Orbit

Blood vessels and Nerves

Ophthalmic artery: (*short note)

It is the main artery of the orbit.

Origin: It originates from the cerebral part of internal carotid artery.
Termination: It terminates by dividing into dorsal nasal & supratrochlear artery.
Course & Relations:
• It originates from cerebral part of Internal carotid artery after emerging from the
cavernous sinus.
• It enters in the orbit via optic canal along with optic nerve. Here it is inferolateral to the
nerve. It runs a short course lateral to then nerve.
• Then it crosses the nerve from lateral to medial superiorly along with nasociliary nerve.

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 • Then it runs along the medial wall & near the medial canthus it divides into dirsal nasal
& supratrochlear arteries.
Branches:
• Central artery of retina: It is most important branch of ophthalmic artery. It enters in
the optic nerve (Embedded in the nerve) & then divides into branches for the retina in
the eyeball. It is an End Artery does not having any anastomosis. Hence blockage of this
artery will lead to blindness.
• Lacrimal artery: Runs along the lateral wall of orbit & supplies lacrimal gland.
• Ciliary branches: supplies the sclera & choroid of the eyeball.
• Anterior & Posterior ethmoidal arteries: Enters in the ethmoidal bone at medial wall &
supplies the nasal cavity.
• Supraorbital & Supratrochlear arteries: emerge at supraorbital margin and supplies
scalp.
• Dorsal nasal artery: Anastomosis with lateral nasal branch of facial artery at the medial
canthus of eye and supplies nose.
Applied anatomy of Ophthalmic artery:
 Central artery of retina is an End Artery does not having any anastomosis. Hence
blockage of this artery will lead to complete blindness. Intraocular part of the artery can
be seen in fundoscopy.
 The medial canthus of eye is a site for anastomosis between ICA & ECA via dorsal nasal
artery & lateral nasal arteries.

Veins in the orbit:

Superior ophthalmic vein: Accompanies ophthalmic artery. Lies above optic nerve. Passes via
lateral part of superior orbital fissure and end in Cavernous sinus.
Inferior ophthalmic vein: Lies below optic nerve and passes via medial part of superior orbital
fissure and end in cavernous sinus.
Central vein of retina ends in the cavernous sinus directly or via superior ophthalmic vein.

Lymphatics in the orbit: Drains into preauricular and parotid lymph nodes.

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 Nerves in orbit

Occulomotor nerve: (**** long question/short note/viva)

(Draw this Diagram for the short note)

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 Occulomotor nerve: (**** long question/short note/viva)
It is a 3rd cranial nerve. It supplies all the muscles of eyeball except superior oblique & lateral
rectus. It also supplies sphincter pupillae & Ciliaris (Intra-ocular msucles).
Nuclei of occulomotor nerve: The nuclei are located in the periacqueductal region of midbrain
at the level of superior colliculus.
• Somatic efferent component: The nucleus is divided into different parts for different
extraocular muscles.
• Special visceral efferent component (Parasympathetic nucleus): Also known as Edinger
Westphal nucleus.
Course & Relations:
• In the brain stem: It emerge from occulomotor nucleus & passes through red nucleus to
emerge at the medial border of crus cerebri.
• In the cranial cavity:
• It passes between posterior cerebral and superior cerebellar arteris at the
interpeduncular fossa.
• Then it pierces the roof of cavernous sinus (Dura matter) at the crossing of
attached and free margin of tentorium cerebelli.
• Then it runs in the lateral wall of cavernous sinus (In the wall the structures
above downwards are 3rd, 4th cranial nerves and ophthalmic and maxillary
division of trigeminal nerves).
• Then it divides into superior and inferior divisions.
• In the orbit:
• It enters the orbit via intermediate part of superior orbital fissure.
• Between two divisions of occulomotor nerve, there is nasocilairy nerve (Branch
of ophthalmic division of trigeminal nerve).
• The superior division supplies Superior rectus, Medial recuts and Levator
palpabrae superioris.
• The inferior division supplies Inferior rectus & Inferior oblique. The branch to
inferior oblique contains ciliary ganglion.

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 CILIARY GANGLION

•
• Ciliary ganglion: (*short note)
• It is a parasympathetic ganglion in the course of occulomotor nerve in tis branch
to inferior oblique muscle.
• Location: It is located near the apex of orbit between optic nerve & lateral rectus
muscle.
• Roots of Ciliary ganglion:
• Parasympathetic root: The preganglionic fibers originate from Edinger
Westphal nucleus in midbrain. These fibers travel via occulomotor nerve
to the ganglion. The fibers relay in the ganglion. The postganglionic fibers
passes via ciliary nerves to the sphincter pupillae & ciliaris muscles.
• Sympathetic root: It comes from the sympathetic plexus around the
ophthalmic artery. The fibers originate from T1 segmentt of spinal cord.
Relay in the superior cervical ganglion. Postganglionic fibers travel via
plexus around the ophthalmic artery. These fibers do not relay into
Ciliary ganglion. They supply dilator pupilae.
• Sensory root: comes from the nasociliary nerve and supplies the sensory
fibers to the eyeball.

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 • Significance of the Ciliary ganglion:
• Pupillary reflex: constriction of pupil by sphincter pupillae
• Dilatation of pupil in darkness is done by Dilator pupillae.
• Accommodation reflex: Convergence of eye with constriction of pupil for
near vision.
• Sensations of pain following stretching of structures of eyeball-referred
to forehead (Headache) by trigeminal nerve.
Distribution of Occulomotor nerve:
• Extraocular muscles (Levator palpabrae superioris, Superior rectus, Inferior rectus,
Medial rectus and Inferior oblique).
• Intraocular muscles by parasympathetic root (Sphincter pupillae & Ciliaris).
Applied anatomy of Occulomotor nerve:
 Pupillary reflex:
o Direct pupillary light reflex: constriction of pupil following throwing light into the
eye.
o Indirect pupillary light reflex: (Consensual pupillary reflex): Constriction of the
pupil of opposite side eye in which light is not thrown following throwing light in
one of the eye.
 Accommodation reflex: In this there is convergence of eyeball by medial rectus. There is
increase in curvature of lens by ciliaris muscle and constriction of pupil by sphincter
pupillae.
 Damage to occulomotor nerve leads to:
o Ptosis: drooping of eyelid (Paralysis of LPS)
o Dilatation of pupil (Paralysis of sphincter pupillae)
o Lateral squint/strabismus: paralysis of medial rectus. Unopposed action of lateral
rectus pulls the eyeball laterally.
o Loss of accommodation reflex.

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Trochlear nerve: (***short note/viva)
It is a 4th cranial nerve.
Trochlear nucleus: located in the periacqueductal region of midbrain at the level of inferior
colliculus.
Course & Relations:
• It runs backwards in the midbrain & originates from dorsal surface of midbrain below
the inferior colliculus.
• In the cranial cavity:
• It passes between posterior cerebral and superior cerebellar arteris at the
interpeduncular fossa.
• It pierces the roof of cavernous sinus (Dura matter& runs in the lateral wall of
cavernous sinus between occulomotor nerve & Ophthalmic division of trigeminal
nerve. (In the wall the structures above downwards are 3rd, 4th cranial nerves
and ophthalmic and maxillary division of trigeminal nerves).
• In the orbit:
• It enters the orbit via superior orbital fissure and supplied superior oblique
muscle.
Distribution of Trochlear nerve:
• Superior oblique muscle.
Applied anatomy of trochlear nerve:
 Damage to trochlear nerve leads to paralysis of superior oblique muscle. This leads to
diplopia while looking downwards.

Abducent nerve: (***short note/viva)

It is a 6th cranial nerve.
Abducent nucleus: located at the level of pons.
Course & Relations:
• Emerge at the junction of pons & Medulla oblongata near the pyramid.
• It has a long course in subarachnoid space. While passing through subarachnoid space it
crosses the upper border of the petrous temporal bone. Then it enters in cavernous

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 sinus & runs in its medial wall near the ICA. It enters the orbit via superior orbit fissure &
Supplied Lateral rectus.
Distribution of Trochlear nerve:
• Lateral rectus muscle.
Applied anatomy of trochlear nerve:
 The long course of nerve in subarachnoid space makes the nerve vulnerable to injury
against petrous temporal bone during raised intracranial pressure. Damage to nerve
leads to paralysis of lateral rectus causing Medial squint.

Optic nerve in Orbit:

It is a 2nd cranial nerve. It is formed by fibers from the ganglion cells in retina.
Total length: 4cm (2.5cm in orbit, 0.5cm in optic canal & 1.0cm in cranial cavity.)
Abducent nucleus: located at the level of pons.
Course & Relations:
• Emerge at the junction of pons & Medulla oblongata near the pyramid.
It has a long course in subarachnoid space. While passing through subarachnoid space it
crosses the upper border of the petrous temporal bone. Then it enters in cavernous
sinus & runs in its medial wall near

Branches of Ophthalmic nerve in orbit: (**viva)

Ophthalmic division is branch of trigeminal nerve (5th cranial nerve).
Frontal nerve:
• It runs on Levator palpabrae superioris & divides into supraorbital & supratrochlear
nerves to supply scalp and frontal air sinus. (Hence frontal sinusitis causes headache).
Lacrimal nerve:
• It supplies the lacrimal gland & the eyelid.
Nasociliary nerve:
• It supplies sensory fibers for the structures in the orbit. It gives ethmoidal branches to
supply lateral wall of nose. (Nasal cavity).

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