between visual and orbital axis

Boundaries of Orbit
Roof Floor Side walls Orbital apex

 Roof

of orbit

Frontal bone [Orbital plate] & lesser wing of sphenoid Separated from frontal sinus and anterior cranial fossa above Lacrimal gland fossa and trochlear fossa behind orbital rim

Orbital roof anomaly / fracture pulsatile exophthalmos

CSF pulsation

Orbital meningocele / encephalocele

 Medial

wall

Body of sphenoid Ethmoid Lacrimal Maxilla[frontal process]

Orbital cellulitis

Extremely thin wall Prone for damage & sinusitis spread Infection across Orbital cellulitis

 Floor
Maxilla Zygomatic Palatine

of orbit

Triangular segment -- thinnest Inferior orbital groove

 Blow

out fractures

Fragile barrier to maxillary sinus Due to trauma eyeball collapse into Maxillary sinus

Le forts fracture
Type 2 - Pyramidal Type 3 - Craniofacial dissociation

 Lateral

wall

Greater wing sphenoid Orbital surface Frontal process of zygomatic Inferiorly inf orbital fissure Medially sup orbital fissure

Behind Zygomatic sphenoidal suture lateral orbitotomy of greater wing ( thin wall ) cancellous bone middle cranial fossa dura matter

At frontal sphenoidal suture -- meningeal foramen Site of anastomosis of Lacrimal artery and meningeal artery collaterals Periosteal elevation at this site bleeding Brisk

 Orbital

apex

Orbital apex syndrome / Tolosa - hunt syndrome :

Damage to structures at apex 2 nd, 3 rd, 4 th ,6 th nerves Symptoms : visual loss, ophthalmoplegia periorbital & facial pain

Other causes: Inflammatory Infectious Neoplastic Iatrogenic / traumatic Vascular

a. b. c. d. e.

Superior orbital fissure syndrome / Rochon Duvigneaud syndrome :

Lesion anterior to orbital apex excluding optic nerve pathology

Contents of orbit
Eye ball Orbital fat Connective tissue system Blood vessels Nerves Extraocular muscles

Eyeball - Applied anatomy:

Connective tissue system

 Periorbita:
Loosely attached to orbital bone Attached firmly to
a. b. c. d. e. f.

Arcus marginalis Trochlea Lateral orbital tubercle Optic foramen Orbital fissures Dura and optic canal margins

 Orbital

septum:

Interconnecting / circumferential radial webs of fascial system support and transmit forces in trauma Compressive optic neuropathy following trauma

Anterior fascial system

Formed by condensation of fibrous septa Lockwood lig, whitnall sup susp lig Lacrimal lig Intermuscular septum

Posterior Fascial system

Incompletely formed

 Tenons

capsule

Dense elastic , vascular Extent : from perilimbal sclera to optic nerve meninges with bursa within Sleeve like extensions for extra ocular muscles continues as fibrous capsule along its length

Surgical spaces in orbit :

Extra ocular muscles

To serve in eyeball movements in the orbital cavity

Arterial supply

Venous drainage

Optic nerve
Intra orbital part = 25 mm out of 4 cm Enclosed in three meningeal sheaths At apex surrounded by recti muscles , Central retinal artery and vein pierces optic nerve 1.25 cm behind optic nerve Relations: superiorly ophthalmic artery sup ophthal vein nasociliary nerve nerve to medial rectus

inferiorly

Oculomotor nerve
Divides at anterior part of cavernous sinus before Entering sup orbital fissure Sup division Inf division Sup rectus LPS Medial rectus Inf rectus Inf oblique

And motor root relay at ciliary ganglion sphincter pupillae , ciliary muscle

Trochlear nerve
Runs medially from lateral wall of cavernous sinus Above Levator palpebral sup Then supplies orbital surface of Superior oblique

Abducent nerve
Running inferior lateral to 3 rd nerve then supplies ocular surface of lateral Rectus

Trigeminal nerve
I.

Three terminal branches of ophthalmic division: Frontal nerve

I.

Lacrimal nerve

Sensory and secretomotor fibres to lacrimal gland tru zygomaticotemporal nerve


1. 2. 3. 4.

Nasociliary nerve:
Communicating branch to sensory root of ciliary ganglion Long ciliary nerves - dilator pupillae Posterior and anterior ethmoidal branches Infratrochlear nerve

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