The Orbit

1
 Orbit
• Bony cavity in anterior side of skull
• Are bilateral structures in the upper half of the face below
the anterior cranial fossa and anterior to the middle cranial
fossa
• Lodges eye ball and associated structures
• Shape - four-sided pyramid with a base, apex and four
walls (roof, floor, medial and lateral walls)
• The long axis directs medially and back ward

2
 Bony orbit
• Seven bones contribute to the framework of each orbit.
• They are the maxilla, zygomatic, frontal, ethmoid,
lacrimal, sphenoid, and palatine bones.
• Together they give the bony orbit the shape of a pyramid,
with its wide base opening anteriorly onto the face and its
apex extending in a posteromedial direction.
• Completing the pyramid configuration are medial, lateral,
superior, and inferior walls.
 Bony orbit…
• The apex of the pyramid-shaped bony orbit is the optic
foramen, whereas the base (the orbital rim) is formed:
– superiorly by the frontal bone,
– medially by the frontal process of the maxilla,
– inferiorly by the zygomatic process of the maxilla and the
zygomatic bone, and
– laterally by the zygomatic bone, the frontal process of
the zygomatic bone, and the zygomatic process of the
frontal bone
 The superior wall (roof)

• Is approximately horizontal and is formed by:

– Anteriorly - orbital plate of frontal bone(mainly)
– Posteriorly - lesser wing of sphenoid
– Separate orbit from anterior cranial fossa
• Anterolaterally, a shallow depression in the orbital part of
the frontal bone, called the fossa for lacrimal gland
(lacrimal fossa), accommodates the lacrimal gland.
 The inferior wall (orbital floor)
• Formed:
– mainly by the maxilla
– Partly by Zygomatic and
– Orbital process of palatine bone
• The thin inferior wall is shared by the orbit and maxillary
sinus.
• It slants inferiorly from the apex to the inferior orbital
margin.
• Is demarcated from the lateral wall of the orbit by the
inferior orbital fissure, a gap between the orbital surfaces
of the maxilla and the sphenoid
 Medial wall
• Formed by:
– Frontal process of maxilla
– Lacrimal bone
– Orbital pate of ethmoid
– Anterior part of body of sphenoid
• Lacrimal groove – formed by maxilla and lacrimal bone;
fossa for lacrimal sac
• The medial walls of the contralateral orbits are essentially
parallel.
 Lateral wall
• Is formed by:
– Anteriorly – frontal process of zygomatic bone; separate
the orbit from the temporal fossa
– Posteriorly - greater wing of the sphenoid; separating the
middle cranial fossa from the orbit
– This is the strongest and thickest wall, which is important
because it is most exposed and vulnerable to direct
trauma.
• The lateral walls of the contralateral orbits are nearly
perpendicular to each other.
• Superior orbital fissure is between the greater wing of the
sphenoid and the lesser wing of the sphenoid that forms part
of the roof.
10
 Features of the orbit
• Lacrimal fossa - anterolateral part of the roof
– Fossa of lacrimal sac
• Trochlear fossa – anteromedially, attachment for trochlea
• Anterior and posterior ethmoidal foramen - transmits anterior and
posterior ethmoid nerves and vessels.
• Optic canal - at the apex of the orbit, the passage for optic nerve
and ophthalmic artery
• Infraorbital groove and canal - passage for infraorbital nerve and
vessels
• Zygomaticofacial foramen - transmits zygomaticofacial nerve
• Zygomaticotemporal foramen - for Zygomaticotemporal nerve

11
 Superior orbital fissure
• It is the gap between the greater and lesser wings of the
sphenoid bone
• Connects the orbit with middle cranial fossa.
• Common tendinous ring divide it into 3 parts
• The structures passing through the fissure are divided into
three.
– Lateral to the tendinous ring - lacrimal, frontal and trochlear
nerves and superior ophthalmic vein
– In the tendinous ring - superior division of oculomotor, nasocilary,
inferior division of oculomotor and abducent nerves
– Medial to the tendinous ring - inferior ophthalmic vein
• Inferior orbital fissure
– Connects the orbit with infratemporal fossa.
– It is located between the sphenoid and the maxillary bones.
– Structures passing are maxillary nerve, zygomatic nerve,
infraorbital vessels and inferior ophthalmic vein
• Orbital fascia
– Periosteum of the bones forming the orbit
– Become continuous with periosteum covering the outer surfaces of
bones and the endosteal layer of the dura matter through the
foramina and fissure.
• Orbital muscle
– The layer of smooth muscle bridging the inferior orbital fissure;
innervated by sympathetic nerves

14
Periorbita. A. Lateral view. B. Common tendinous ring
 Contents of the orbit
• Consist of:
1. Eye ball, eyelid
2. Fascia - forms the fascial sheath of the eyeball
3. Lacrimal glands –lubricates it
4. Muscles:
– Intrinsic – sphincter pupillae, dilator pupillae and ciliary
muscles
– Extrinsic – four recti and two oblique
5. Nerves
– Sensory - optic, branches of ophthalmic, zygomatic
– Motor – CN III, IV and VI
6. Ganglion - ciliary
7. Blood vessels - ophthalmic veins and ophthalmic artery
8. Fat - forms a matrix in which the structures of the orbit are
embedded
 The eye lids
• When closed, the eyelids cover the eyeball anteriorly, thereby
protecting it from injury and excessive light
• Separated from each other by palpebral fissures
• Features :
– Lacrimal papilla – small elevation at medial angle of eye
– Lacrimal punctum – opening at the submit of the papilla
– Eye lashes – at the free margins of the eye lid, lateral to the papilla
• Structures of the eye lid from out side to inside
– Skin
– Subcutaneous tissue – no fat, contain orbicularis occuli
– Palpebral fascia – forms
• Orbital septum
• Tarsal plate – dense fibrous tissue that makes the eye lid hard
• Palpebral ligaments - lateral and medial palpebral ligaments
– Conjunctiva – lines the eye lid

18
 Neurovascular structure of eye lids
• Sensory nerves of the eye lid
– Upper eye lid
• Medial 1/3 - infratrochlear & Supratrochlear
• Middle 1/3 - supraorbital
• Lateral 1/3 - palpebral branch of lacrimal
– Lower eye lid - infraorbital
• Arterial supply
– Both eye lid - Medial and lateral palpebral
– Upper eye lid - Supratrochlear and supraorbital
– Lower eye lid - branches of facial and infraorbital
• Veins
– Supraconjunctival - ophthalmic
– pretarsal - facial and superficial temporal vein
• Lymph
– Medial half - submandibular
– lateral half - parotid
 Conjunctiva

• Membrane that lines the eye lids posteriorly

• At point where it leave the eye lids to cover the sclera
it forms the superior and inferior fornices
• Conjunctival sac – formed when the eye is closed,
communicate with lacrimal sac through lacrimal
canaliculi

21
 Lacrimal apparatus
• Structures concerned with secretion and drainage of tear
• consists of
– Lacrimal gland – two parts
• Large orbital – in the lacrimal fossa
• Small palpebral – lateral part of eye lid, b/n
palpebral fascia and conjunctiva
– Excretory ducts open into superior fornix of conjuctival
sac
– Secretory parasympathetic nerve originate in the pons
→ facial nerve → greater petrosal → nerve of
pterygoid canal → pterygopalatine ganglion →
zygomatic nerve → zygomaticotemporal nerve →
lacrimal nerve → lacrimal gland
22
• Conjunctival sac
– space b/n palpebral and bulbar conjunctivae
– enables the eyelids to move freely over the surface of
the eyeball as they open and close
• Lacrimal puncta- opening on the lacrimal papilla
• Lacrimal canaliculi
– 2 small channels begin at lacrimal punctum and passes medially
to open into lacrimal sac
• Lacrimal sac – within lacrimal groove; continuous with
nasolacrimal duct
• Nasolacrimal duct – runs downwards and open into
inferior meatus of nose
– conveys the lacrimal fluid to the inferior nasal meatus

25
 Orbital fascia (periorbita)
• Periosteum of orbit, posteriorly continuous with dura of optic nerve
• At upper and lower margins of orbit it sends off flaps into eyelid
called orbital septum
• Bulbal fascia (Tenon’s capsule)
– Forms loose, membranous sheath around eye ball except corneal
part
– Eye ball freely move within it
– Pierced by tendons of extra ocular muscles and ciliary veins and
nerves
– It forms
– Tubular sheath around muscle
– Median check ligament
– Lateral check ligament
– Suspensory ligament of eye ball

27
 Eyeball

• Spherical in shape with anterior and posterior poles

• Suspended in anterior half of orbital cavity
• The wall is composed of three concentric coats (tunics) –
fibrous, vascular, and sensory
• The internal cavity is fluid filled with humors – aqueous and
vitreous
• The lens separates the internal cavity into anterior and
posterior segments

30
 Layers of the eyeball

• The three layers of the eyeball are the :

– Fibrous layer (outer coat), consisting of the sclera and
cornea.
– Vascular layer (middle coat), consisting of the choroid,
ciliary body, and iris.
– Inner layer (inner coat), consisting of the retina that has
both optic and non-visual parts.
33
 Fibrous Tunic
• Forms the outermost coat of the eye and is composed of
– Opaque sclera (posterior)
– Clear cornea (anterior)
• Sclera
– protects the eye and anchors extrinsic muscles
– dense fibrous tissue
– form posterior 5/6 of eye ball
– posteriorly perforated for passage of optic nerve
– continues anteriorly with cornea at sclerocorneal junction (limbus)
– inner part of limbus contains circular canal called sinus venosus sclerae (canal of
Schlemm)
– posteriorly fused with dura of optic nerve
– it provides insertion to extrinsic muscles
– pierced by optic nerve, ciliary ganglion, anterior ciliary arteries, choroids veins
– it is avascular

34
 The Cornea

• Transparent and avascular

• Lets light enter the eye
• Forms anterior 1/6
• More convex than sclera
• Made up of special connective tissue
 Vascular Tunic (Uvea)
• Has three regions: choroid, ciliary body and iris
• Choroid region
– A dark brown membrane that forms the posterior portion of the uvea
– Supplies blood to all eye tunics
– Anteriorly ends at oraserrata by merging with ciliary body
– Posteriorly pierced by optic nerve
– Attached to sclera loosely and retina firmly
– Contain venous plexus and capillaries
• Ciliary Body
– A thickened ring of tissue surrounding the lens
– Connects choroids with iris
– Composed of smooth muscle bundles (ciliary muscles) and ciliary processes
– Anchors the suspensory ligament that holds the lens in place

36
 Iris
• The colored anterior part of the eye
• Posses pigment cells; determine eye color
• Form circular curtain with opening at center called pupil
• Regulates the amount of light entering the eye by 2 muscles
– Sphincter pupillae (ring muscle)
– Dilator pupillae (radial muscle)
• Close vision and bright light – pupils constrict
• Distant vision and dim light – pupils dilate
Layers of eyeball. The three layers are added sequentially. A. Outer fibrous layer. B.
Middle vascular layer. C. Inner layer (retina).
 Sensory Tunic: Retina
• A delicate membrane between choroids and vitreous body
• Composed of two layers:
– Pigmented layer – the outer layer that absorbs light and prevents its scattering
– Neural layer – inner layer which contains:
• Photoreceptors that transduce light energy
• Bipolar cells and ganglion cells
• Amacrine and horizontal cells
– Neural layer ends at posterior edge of ciliary body in a wavy border called ora
serrata retinae
– Beyond ora serrata it is continued as a non-nervous layer
– Ganglion cell axons: run along the inner surface of the retina and leave the eye
as the optic nerve
– The optic disc:
• A circular depression at the site where the optic nerve leaves the eye
• Lacks photoreceptors; it is insensitive to light thus called the blind spot

39
 Photoreceptors
• Rods:
– Respond to dim light
• Cones:
– Respond to bright light
– Have high-acuity color vision
• Lateral to optic disc at posterior pole is a small oval
yellowish area called macula lutea; at center is depressed
area called fovea centralis (site of maximum acuity of vision)
 Blood Supply to the Retina

• The neural retina receives its blood supply from two sources
– The outer third receives its blood from the choroids
– The inner two-thirds are served by the central artery and
vein (enter eye with optic nerve)
– Small vessels radiate out from the optic disc; can be seen
with an ophthalmoscope
 Retinal Detachment

• May follow a blow to the eye

• Usually results from seepage of fluid between the
neural and pigment cell layers of the retina
• Perhaps days or even weeks after trauma to the eye.
• Patient may complain of flashes of light or specks
floating in front of the eye.
 Inner Chambers and Fluids
• The lens separates the internal eye into anterior and
posterior segments
• Posterior segment
– Filled with a clear gel called vitreous humor (body)
– Vitreous humor is not replaced continuously
– functions
• Transmits light
• Supports the posterior surface of the lens
• Holds the neural retina firmly against the pigmented layer
• Contributes to intraocular pressure
• Anterior Segment
– Composed of two chambers
• Anterior – between the cornea and the iris
• Posterior – between the iris and the lens

44
 Aqueous humor
• A plasma like fluid that fills the anterior segment
• Produced by ciliary processes (capillaries)
• Drains at iridocorneal angle via the canal of Schlemm
• Function
– Produce intraocular pressure
– Provide nutrient and removes wastes for cornea and lens
• Interference with drainage results in an increase in
intraocular pressure (glaucoma) which lead to atrophy of
retina
46
 The Lens
• A biconvex, transparent, flexible, avascular structure
• Allows precise focusing of light onto the retina
• Is composed of epithelium and lens fibers; encapsulated
• Held in position by radially arranged zonular fibers called
suspensory ligament of lens
• Contraction of ciliary muscles relax them and change
curvature of lens
• With age, the lens becomes more compact and dense and
loses its elasticity
• Refractive media of the eye
– Light waves pass through cornea, aqueous humor, lens and vitreous
body

47
 Refractive disorders
• Myopia: Nearsightedness; difficulty seeing distant
objects clearly
• Hyperopia: Farsightedness; difficulty seeing close
objects clearly
• Presbyopia: Progressive loss of ability to accommodate
the lens and clearly focus on close objects
• Astigmatism
– is a condition in which the eye does not focus light evenly
onto the retina, the light-sensitive tissue at the back of the
eye.
– This can cause images to appear blurry and stretched out.
 Muscles of orbit

• There are two groups of muscles within the orbit:

 Extrinsic muscles of eyeball (extra-ocular muscles)
– involved in movements of the eyeball or raising upper
eyelids.
 Intrinsic muscles within the eyeball
– control the shape of the lens and size of the pupil.
 Extraocular muscles- Levator palpebrae superioris
• Elevates upper eye lid
• Origin – roof of orbit
• Insertion – tendon split into superior and inferior lamina
– Superior lamina – insert into skin
– Inferior lamina – contains some smooth muscle fibers (superior
tarsal muscle) which insert into tarsal plate
• Innervation
– Superior fibers – oculomotor nerve
– Superior tarsal muscle – fibers from cervical sympathetic trunk
• Applied anatomy
– CN III palsy – upper eye lid cannot be raised voluntarily
– Cervical sympathetic trunk interruption – superior tarsal muscle is
paralyzed causing drooping of eye lid (ptosis)
50
 Rectus muscles
• 4 recti: superior, inferior, medial and lateral
• Origin – from common tendenous ring surrounding optic canal
and middle part of superior orbital fissure
• Insertion – sclera of eye ball posterior to sclerocorneal junction
 The superior rectus & inferior rectus muscles
• The superior rectus
– originates from the superior part of the common tendinous ring
above the optic canal.
• The inferior rectus
– originates from the inferior part of the common tendinous ring
below the optic canal
 The superior rectus & inferior rectus muscles…

• As these muscles pass forward in the orbit to attach to

the anterior half of the eyeball, they are also directed
laterally
• Because of these orientations:
– Contraction of the superior rectus: elevates, adducts,
and internally rotates the eyeball.
– Contraction of the inferior rectus: depresses, adducts,
and externally rotates the eyeball.
• Innervation:
– The superior &inferior branches of the oculomotor nerve [III]
respectively
 Medial and lateral rectus muscles
• The medial rectus
– originates from the medial part of the common tendinous
ring
– Inserted to the anterior half of the eyeball
– Action- adducts the eyeball
– Nerve - inferior branch of the oculomotor nerve [III]
• The lateral rectus
– originates from the lateral part of the common tendinous ring
– Inserted to the anterior half of the eyeball
– Action - abducts the eyeball
– Nerve - the abducent nerve [VI]
Lateral view
 Oblique muscles
• Superior oblique
– origin – body of sphenoid, superomedial to common ring
– insertion – tendon pass through a fibrous pulley (trochlea) and
pass downwards and backwards and insert into sclera at
posterosuperior aspect
– Action – its contraction directs the pupil down and out
– Nerve -The trochlear nerve [IV]
• Inferior oblique
– Origin – orbital surface of maxilla
– Insertion – pass upwards and backwards and insert
below superior oblique
– Action – its ontraction the pupil up and out
– Nerve - The inferior branch of the oculomotor nerve
56
57
58
Actions of muscles of the eyeball. A. Action of individual muscles (anatomical action).
Movement of eye when testing specific muscle (clinical testing).
Intrinsic Muscles of Eyeball
 Blood vessels of the orbit & eyeball
• Ophthalmic artery
– Branch of internal carotid artery after leaving the cavernous
sinuses; enter the orbit through the optic canal below the optic
nerve; become lateral to the optic nerve; finally positioned above
the nerve
– Branches
• Central artery of the retina – enter optic nerve; at optic disc; divide and
spread on retina
• Ciliary arteries - supply the eye ball; anterior groups enter the eye ball at
the corneoscleral junction ; the posterior groups enter around the optic nerve
• Muscular
• Lacrimal artery – supply lacrimal gland, conjunctiva and eye lid
• Anterior and posterior ethmoidal – for nasal mucosa and sinuses
• Supratrochlear and Supraorbital – supply forehead
• Medial palpebral – eye lid
• Dorsal nasal branches – supply upper nose
63
 Ophthalmic veins
• Superior ophthalmic vein
– Accompany the artery, receive tributaries
– Pass through superior orbital fissure and ends in
cavernous sinus
– communicate with facial vein
• Inferior ophthalmic vein
– Begins on floor of orbit, receive tributaries
– Ends in superior ophthalmic or cavernous sinus
– communicate with pterygoid venous plexus
• central vein of retina
– ends in cavernous sinus or superior ophthalmic vein
 Applied anatomy

• Cavernous sinus communicate with veins of the face

through superior and inferior ophthalmic veins; all are
valve less thus blood flow in either direction which
may result in spread of infection to cavernous sinus
 Nerves of orbit
Optic nerve (CN II)
– nerve of sight
– made up of axons of cells in ganglionic layer of retina
– emerge from eye ball medial to posterior pole
– runs posteromedially and pass through optic canal to cranial cavity
and forms optic chiasma
– entirely enclosed in meningeal sheaths
• Relations:
– apex – recti muscles surround it
– ciliary ganglion between it and lateral rectus
– inferomedially – pierced by central artery and vein
– superiorly – ophthalmic artery, vein and nasociliary nerve

68
 Occulomotor nerve (CN III)
• Course - on the lateral wall of the cavernous sinus and
divide into superior and inferior divisions
• both divisions enter cranial cavity through superior orbital
fissure inside the tendinous ring
• Superior division – supply superior rectus and levator
palpebrae
• Inferior division – supply medial rectus, inferior rectus and
inferior oblique and gives branch to ciliary ganglion
• Send parasympathetic preganglionic fiber to ciliary
ganglion.
• The postganglionic fiber from the ciliary ganglion supply
sphincter pupilae and ciliary muscles
 Ciliary Ganglion
• Parasympathetic ganglion in the course of oculomotor nerve
• Lies at the apex of the orbit between the optic nerve and
lateral rectus muscle
• Roots:
 Motor root
– From nerve to inferior oblique
– Contains parasympathetic preganglionic fiber originate in the mid
brain (Edinger-westphal nuclei) → oculomotor → nerve to inferior
oblique → ciliary ganglion
– Post ganglionic fibers pass through short ciliary nerves and supply
sphincter pupilae and ciliary muscles
 Ciliary Ganglion…

 Sensory root
– from nasociliary nerve
– contains sensory fibers from eye ball
– fibers do not relay in the ganglion
 sympathetic root
– from plexus around the internal carotid artery
– contains postganglionic fibers from superior cervical ganglion
– fibers do not relay, pass in short ciliary nerves to supply blood
vessels and dilator pupilae
• Branches – 8 -10 short ciliary nerves, enter sclera around
optic nerve
• Trochlear nerve (CN IV)
– Course
• lateral wall of the cavernous sinus below CN III
• Enter orbit through superior orbital fissure lateral to the
tendinous ring
• Passes in the orbit superior to the levator palpabrae muscle
medially and supply the superior oblique muscle
• Abducent nerve (CN VI)
– Passes inside the cavernous sinus inferolateral to the internal
carotid artery
– enter the orbit through the superior orbital fissure inside the
tendinous ring
– directs laterally to supply the lateral rectus

75
 Ophthalmic nerve

• The medial and the smallest branch of the CN V

• Purely sensory
• Course: origin from trigeminal ganglion, found on the
lateral wall of cavernous sinus below the trochlear and
oculomotor nerve
• Branches - lacrimal, frontal and nasociliary
• Exit through superior orbital fissure to enter orbital
cavity
 Lacrimal Nerve
• Enter the orbit on the lateral part of superior orbital fissure
outside the tendinous ring
• moves on the lateral part of the orbit above the lateral
rectus muscle
• It passes deep into the lacrimal duct, pierce the orbital
septum to the eye lid
• Distribution - lacrimal gland, lateral conjunctiva and
lateral part of the upper eye lid
• Receive branches from Zygomaticotemporal nerve , a fiber
carrying parasympathetic secretomotor fiber from greater
petrosal nerve to lacrimal glands
• Its own fibers are sensory to the gland
 Frontal nerve
• Enter the orbit through the superior orbital fissure on the
lateral part of the orbital wall, out side the tendinous ring,
medial to the lacrimal nerve
• Course - superior to the levator palpabrae superioris, below
the roof of the orbit. Before reaching the orbital margin,
gives two terminal branches; supratrochlear and
supraorbital.
• Supraorbital nerve – leave to the forehead through
supraorbital foramen/notch, supply skin & conjunctiva of
the middle part of superior eye lid and skin of
anterolateral forehead and scalp to vertex
• Supratrochlear nerve – leave the orbit lateral to trochlea
and supply skin and conjunctiva of the medial part of
superior eye lid & skin of anteromedial part of forehead
 Nasociliary nerve
• Enter orbit through superior orbital fissure in the ring
• Course - above CNII, directs anteromedially, b/n superior oblique and
medial rectus
• Branches
– Sensory root to the ciliary ganglion and supply the eyeball
– 2 or 3 long ciliary nerves - contain sympathetic fibers from superior
cervical ganglion to supply the dilator papillae
– Posterior ethmoidal nerves - passes through the posterior ethmoidal canal
and supply air sinuses in the sphenoid and ethmoid bones
– Anterior ethmoidal nerves - one of the terminal branch of the nasociliary
nerve, enter the cranial cavity through the anterior ethmoidal canal, and
then leaves the cavity through the cribrifom plate of the ethmoid to enter
the nasal cavity
– Internal nasal branch – mucus membrane of the nose
– External nasal branch - leave the nasal cavity b/n the nasal bone and
cartilage, supply the lower ½ of the skin of the nose
– Infratrochlear – 2nd terminal branch, leave the orbit to enter the face
above the medial palpebral ligament; supply medial part of skin and
conjunctiva of both eyelids and skin of the upper ½ of the nose
 Infra orbital nerve
• Continuation of maxillary nerve, enter orbit through inferior
orbital fissure
• Runs on floor of orbit through infraorbital groove and canal
• Emerges on face through infraorbital foramen and divide
into palpebral, nasal and labial branches
• Branches
– Middle superior alveolar nerve – supplies upper premolar
– Anterior superior alveolar nerve – supplies upper incisor and
canine teeth and maxillary sinus
– Terminal branches – supply upper lip, nose and lower eye lid
 Zygomatic nerve
• Origin - maxillary nerve in the infratemporal fossa
• Entry to the orbit - inferior orbital fissure
• Course in the orbit - on the lateral wall of the orbit b/n the
bone and the periosteum
• Branches
– Zygomaticotemporal - leave the orbit through a foramen
having the same name to join the temporal fossa. It sends
fiber to the lacrimal nerve and lacrimal gland in the orbit. It
supplies skin of anterior ½ of the temple and the adjoining
scalp.
– Zygomaticofacial - leave the orbit through zygomaticofacial
foramen to the face; supply the skin of the cheek
 Sympathetic nerve

• Arise from internal carotid plexus

• Enter orbit through nasociliary nerve, plexus around
ophthalmic artery, or directly
Thank you!