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Guy Ben Simon
Gahl Greenberg
Daphna Landau Prat
Editors

Atlas of
Orbital Imaging
Atlas of Orbital Imaging
Guy Ben Simon • Gahl Greenberg •
Daphna Landau Prat
Editors

Atlas of Orbital Imaging

With 1275 Figures and 5 Tables

Editors
Guy Ben Simon Gahl Greenberg
Ophthalmic Plastic and Lacrimal Department of Diagnostic Imaging
Surgery Institute Sheba Medical Center
Department of Ophthalmology Tel Hashomer, Israel
The Goldschleger Eye Institute
Sheba Medical Center
Tel Hashomer, Israel

Daphna Landau Prat

Ophthalmic Plastic and Lacrimal
Surgery Institute
Department of Ophthalmology
The Goldschleger Eye Institute
Sheba Medical Center
Tel Hashomer, Israel

ISBN 978-3-030-62425-5 ISBN 978-3-030-62426-2 (eBook)

ISBN 978-3-030-62427-9 (print and electronic bundle)
https://doi.org/10.1007/978-3-030-62426-2
© Springer Nature Switzerland AG 2022
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to
be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG.
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword 1

Inspired perhaps by my mentor Jack Rootman, I have been studying art. More, I am making my
fellows take drawing classes during their training. The discipline of learning to draw is all about
increasing one’s skill in observation. And careful observation is the heart of learning to interpret
orbital imaging.
As much as looking at a photo of some breathtaking vista, or the mesmerizing photomicro-
graphic patterns of some wonder of nature, I view orbital images with certain sense of artistic
awe. Nature’s art is revealed in the intricate anatomic patterns, fascinating contour changes that
occur with orbital pathology, and nuances of shape and shading that are created with different
imaging techniques.
In this atlas, Professor Ben Simon, Drs. Greenberg, and Landau Prat have put together a
masterful collection of images that will provide an ideal tool for both the beginning student and
the experienced practitioner, to increase their skills of careful observation and pattern recogni-
tion. The more one looks at orbital images, the more one sees. I hope that the readers of this
atlas can appreciate the amount of dedication and effort that the editors and authors have applied
to produce this outstanding product. I am optimistic that it will improve our ability to optimally
understand orbital disease and help our patients. And perhaps the readers will, as well, be better
able to appreciate the intrinsic artistic beauty of orbital imaging.

Sincerely,
Robert Alan Goldberg, M.D. F.A.C.S.
Karen and Frank Dabby Endowed Chair in Ophthalmology
Chief, Orbital and Ophthalmic Plastic Surgery
Stein Eye, David Geffen School of Medicine at UCLA

v
Foreword 2

Orbital disease is uncommon, and, in a relatively small part of the body, there is a very broad
range of pathologies that can occur. This makes the diagnosis and management of orbital
disease challenging. Improvements in imaging over a number of decades have helped the
clinician enormously in establishing a diagnosis or a short list of differential diagnoses.
However, even with this additional information, experience in the interpretation of orbital
images is important, and correlating these images with the clinical presentation is vital in
order to optimally manage each patient with orbital disease.
This atlas fills an important niche by comprehensively documenting the appearances on
orbital imaging (largely computerized tomography (CT) and magnetic resonance imaging
(MRI)) of the broad range of orbital pathologies encountered in clinical practice. Drs Ben
Simon and Landau Prat have assembled a large international group of experienced orbital
specialists to author these chapters. The chapters and their numerous images have been
carefully selected, edited, and described with the aid of specialist radiologist Dr Gahl
Greenberg. The atlas should therefore provide invaluable information to those clinicians
managing patients with orbital disease, especially as the majority of such patients will be first
seen by doctors with limited experience in managing the broad range of diseases affecting the
orbit.
This atlas will be a useful reference tool for all those clinicians managing patients with
orbital disease for many years to come. Drs Ben Simon, Greenberg, and Landau Prat should be
congratulated for putting together such a useful resource.

Alan A. Mcnab
Associate Professor
Consultant, Orbital Plastic and Lacrimal Clinic
Royal Victorian Eye and Ear Hospital
Melbourne, Australia

vii
Foreword 3

The foundation for the management of orbital disorders requires a multidisciplinary approach.
In addition, the approach is based on knowledge of the anatomical territory of the orbit as well
as the diversity of the complex tissues within and surrounding it. Indeed, the orbit is also
affected by many systemic and neurological disorders as well. Clinical practice includes
structural lesions, inflammations, vascular anomalies, benign and malignant neoplasms, both
regional and metastatic, as well as lymphoproliferative disorders. In addition, an orbital
specialist has to interact with colleagues in many related disciplines and collate the clinical
observations, imaging, and pathology to arrive at a diagnosis and treatment plan in the context
of evolving knowledge and techniques.
The authors of this book have focused on the imaging of orbital disorders derived from their
own cases and from outstanding institutions that focus on orbital disorders throughout the
world. The many cases are critically organized with contemporary imaging technology and
cover a wide range of disorders.
I am pleased to be part of this publication along with my colleague, Mr. Bruce Stewart, to
provide our anatomical drawings of the orbit as a foundation for evaluation of disorders
requiring surgery. These images define the territory within and surrounding the orbit. When
paired with modern imaging, they will be useful for planning diagnostic, interventional, and
new surgical approaches.

Jack Rootman MD FRCSC

Professor Emeritus
Ophthalmology and Vision Science
Pathology and Laboratory
University of British Columbia
Vancouver Canada

ix
Preface

Every journey begins with a dream. Ours was clear, figuring out how to decipher orbital
imaging. Throughout the years as orbital surgeons, every case has brought us a little closer to
this goal. Yet, the more you learn, the more you realize that there is an endless amount of
knowledge to acquire. As is so well put by our mentors, orbital imaging is more art than science.
We have been fortunate to know all these great teachers – world experts in oculoplastic and
orbital surgery. Not only have they set a path for excellence in patients care, but also their
kindness and generosity have been irreproachable. Such an atlas could never stand alone based
on the work of one person. It is a collaborative effort of many. We cannot fully express our
gratitude to all authors who have made a tremendous effort in establishing guidelines to orbital
imaging, using their personal experience, know-how, and sharing their knowledge.
We have the honor and privilege to include Jack Rootman’s and Bruce Stewart’s anatomy
illustrations which have become inalienable assets for the ophthalmic literature. This is
somewhat symbolic as they started off with the anatomy atlas and have now merged into the
imaging atlas, constituting a single continuum in oculoplastic database. An irreplaceable tool in
the understanding and teaching this wonderful world of orbital surgery.
The Atlas of Orbital Imaging is a joint venture of ophthalmologists, oculoplastic surgeons,
anatomists, and neuroradiologists, facing the everlasting challenge of combining their clinical
and imaging interpretation skills. It is a known fact that imaging has captured a pivotal role in
both surgical planning and medical management of our patients, necessitating close and
efficient collaborations between physicians, either through daily communications, timely
consultations as well as structured tumor boards and in the form of multidisciplinary meetings.
We hope that the orbital imaging atlas will bring us a small step toward diagnosis and
enhanced patient care.

Tel Hashomer, Israel Guy Ben Simon

October 2021 Gahl Greenberg
Daphna Landau Prat

xi
Contents

Part I Orbital Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 Bones of the Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
2 Vascular Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Daniel B. Rootman, Bruce Stewart, and Jack Rootman
3 Ocular Adnexa, Soft Tissue, and Extraocular Muscles . . . . . . . . . . . . . . 33
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
4 Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
5 Orbital Fissures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
6 Orbital Fissures: Inferior Orbital Fissure . . . . . . . . . . . . . . . . . . . . . . . . 69
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
7 Orbital Fissures: Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . 75
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
8 Orbital Fissures: Infratemporal Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom
9 Cavernous Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom

xiii
xiv Contents

10 Meckel’s Cave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran,
Ben Kaplan, and Assaf Marom

Part II Orbital Imaging Modalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

11 Orbital CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Denise S. Kim, Remy R. Lobo, and Alon Kahana
12 Orbital MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Arnaldo Mayer and Gahl Greenberg
13 Orbital CTA/CTV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Denise S. Kim, Remy R. Lobo, and Alon Kahana
14 Orbital MRA/MRV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Denise S. Kim, Remy R. Lobo, and Alon Kahana
15 Intraoperative Dynamic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Denise S. Kim, Remy R. Lobo, Neeraj Chaudhary, and Alon Kahana
16 Ultrasound of Orbit Tumors and Tumorlike Lesions . . . . . . . . . . . . . . . 127
Bernadete Ayres and Alon Kahana
17 Orbital Ultrasound with Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Stefania B. Diniz and Robert A. Goldberg
18 Orbital Positron Emission Tomography/Computed Tomography
(PET/CT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
J. Matthew Debnam and Bita Esmaeli
19 Orbital Imaging Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Gahl Greenberg, Daphna Landau Prat, and Guy Ben Simon

Part III Congenital Malformations/Anomalies . . . . . . . . . . . . . . . . . . . . . . 189

20 Craniofacial Dystosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

William R. Katowitz
21 Neurofibromatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
William R. Katowitz
22 Anophthalmia and Microphthalmia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
William R. Katowitz
23 Cystic Lesions of the Orbit: Dermoid and Epidermoid Cysts . . . . . . . . . 215
William R. Katowitz
24 Cystic Lesions of the Orbit: Teratomas . . . . . . . . . . . . . . . . . . . . . . . . . 221
William R. Katowitz
25 Other Cystic Lesions of the Orbit: Encephalocele . . . . . . . . . . . . . . . . . . 225
William R. Katowitz
26 Congenital Lacrimal Pathologies: Dacryocystocele . . . . . . . . . . . . . . . . . 233
William R. Katowitz
27 Pediatric Orbital Vascular Tumors: Infantile Hemangioma . . . . . . . . . . 239
William R. Katowitz
Contents xv

Part IV Lacrimal Gland Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

28 Lacrimal Gland Prolapse and Dacryops . . . . . . . . . . . . . . . . . . . . . . . . . 249

Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
29 Pleomorphic Adenoma of the Lacrimal Gland . . . . . . . . . . . . . . . . . . . . 253
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
30 Recurrent Pleomorphic Adenoma of the Lacrimal Gland
(RLGPA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
31 Lacrimal Gland Carcinoma: Primary . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
32 Carcinoma Ex-Pleomorphic Adenoma of the Lacrimal
Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
33 Benign (Reactive) Lymphoid Hyperplasia and Lymphoma . . . . . . . . . . . 271
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli

Part V Lacrimal Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

34 Normal Anatomy of the Lacrimal System . . . . . . . . . . . . . . . . . . . . . . . 279

Swati Singh and Mohammad Javed Ali
35 Imaging in Lacrimal Drainage Obstruction and Acute
Dacryocystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Swati Singh and Mohammad Javed Ali
36 Lacrimal Sac Tumors Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Swati Singh and Mohammad Javed Ali

Part VI Primary Orbital Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

37 Orbital Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Jaskirat Aujla, Valerie Juniat, Sandy Patel, and Dinesh Selva
38 Orbital Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Jaskirat Aujla, Valerie Juniat, Sandy Patel, and Dinesh Selva
39 Orbital Soft Tissues Sarcomas/Liposarcoma . . . . . . . . . . . . . . . . . . . . . . 313
Jaskirat Aujla, Valerie Juniat, Sandy Patel, and Dinesh Selva
40 Orbital Rhabdomyosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Ran Ben Cnaan, Dana Niry, and Igal Leibovitch
41 Orbital Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Ran Ben Cnaan, Dana Niry, and Igal Leibovitch
42 Solitary Fibrous Tumor of the Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Ran Ben Cnaan, Justin N. Karlin, Dana Niry, Igal Leibovitch, and
Robert A. Goldberg
43 Granulomatous Orbital Inflammation: Orbital Langerhans Cell
Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Alan A. McNab
xvi Contents

Part VII Eye and Ocular Adnexa Tumors with Orbital Extension . . . . . . . 347

44 Periocular Basal Cell Carcinoma (BCC) . . . . . . . . . . . . . . . . . . . . . . . . 349

Alon Tiosano, Natalia Michaeli, and Iftach Yassur
45 Periocular Squamous Cell Carcinoma (SCC) . . . . . . . . . . . . . . . . . . . . . 353
Alon Tiosano, Natalia Michaeli, and Iftach Yassur
46 Periocular Sebaceous Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Alon Tiosano, Natalia Michaeli, and Iftach Yassur
47 Ocular Surface Squamous Neoplasia with Orbital Extension . . . . . . . . . 365
Swathi Kaliki and Ido Didi Fabian
48 Uveal Melanoma with Extraocular Spread . . . . . . . . . . . . . . . . . . . . . . . 369
Andrew W. Stacey, Mahmud Mossa-Basha, and Ido Didi Fabian
49 Retinoblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Vikas Khetan, Pim de Graaf, Devjyoti Tripathy, and Ido Didi Fabian
50 Metastatic Orbital Lesions: Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . 385
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
51 Metastatic Orbital Lesions: Lung Cancer, Prostate Cancer, and
Renal Cell Carcinoma (RCC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
52 Metastatic Orbital Lesions: Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
53 Orbital Extension of Tumors from the Paranasal Sinuses:
Squamous Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
54 Differential Diagnosis of Malignant Tumors of the Lacrimal Sac . . . . . . 403
Oded Sagiv, J. Matthew Debnam, and Bita Esmaeli
55 Merkel Cell Carcinoma of Eyelid (MCC) . . . . . . . . . . . . . . . . . . . . . . . . 407
Soltan Khalaila, Rosa Novoa, Benzion Samueli, and Erez Tsumi

Part VIII Osseous and Meninges Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . 415

56 Imaging of Orbital Osteoma and Osteosarcoma . . . . . . . . . . . . . . . . . . . 417

Alexandra Manta, Stefania B. Diniz, and Robert A. Goldberg
57 Ossifying Fibroma and Chondromyxoid Fibroma of the Orbit . . . . . . . . 423
Alexandra Manta, Stefania B. Diniz, and Robert A. Goldberg
58 Fibrous Dysplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Stefania B. Diniz and Robert A. Goldberg
59 Intraosseous Hemangioma and Cholesterol Granuloma of
the Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Liza M. Cohen, Stefania B. Diniz, and Robert A. Goldberg
60 Aneurysmal Bone Cyst and Ewing Sarcoma of the Orbit . . . . . . . . . . . . 439
Stefania B. Diniz, Liza M. Cohen, and Robert A. Goldberg
Contents xvii

61 Meningioma of the Orbit and Orbital Vicinity . . . . . . . . . . . . . . . . . . . . 445

Justin N. Karlin and Robert A. Goldberg

Part IX Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453

62 Optic Nerve Glioma: Pilocytic Astrocytoma . . . . . . . . . . . . . . . . . . . . . . 455

Yoon-Duck Kim
63 Optic Nerve Sheath Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Yoon-Duck Kim
64 Intrinsic and Extrinsic Etiologies of Optic Nerve Damage . . . . . . . . . . . 475
Ofira Zloto, Nina Borissovsky, Judith Luckman, and
Nitza Goldenberg Cohen

Part X Vascular Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489

65 Lymphatic Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491

Kasturi Bhattacharjee, Nirod Medhi, and Shyam Sundar Das Mohapatra
66 Venous Malformations (VM) Distensible/Lymphatico-Venous
Malformations (LVM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Kasturi Bhattacharjee, Shyam Sundar Das Mohapatra, and
Aditi Mehta
67 Orbital Venous Malformations (VM): Nondistensible . . . . . . . . . . . . . . . 507
Kasturi Bhattacharjee, Nirod Medhi, and Shyam Sundar Das Mohapatra
68 Carotid-Cavernous Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Kasturi Bhattacharjee, Nirod Medhi, and Shyam Sundar Das Mohapatra
69 Arteriovenous Malformations of the Orbit . . . . . . . . . . . . . . . . . . . . . . . 521
Kasturi Bhattacharjee and Aditi Mehta
70 Other Rare Vascular Tumors of the Orbit . . . . . . . . . . . . . . . . . . . . . . . 529
Kasturi Bhattacharjee and Vatsalya Venkatraman

Part XI Orbital Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537

71 Idiopathic Orbital Inflammation (IOI) . . . . . . . . . . . . . . . . . . . . . . . . . . 539

Alan A. McNab
72 Orbital Myositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Alan A. McNab
73 Dacryoadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Alan A. McNab
74 Scleritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Alan A. McNab
75 Orbital Manifestations of Granulomatosis with Polyangiitis . . . . . . . . . . 561
Alan A. McNab
76 IgG-4 Related Orbital Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567
Alan A. McNab
xviii Contents

77 Granulomatous Orbital Inflammation: Orbital Sarcoidosis . . . . . . . . . . 573

Alan A. McNab
78 Xanthogranulomatous Disease of the Orbit . . . . . . . . . . . . . . . . . . . . . . 577
Alan A. McNab
79 Thyroid Eye Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Kelsey A. Roelofs and Ezekiel Weis

Part XII Orbital Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589

80 Pre-septal Orbital Cellulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591

Kelsey A. Roelofs and Ezekiel Weis
81 Orbital Cellulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599
Kelsey A. Roelofs and Ezekiel Weis
82 Mucocele with Orbital Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605
Kelsey A. Roelofs and Ezekiel Weis
83 Subperiosteal Orbital Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Kelsey A. Roelofs and Ezekiel Weis
84 Aspergillosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615
Kelsey A. Roelofs, Erin D. Wright, and Ezekiel Weis
85 Mucormycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
Kelsey A. Roelofs and Ezekiel Weis
86 Orbital Hydatid Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Milind N. Naik and Dilip K. Mishra
87 Orbital Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633
Jaee M. Naik and Milind N. Naik
88 Granulomatous Orbital Inflammation: Orbital Tuberculosis (TB) . . . . . 637
Milind N. Naik and Joveeta Joseph

Part XIII Orbital Trauma and Other Inferred Changes . . . . . . . . . . . . . . . 647

89 Orbital Trauma: Orbital Soft Tissue Injuries and Intraorbital

Foreign Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 649
Gangadhara Sundar
90 Orbital Trauma: Orbital and Orbitofacial Fractures . . . . . . . . . . . . . . . 661
Kavya Sundar and Gangadhara Sundar
91 Ocular Trauma and Intrinsic Pathology . . . . . . . . . . . . . . . . . . . . . . . . . 677
Ofira Zloto
92 Nontraumatic Orbital Hemorrhage (NTOH) . . . . . . . . . . . . . . . . . . . . . 683
Daphna Landau Prat, Gahl Greenberg, Alan A. McNab, and
Guy Ben Simon
93 Postoperative Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
Ofira Zloto
Contents xix

94 Periocular Fillers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705

Ayelet Priel, Don Kikkawa, Gahl Greenberg, Dana Niry, and S. Cohen
95 Periocular Fillers–Related Complications: Imaging Features . . . . . . . . . 713
S. Cohen, Dana Niry, and Ayelet Priel
96 Acquired Anophthalmus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Yoav Vardizer, Nina Borissovsky, and Daphna Landau Prat
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
About the Editors

Guy Ben Simon

Ophthalmic Plastic and Lacrimal Surgery Institute
Department of Ophthalmology
The Goldschleger Eye Institute
Sheba Medical Center
Tel Hashomer, Israel

Guy Ben Simon, MD, is Professor of Ophthalmology, Master of

Health Administration and Chairman of the Institute of Orbital,
Ophthalmic Plastic and Lacrimal Surgery at the Sheba Medical
Center, Tel Hashomer, Israel. He has international standing in the
field of oculoplastics and has published over 130 peer-reviewed
scientific papers, also serving as reviewer for leading ophthalmol-
ogy journals. Prof. Ben Simon is a much sought-after speaker at
international conferences. He has also chaired many international
conferences in Israel. Much of his scientific work is in collaboration
with world-renowned researchers. He has been awarded numerous
research grants and prizes for excellence in research. He established
the Oculoplastics Fellowship Training Program at Sheba Medical
Center and has trained many fellows and postdoctorate students.
Prof. Ben Simon served as course instructor in orbital surgery in the
American Academy of Ophthalmology and as a member of the
Ophthalmology News and Education Committee
(O.N.E. network). He was the Chairman of the Israeli Oculoplastic
Society and the Chairman of the Ophthalmology Board Exams
Committee, Israel Medical Association. His main fields of interest
are orbital imaging, vascular malformations, thyroid eye disease,
and orbital anatomy. He regularly participates in and directs volun-
tary missions to many third world countries to perform oculoplastic
surgeries. He is a member of the Talpiot Medical Leadership pro-
gram at the Sheba Medical Center.

xxi
xxii About the Editors

Gahl Greenberg
Department of Diagnostic Imaging
Sheba Medical Center
Tel Hashomer, Israel

Gahl Greenberg is a Senior Staff Neuroradiologist and the current

Head of the Head and Neck Imaging Service at the Department of
Diagnostic Imaging, Sheba Medical Center, Israel. Dr. Greenberg
serves as the primary consultant for the Maxillo-Facial, ENT, and
Ophthalmology units and the chief advisor in multidisciplinary
head and neck tumor boards. He is also the designated Safety
Officer for MRI and a regular instructor in Continuing Medical
Education courses at the Sackler Faculty of Medicine, Tel Aviv
University. Dr. Greenberg is a graduate of the Hebrew University’s
medical school in Jerusalem and completed a two-year Diagnostic
Neuroradiology Fellowship program in Toronto, Canada. His main
fields of interest are craniofacial, orbit and paranasal sinuses oncol-
ogy, temporomandibular joint and odontogenic disorders, and skull
base pathology, and he has co-authored several publications in the
field.

Daphna Landau Prat

Ophthalmic Plastic and Lacrimal Surgery Institute
Department of Ophthalmology
The Goldschleger Eye Institute
Sheba Medical Center
Tel Hashomer, Israel

Daphna Landau Prat is an orbital and oculoplastic surgeon at the

Goldschleger Eye Institute, Sheba Medical Center, Israel, and a
research affiliate at the Division of Ophthalmology, Children’s
Hospital of Philadelphia (CHOP). She has an MD degree from
Tel Aviv University and a BSc in Mathematics with Computer
Science from the Technion – Israel Institute of Technology, and is
a graduate of the Rothschild Scholars Program, the Technion
Program for Excellence. Dr. Landau was trained in oculoplastic
surgery at CHOP. She participated in several humanitarian delega-
tions, performing oculoplastic surgeries. Dr. Landau is a member of
the “Sheba Talpiot Medical Leadership” program for excellence in
medicine and medical research and is leading various academic and
innovative projects.
Contributors

Mohammad Javed Ali Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Insti-
tute, Hyderabad, Telangana, India
Center for Ocular Regeneration, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
Jaskirat Aujla South Australian Institute of Ophthalmology, Adelaide, SA, Australia
Bernadete Ayres Department of Ophthalmology, University of Michigan Medical School,
Ann Arbor, MI, USA
Ran Ben Cnaan Oculoplastic and Orbital Institute, Division of Ophthalmology, Sourasky
Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Guy Ben Simon Ophthalmic Plastic and Lacrimal Surgery Institute, Department of Ophthal-
mology, The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
Kasturi Bhattacharjee Department of Ophthalmic Plastic and Reconstructive Surgery, Sri
Sankaradeva Nethralaya, Guwahati, India
Nina Borissovsky Imaging Department, Bnai-Zion Medical Center, Rappaport Faculty of
Medicine, Technion, Haifa, Israel
Neeraj Chaudhary Department of Radiology, University of Michigan Medical School, Ann
Arbor, MI, USA
Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA
Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
Department of Otorhinolaryngology, University of Michigan Medical School, Ann Arbor, MI,
USA
Liza M. Cohen Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute,
University of California, Los Angeles, CA, USA
S. Cohen Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center,
Zerifin, Israel
Nitza Goldenberg Cohen Krieger Eye Research Laboratory, Bnai-Zion Medical Center,
Haifa, Israel
Department of Ophthalmology, Bnai-Zion Medical Center, Haifa, Israel
Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
J. Matthew Debnam Department of Neuroradiology, The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
Pim de Graaf Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije
Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

xxiii
xxiv Contributors

Stefania B. Diniz Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye
Institutes, University of California, Los Angeles, CA, USA
Ayelet Eran Neuroradiology Unit, Radiology Department, Rambam Healthcare Medical
Center, Haifa, Israel
Department of Anatomy, Rappaport Faculty of Medicine, Technion – Israel Institute of
Technology, Haifa, Israel
Bita Esmaeli Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of
Texas MD Anderson Cancer Center, Houston, TX, USA
Ido Didi Fabian Ocular Oncology Service, The Goldschleger Eye Institute, Sheba Medical
Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
Robert A. Goldberg Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny
Eye Institutes, University of California, Los Angeles, CA, USA
Gahl Greenberg Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer,
Israel
Joveeta Joseph LV Prasad Eye Institute, Hyderabad, India
Valerie Juniat South Australian Institute of Ophthalmology, Adelaide, SA, Australia
Alon Kahana Ophthalmology Department, Oakland University William Beaumont School of
Medicine, Rochester, MI, USA
Attending Surgeon, Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, MI, USA
Swathi Kaliki Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute,
Hyderabad, India
Ben Kaplan Department of Anatomy, Rappaport Faculty of Medicine, Technion – Israel
Institute of Technology, Haifa, Israel
Justin N. Karlin Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute,
University of California, Los Angeles, CA, USA
William R. Katowitz The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Soltan Khalaila Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel
Vikas Khetan Sankara Nethralaya, Chennai, India
Don Kikkawa Division of Oculofacial Plastic and Reconstructive Surgery, Department of
Ophthalmology, University of California San Diego, La Jolla, CA, USA
Denise S. Kim Department of Ophthalmology and Visual Sciences, University of Michigan
Medical School, Ann Arbor, MI, USA
Yoon-Duck Kim Oculoplastic and Orbital Surgery Division, Nune Eye Hospital, Seoul, South
Korea
Daphna Landau Prat Ophthalmic Plastic and Lacrimal Surgery Institute, Department of
Ophthalmology, The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
Igal Leibovitch Oculoplastic and Orbital Institute, Division of Ophthalmology, Sourasky
Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Remy R. Lobo Department of Radiology, University of Michigan Medical School, Ann
Arbor, MI, USA
Judith Luckman Radiology Department, Rabin Medical Center-Beilinson Hospital, Petah
Tikva, Israel
Contributors xxv

Alexandra Manta Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye
Institute, University of California, Los Angeles, CA, USA
Assaf Marom Department of Anatomy, Rappaport Faculty of Medicine, Technion – Israel
Institute of Technology, Haifa, Israel
Arnaldo Mayer PI at the Computational imaging lab (Cilab), Sheba Medical Center, Ramat
Gan, Israel
Alan A. McNab Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital,
Melbourne, VIC, Australia
Nirod Medhi Primus Imaging, Guwahati, India
Aditi Mehta Department of Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva
Nethralaya, Guwahati, India
Natalia Michaeli Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
Dilip K. Mishra LV Prasad Eye Institute, Hyderabad, India
Shyam Sundar Das Mohapatra Sri Sankaradeva Nethralaya, Guwahati, India
Mahmud Mossa-Basha Department of Radiology, University of Washington, Seattle, WA,
USA
Milind N. Naik LV Prasad Eye Institute, Hyderabad, India
Jaee M. Naik St. John’s Medical College, Bangalore, India
Dana Niry Department of Radiology, Sourasky Medical Center, Tel Aviv University, Tel Aviv,
Israel
Rosa Novoa Diagnostic Imaging, Soroka University Medical Center, Beer-Sheva, Israel
Sandy Patel Department of Radiology, Royal Adelaide Hospital, Adelaide, SA, Australia
Ayelet Priel Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Cen-
ter, Ramat-Gan, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Kelsey A. Roelofs Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye
Institutes, University of California, Los Angeles, CA, USA
Daniel B. Rootman Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny
Eye Institutes, University of California, Los Angeles, CA, USA
Jack Rootman University of British Columbia, Vancouver, BC, Canada
Oded Sagiv The Goldschleger Eye Institute, Sheba Medical Center, affiliated to the Sackler
Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
Benzion Samueli Pathology, Soroka University Medical Center, Beer-Sheva, Israel
Dinesh Selva South Australian Institute of Ophthalmology, Adelaide, SA, Australia
Swati Singh Center for Ocular Regeneration, L.V. Prasad Eye Institute, Hyderabad,
Telangana, India
Claire S. Smith Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye
Institutes, University of California, Los Angeles, CA, USA
xxvi Contributors

Andrew W. Stacey Department of Ophthalmology, University of Washington, Seattle, WA,

USA
Bruce Stewart BFA Art Center College of Design, UBC Faculty of Medicine, Kelowna, BC,
Canada
Kavya Sundar Faculty of Dentistry, National University Centre for Oral Health, National
University of Singapore, Singapore, Singapore
Gangadhara Sundar Orbit & Oculofacial Surgery, Department of Ophthalmology, National
University Hospital, National University of Singapore, Singapore, Singapore
Alon Tiosano Department of Ophthalmology, Rabin Medical Center – Beilinson Hospital,
Petach Tikva, Israel
Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
Devjyoti Tripathy Ophthalmic Plastics, Orbit & Ocular Oncology Services, MTC Campus,
LV Prasad Eye Institute, Bhubaneswar, India
Erez Tsumi Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel
Yoav Vardizer Ophthalmology Department, Bnai-Zion Medical Center, Rappaport Faculty of
Medicine, Technion, Haifa, Israel
Vatsalya Venkatraman Sri Sankaradeva Nethralaya, Guwahati, India
Ezekiel Weis Department of Ophthalmology and Visual Sciences, University of Alberta,
Edmonton, AB, Canada
Department of Surgery, University of Calgary, Calgary, AB, Canada
Erin D. Wright Department of Surgery, University of Alberta, Edmonton, AB, Canada
Iftach Yassur Department of Ophthalmology, Rabin Medical Center – Beilinson Hospital,
Petach Tikva, Israel
Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
Ofira Zloto Department of Ophthalmology, Créteil, France
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
 Part I
Orbital Anatomy
 Bones of the Orbit
1
Jack Rootman, Daniel B. Rootman, Bruce Stewart, Stefania B. Diniz,
Kelsey A. Roelofs, Liza M. Cohen, Claire S. Smith, Ayelet Eran, Ben Kaplan,
and Assaf Marom

Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Figures with Captions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Abstract nerve; the lacrimal gland and nasolacrimal system; and

The facial skeleton comprises two orbital cavities. Each of
them is an elongated square pyramidal cavity with its base
facing anteriorly as the orbital opening, and its axis is
directed posteromedially towards the orbital apex.
Supported within the orbital cavity by a sizable amount of
adipose tissue, the main orbital constituents are the bulbus
oculi (the eyeball) and the second cranial (optic) nerve; the
extraocular muscles; the third (oculomotor), fourth (troch-
lear), and sixth (abducens) cranial nerves; the ophthalmic
and maxillary divisions of the fifth (trigeminal) cranial
J. Rootman
University of British Columbia, Vancouver, BC, Canada
D. B. Rootman · S. B. Diniz · K. A. Roelofs · C. S. Smith
Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny
Eye Institutes, University of California, Los Angeles, CA, USA
B. Stewart
BFA Art Center College of Design, UBC Faculty of Medicine, Kelowna,
BC, Canada
L. M. Cohen
Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute,
University of California, Los Angeles, CA, USA
A. Eran
Neuroradiology Unit, Radiology Department, Rambam Healthcare
Medical Center, Haifa, Israel
Department of Anatomy, Rappaport Faculty of Medicine, Technion –
Israel Institute of Technology, Haifa, Israel
B. Kaplan · A. Marom (*)
Department of Anatomy, Rappaport Faculty of Medicine, Technion –
Israel Institute of Technology, Haifa, Israel
e-mail: assafma@technion.ac.il
the ciliary (parasympathetic) ganglion.
The bony orbit and ocular adnexa provide globe protec-
tion, allowing normal function and vision. The orbit is
comprised of seven distinct cranial bones. CT is the modal-
ity of choice for orbital bone imaging; however, MRI can
be a valuable adjunct in certain osseous pathologies espe-
cially in determining bone marrow involvement.
Keywords
Orbital bones · Frontal bone · Sphenoid bone · Zygomatic
bone · Lacrimal bone · Maxillary bone · Ethmoidal bone ·
Palatine bone
1 Introduction
Each orbital cavity has a roof and a floor, a medial wall, and a
lateral wall. Several cranial bones contribute to the formation
of these bony boundaries.
The orbital roof is mainly formed by the orbital surface of
the frontal bone, which also serves as the floor for the anterior
cranial fossa. Anteromedially the orbital roof relates to the
frontal sinus, where there is also a trochlear spine where the
trochlea (pulley) of the superior oblique muscle attaches.
Situated anterolaterally is the lacrimal fossa for the lacrimal
gland. Posteriorly there is a short horizontal suture with the
lesser wing of the sphenoid bone, the inferior surface of
which contributes a small portion to the orbital roof. Lastly,
the optic canal is situated posteriorly at the apex, bounded
between the roots of the lesser wing of the sphenoid bone.

© Springer Nature Switzerland AG 2022 3

G. Ben Simon et al. (eds.), Atlas of Orbital Imaging,
https://doi.org/10.1007/978-3-030-62426-2_1
4 J. Rootman et al.
From anterior to posterior, the thin medial wall of the
orbital cavity consists of the frontal process of the maxilla,
the lacrimal bone, and the orbital surface of the ethmoid
labyrinth. The latter forms a vertical suture with the sphenoid
body. The groove for the lacrimal sac (the superior blind
widening of the vertical nasolacrimal duct) is situated
between the frontal process of the maxilla and the lacrimal
bone, and it is bounded anteriorly and posteriorly by the
anterior and posterior lacrimal crests of these bones, respec-
tively. The maxillo-lacrimal suture lies at the floor of this
fossa, and the lacrimal part of the orbicularis oculi muscle
attaches to the posterior lacrimal crest and bridges the groove.
The vertical nasolacrimal canal opens inferiorly into the
inferior nasal meatus. Posterior to the lacrimal groove, most
of the medial orbital wall is mostly formed by the rectangular
orbital surface of the ethmoid bone. Anteriorly, it articulates
with the lacrimal bone; posteriorly, with a small portion of the
sphenoid body that forms the most posterior part of the
medial orbital wall; inferiorly, with the orbital surface of the
maxilla and the triangular orbital surface of the palatine bone;
and superiorly, it articulates with the orbital surface of the
frontal bone at the fronto-ethmoidal suture. Along the latter,
the anterior and posterior ethmoidal foramina are situated.
The orbital floor is formed by the orbital surfaces of the
maxilla (medially) and zygomatic bone (anterolaterally) and
the palatine bone.
The lateral orbital wall is formed posteriorly by the orbital
surface of the sphenoid bone and anteriorly by the orbital
surface of the zygomatic bone, where the openings of the
canals for the zygomaticotemporal (higher) and the
zygomaticofacial (lower) nerves are situated. The lateral
wall and the floor are separated by the inferior orbital fissure,
which connects the orbital cavity with the pterygopalatine
and infratemporal fossae. This fissure is bounded superiorly
by the greater wing of the sphenoid and inferiorly mostly by
the maxilla. Posteriorly, the lateral wall and the roof are
separated by the superior orbital fissure, which is the gap
between the greater and lesser wings of the sphenoid bone.
This fissure, which allows the communication between the
orbital cavity and the middle cranial fossa, is widest medially
and tapers laterally.
The apex of the orbit is situated at the medial end of the
superior orbital fissure, above which is the optic canal. The
optic canal lies between the flat anterior (thin) root and the
posterior (thick) root that connect the lesser wing to the body
of the sphenoid bone.
1 Bones of the Orbit 5

2 Figures with Captions

Fig. 1 Lateral view – drawing (upper) and corresponding 3D CT reconstruction (lower left plain, and lower right with surface rendering) of
constituents of the orbital bony structures and adjacent spaces
6 J. Rootman et al.

Fig. 2 Lateral view of the orbital

cavity, human skull (upper), and
CT bone window sagittal oblique
MPR (lower)

Fig. 3 Anterior-medial view of orbital bony and adjacent skeletal structures, drawing (left) and matching 3D CT reformat (right)
1 Bones of the Orbit 7

Fig. 4 Anterior view of the left orbital cavity – human skull (upper image) with 3D reconstruction (lower image)
8 J. Rootman et al.

Fig. 5 Anterolateral view of the

orbital cavity. The dashed yellow
line indicates the borders of the
missing lacrimal bone; human
skull (upper) with corresponding
3D reformat (lower)
1 Bones of the Orbit 9

Fig. 6 Anterosuperior view of

the orbital cavity, human skull
(upper), and corresponding 3D
reconstruction (lower)
10 J. Rootman et al.

Fig. 7 Superior view of the

orbital rim, human skull (upper),
and 3D reconstruction (lower)
1 Bones of the Orbit 11

Fig. 8 Transview of the globe and optic nerves with the major orbital T2 space (lower right) better demonstrates the entire length of the
dimensions and relationships, drawing (upper) and axial T2W MRI anterior visual pathway
(lower left). Note the relationship of the globe to the infraorbital canal.
12 J. Rootman et al.

Fig. 9 Constituents of the lateral

orbital wall drawing (upper) with
corresponding 3D CT reformat of
a 6-month-old boy (lower). A
pediatric scan was chosen in order
to accentuate the suture lines of
the lateral orbital wall
1 Bones of the Orbit 13

Fig. 10 The lateral wall and floor of the orbit as seen from above the trigone of the sphenoid wing. Drawing (upper) and sequential upper
showing relationships of adjacent spaces (sinuses, temporalis fossa, and to lower 3D axial reformat CT images (lower)
middle cranial fossa) as well as canals and fissures. Note the marrow at
14 J. Rootman et al.

Fig. 11 The infraorbital canal as depicted in coronal and sagittal bone

window CT images
1 Bones of the Orbit 15

Fig. 12 Major relationships of

the optic canal to the sphenoid
sinus and sphenoid bone. Lower
drawing is a view from behind
with a block of bone excised
(level indicated as dotted line) to
demonstrate relationships at the
anterior and posterior ends of the
optic canal and superior orbital
fissure. Corresponding coronal
CT scans are shown below (lower
images)
16 J. Rootman et al.

Fig. 13 Sequential axial CT images of the skull base at the level of the orbital fissures and neural foramina
1 Bones of the Orbit 17

Fig. 14 The infratemporal fossa. Upper image – human skull, note the mandible is disarticulated, with corresponding 3D CT reformat (lower
image, left with mandible, right – mandible disarticulated)
18 J. Rootman et al.

Fig. 15 Inferior view of the

frontal bone. Skull, upper image;
3D CT reconstruction, lower
image

Fig. 16 Anterolateral view of the

ethmoid bone
1 Bones of the Orbit 19

Fig. 17 Inferior view of ethmoid

bone

Fig. 18 Posterolateral view of

maxillae and lacrimal bones
20 J. Rootman et al.

Fig. 19 Orbital roof and related

structures. Left orbit, anterolateral
view, cadaver dissection (upper),
and axial CT bone window
(lower)
1 Bones of the Orbit 21

Fig. 20 Orbital roof and related

structures. Left orbit,
posterolateral view

Fig. 21 Orbital floor and related

structures. Left orbit, inferior view
(horizontal section at the level of
the middle nasal concha)
22 J. Rootman et al.

Fig. 22 Orbital roof and related

structures. Left orbit,
posteromedial view

Fig. 23 Trans-nasal view

(drawing, upper) and coronal
view (CT, lower) of the inferior
medial orbital wall and the
lacrimal drainage apparatus
1 Bones of the Orbit
References
1. Gray H, Standring S, Ellis H, Berkovitz BKB. Gray’s anatomy: the
anatomical basis of clinical practice. 39th ed. Edinburgh/New York:
Elsevier Churchill Livingstone; 2005.
2. Most SP, Mobley SR, Larrabee WF. Anatomy of the eyelids. Facial
Plast Surg Clin North Am. 2005;13:487–92.
3. Sicher H, DuBrul EL. Oral anatomy. 6th ed. Saint Louis: The CV
Mosby; 1975.
4. Kanagalingam S, Miller NR. Horner syndrome: clinical perspec-
tives. Eye Brain. 2015;7:35–46.
5. Meybodi AT, et al. The oculomotor-tentorial triangle. Part 1: micro-
surgical anatomy and techniques to enhance exposure. J Neurosurg.
2019;130:1426–34.
23
6. Malhotra A, et al. Neuroimaging of Meckel’s cave in normal and
disease conditions. Insights Imaging. 2018;9:499–510.
7. Zhuang W, et al. Anatomical study of the extraocular check
ligament system. J Plast Reconstr Aesthet Surg. 2019;72(12):
2017–26.
8. Marom A. A new look at an old canal. Skull Base. 2011;21(1):
53–8.
9. Voirol JR, Vilensky JA. The normal and variant clinical anat-
omy of the sensory supply of the orbit. Clin Anat. 2014;27:
169–75.
10. Wolfram-Gabel R, Kahn JL. Adipose body of the orbit. Clin Anat.
2002;15:186–92.
11. Goh PS, et al. Review of orbital imaging. Eur J Radiol. 2008;66:
387–95.
 Vascular Anatomy
2
Daniel B. Rootman, Bruce Stewart, and Jack Rootman

Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.1 Arterial Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.2 Venous Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2 Figures with Captions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Abstract Keywords
The orbit and ocular adnexa are highly vascularized, Vascular anatomy · Orbital arterial supply · Orbital venous
receiving arterial flow from both the extremal (ECA) and drainage
internal (ICA) carotid circulations. Likewise, the venous
outflow network is extensive, draining to the cavernous
sinus and through the intracerebral circulation, the ptery- 1 Introduction
goid plexus and temporal veins to the external jugular, and
the facial veins to the internal jugular. True shunt vessels 1.1 Arterial Anatomy
likely exist between vascular territories, creating anasto-
motic flow networks on the arterial side and similarly 1.1.1 Internal Carotid Circulation
multiple bridging veins create direct connection between The carotid artery enters the cranial vault via the carotid
venous territories. These anatomic relationships allow for canal. It then travels anteriorly within the cavernous sinus
dynamic changes in regional flow and evolutionarily and loops back to exit the sinus creating an overlapping
emphasize the critical nature of the ocular structures, configuration described as the carotid siphon (Fig. 2). The
demonstrating extensive circulatory redundancy. anterior most vertical component of the carotid forms a
The modalities of choice would include CTA, MRA – vertical indentation within the lateral wall of the sphenoid
either nonenhanced time-of-flight (TOF) scans, or sinus. This vertical indentation meets superiorly near the roof
contrast-enhanced single-phase/multi-phasic scans – of the sphenoid sinus with the inferolateral component of the
and DSA. optic canal creating a triangular space known as the optico-
carotid recess (Fig. 3).
Immediately after emerging from the cavernous sinus, the
ophthalmic artery branches from the ICA. The ophthalmic
D. B. Rootman (*) artery joins the optic nerve inferiorly as it enters the optic
Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny canal and emerges inferolaterally in the orbit (Fig. 4). Some
Eye Institutes, University of California, Los Angeles, CA, USA variation in this configuration can be encountered rarely with
B. Stewart certain individuals demonstrating a separate ophthalmic
BFA Art Center College of Design, UBC Faculty of Medicine, Kelowna, artery canal in the sphenoid and others in which the ophthal-
BC, Canada mic artery is derived from the recurrent meningeal passing
J. Rootman through the superior orbital fissure. In the orbit, the
University of British Columbia, Vancouver, BC, Canada

© Springer Nature Switzerland AG 2022 25

G. Ben Simon et al. (eds.), Atlas of Orbital Imaging,
https://doi.org/10.1007/978-3-030-62426-2_2
26
ophthalmic artery then crosses from lateral to medial over the
optic nerve in 80% of cases and under the nerve in the
remaining (Fig. 5).
The first major branch of the ophthalmic is the central
retinal artery, piercing the optic nerve sheath near the apex,
and passing forward to supply the inner retina. Two or three
long posterior ciliary arteries also branch in the apex, follow-
ing the surface of the optic nerve sheath towards the globe
where a number of short posterior ciliary arteries branch off
to supply the choroid and optic nerve head before eventually
penetrating the sclera and terminating as supply to the ante-
rior ocular structures.
Ophthalmic branching patterns are quite variable after this
point; however, two main trunks form in the posterior orbit.
The lacrimal artery forms the lateral branch and the
nasofrontal artery forms a similar supply to the medial
orbit. Multiple muscular branches are variably derived from
these major trunks and pass forward in pairs to supply each
rectus muscle and terminate in an anastomotic fashion with
the long posterior ciliary arteries in the anterior segment. The
exception is the lateral rectus, which is typically supplied by a
single muscular branch.
The lacrimal artery passes anterolaterally, where an anas-
tomosis is formed with the recurrent branch of the middle
meningeal artery (ECA), passing typically through the supe-
rior orbital fissure. The lacrimal artery supplies two branches
that exit the orbit through foramina in the zygoma: the
zygomaticofacial and zygomaicofrontal arteries, respectively.
The lacrimal artery continues to supply the lacrimal gland
and terminates as the lateral palpebral artery.
The nasofrontal artery passes forward in the superomedial
orbit roughly along the axis of the frontoethmoidal suture.
Before reaching the medial wall, the supraorbital artery
branches off and follows the roof to exit through the supra-
orbital notch or foramen. The (typically) two ethmoidal arter-
ies branch off of the nasofrontal artery, 6 mm and 12 mm
anteriorly to the optic canal classically. There is however
considerable variation in the number and position of these
branches. Both arteries pass through the similarly named
foramina in the medial wall as the nasofrontal artery passes
forward in the orbit to terminate as the supratrochlear, dorsal
nasal, and medial palpebral arteries (Figs. 2 and 6).
1.1.2 External Carotid Circulation
The external carotid supplies the orbit both anteriorly and
posteriorly. Posteriorly, branches of the internal maxillary
artery supply the inferior and lateral orbit. The meningeal
artery branches off the first segment of the maxillary artery
and enters the skull base through the foramen spinosum. A
recurrent branch then typically passes back out of the calvar-
ium through the superior orbital fissure to anastomose with
the lacrimal artery as noted above (Fig. 7).
D. B. Rootman et al.
The infraorbital artery branches off the third segment of
the maxillary artery and passes through the inferior orbital
fissure to join the infraorbital nerve in the infraorbital groove
before passing through the infraorbital canal and foramen and
terminating in the midface.
Anteriorly two main branches of the ECA, the superficial
temporal and the facial arteries, supply the lateral and medial
orbit, respectively. The superficial temporal artery travels
within the superficial temporalis fascia branching posteriorly
and anteriorly approximately 5 cm above the zygomatic arch
as the parietal and frontal branches, respectively. The frontal
branch continues medially and forms ECA-ICA anastomoses
with the supraorbital and supratrochlear arteries.
The facial artery branches off the ECA in the carotid
triangle and travels tortuously through the anterior facial
structures providing a number of branches in the cervical
and facial region. The angular artery is the terminal branch
of the facial artery and travels along the nasolabial fold where
it has a variable course and then passes along the lateral base
of the nose up to the medial orbit. Extensive anastomoses
between the angular artery and the dorsal nasal, medial pal-
pebral, and supratrochlear arteries are found in this region.
1.1.3 Anastomoses
As noted in previous sections there are rich anastomoses
between the ECA and ICA circulation in the periorbital
region. Superiorly, the superficial temporal provides ECA
supply and merges with the supraorbital and supratrochlear
ICA branches medially and the lateral palpebral branches of
the ICA laterally.
Posteriorly, internal maxillary branches of the ECA anas-
tomose with the ICA supply of the lacrimal artery via the
recurrent meningeal, the muscular branches of the ICA sup-
plied ophthalmic artery via the ECA infraorbital artery, and
the ethmoidal branches of the ICA supplied nasofrontal via
the ECA sphenopalatine artery in the nasal cavity.
Anteriorly, the facial artery provides ECA flow through
the angular artery to anastomose with the supratrochlear,
medial palpebral, and dorsal nasal terminal branches of the
ophthalmic artery (ICA). Additionally, anterior ECA to ICA
anastomotic regions can be found in the territory of the
infraorbital artery (ECA) and the inferior medial palpebral
vessels (ICA).
Virtually the entire orbit and ocular adnexa can be sup-
plied by the ECA through these anastomoses. In conditions
such as internal carotid occlusion, flow can be dynamically
directed through the ECA circulation and ocular ischemia is
uncommon. Similarly, contralateral to ipsilateral ICA flow
can be diverted through the circle of Willis in such cases.
These redundancies again underscore the vital nature of the
ocular apparatus and multiple adaptative states that can be
dynamically marshalled in the case of vascular occlusive
pathology, whether pathologic or iatrogenic.
Another random document with
no related content on Scribd:
 Money should never be carried; one’s servant should keep it, save
a few kerans.
In very cold weather it is as well to put on a big pair of coarse
country socks over one’s boots, and to twist a bit of sheepskin, with
the hair on, round the stirrup iron; these precautions keep the feet
warm.
A sun hat or topi is of the first necessity; also thick and strong
loose-fitting gloves (old ones are best) of buckskin.
A change of trousers or breeches, in case of a soaking, should be
kept with the head servant, who should always have matches.
Bryant and May’s are the best, and with three of their matches a
cigar or pipe can be lit in any wind: they sell a tin outer match-box
which is very useful, as one cannot crush the box; this, with one’s
knife, pipe and pocket-handkerchief, should be one’s only personal
load.
Oxford shirts, grey merino socks, and a cardigan of dark colour,
complete the equipment; the last is a sine quâ non.
A Norfolk jacket is best for outer garment. No tight-fitting thing is of
any use.
On arrival tea should be the first thing, the kettle being got under
way at once; then carpets spread, chairs and table brought,
mattresses filled and laid, beds made, and fire lit if cold. Make tea
yourself in your kettle, and make it strong; never let your servants
make it, as they either steal the tea or put it in before the water is
boiling, so that they may get a good cup, and you, of course, get
wash.
A Persian lantern should be taken of tin and linen (this shuts up)
for visiting the stable at night, and another for the cook to use.
Water should always be carried both to quench thirst, and for a
small supply lest at the next stage water be bad or salt.
Smoked goggles are a necessity.
A puggree of white muslin should be used for day marching.
 A big brass cup can be taken in a leather case on the head
servant’s saddle-bow; it acts as cup or basin.
No English lamps should be used, as they always get out of order.
It is wise before starting to see that the cook’s copper utensils are
all tinned inside. A copper sponge-bath and wash-basin are needed.
Plates and dishes all of tinned copper.
A few nails are required to nail up curtains, stop holes, etc.
 APPENDIX D.
RUSSIAN GOODS VERSUS ENGLISH.

The Karūn River Route—The best means of reaching the Commercial

Centres of Persia—Opinions of Experts—Wishes Of Merchants.

Colonel Bateman Champain, R.E., in a paper read before the

Royal Geographical Society, January 15, 1883, after estimating the
population of Persia at six millions, gives among the products of the
country, “grains of all kinds, cotton, tobacco, silk, opium, fruits, dates,
wool, hides, carpets, rugs, and an immense variety of the luxuries
and necessaries of life. There is, on the other hand, a large demand
for cloth, cotton fabrics, sugar, tea, coffee, and all the innumerable
comforts called for by a moderately civilised community.” He then
goes on to state, “that the great proportion of these articles are
imported from or through Russia” and that “it is but too evident that
Russian manufactures are steadily superseding British wares at
Ispahan, and even in the Persian markets south of that centre.”
Colonel Champain then proceeds to notice the various proposed
means for reaching the commercial centres of Persia; and after
pointing out their disadvantages, draws the attention of the Society
to the proposed route viâ the Karūn River.
General Sir F. Goldsmid, after corroborating the statements of
Colonel Champain as to the roads, spoke of railways in the future
through Persia, particularly a complete railway between England and
India; said that “failing the project of the great Indian railway, which
could not be carried out for many years, nothing could be better than
the proposed communication, partly by water and partly by road, viâ
Ahwaz to Ispahan and Teheran” (the Karūn River route).
Mr. G. S. Mackenzie, after some prefatory remarks, recounted how
he started from Mohammera (to which place goods may be taken by
ocean steamers), on the 27th July, 1878, in the steamer Karūn of
120 tons, built for Hadji Jabar Khan, Governor of Mohammera, at a
cost of 6000l.; in twenty-three hours Mr. Mackenzie arrived at
Ahwaz, without the steamer either bumping or grounding, and he
ascertained that at the lowest season the river is navigable. At
Ahwaz the river is blocked by rapids for about 1100 yards as the
crow flies, but (a canal or) a tramway of some 1600 yards would
reach the open portion of the river; thence Captain Selby, in the
Indian steamer Assyria, succeeded in ascending to within five miles
of Shuster (and also he steamed up the Diz River to within one mile
of Dizful). From Shuster to Ispahan is 266 miles, or twelve ordinary
mule stages.
The time taken by goods in reaching Ispahan from Mohammera by
river is,

Days. hrs.
By steamer to Ahwaz 0 23
By transshipment by (train or) mules 0 4
Thence to Shuster by river, say fifty miles 0 12
By caravan to Ispahan (allowing one day’s detention) 13 0
14 15
The present route is from Bushire to Ispahan (while from
a week’s to a fortnight’s delay at Shiraz is generally 23 0
experienced in getting fresh mules)
Certain difference 8 9
Or probably (on account of delay at Shiraz) 18 0

The land journey (the chief of the Bakhtiaris being favourable, of

which there is no doubt) resolves itself to a journey over an ordinary
Persian mule track, no worse than the old one from Bushire to
Shiraz, while as it passes through a good grazing country, hire would
be cheaper.
After some remarks in praise of Russia from Col. C. E. Stewart,
Mr. Russell Shaw, having a general experience of railways, and
having actually surveyed a proposed line from Baghdad to the
Persian frontier, disposed of the various costly and ideal schemes of
railways for Persia; and suggested the feasibility of reaching Persia
from India.
The President, after a few general remarks, in which he wished
well to large schemes of railway extension through Persia, in the far
distant future, “thought it had been clearly demonstrated that it
was possible, at a very small cost, to get a route into that
part of Persia where alone Englishmen could hope
successfully to compete with Russians.”
The President stated that, “It was clear that if she (Persia) would
offer no obstacles, the route up the Karūn would very soon be made
practicable; and he could not but think that if it were steadily pressed
upon the Persian Government, the desired result would be
obtained.”
He concluded with well-deserved compliments to Colonels
Champain and Smith, and Mr. Mackenzie.
It is a question whether the valuable commercial interests of this
country in Persia receive the attention they deserve. Why do we not
try to imitate Russia in opening the marts of Persia? She has done
so till the word “Russian” has come to mean “anything foreign”! Why
do not we insist on the Karūn River being thrown open to British
enterprise? Russia is a civilising influence, a rough one, perhaps, but
still a civilising influence: and she is civilising the Turkoman.
The export of opium alone in 1881 was 924,000 lbs., which at 16s.
a lb.—an ordinary price—is 739,200l.; and were Persia thrown open
to English enterprise, this sum would have been sent there, not in
specie, but in Manchester manufactured goods, etc.
I have good authority for stating that England is the only country
admitting the produce of Persia duty free; as opium, wool, cotton
(and good cotton), carpets, grain, dates, galls, gums.
Persia gives nothing in the way of facilities in return, for Russian
influence is too strong, and under that influence, or from her own
tortuous policy, she keeps the southern route, viâ the Karūn River,
closed to English enterprise.
 But the principal difficulty that the English merchant has to contend
against, is the difficulty he has as an Englishman to recover debts,
and whether this be impotence or policy on the part of those in
authority, the fact remains, and has necessitated the withdrawal of
important English establishments from Ispahan and Shiraz. The tact
or energy of Her Majesty’s representatives at Teheran and Bushire is
not to be doubted; but Downing Street seems to order a “masterly
inactivity” or “an expectant attitude.” At Teheran we have a Minister
Plenipotentiary and a Vice Consul, with the usual staff of a Legation;
at Tabriz and Bushire, Consuls-General: but at Kermanshah,
Hamadan, Ispahan, Shiraz, Yezd, and Kerman, all great commercial
centres, we have only native agents; these men exercise no
influence, and are held in contempt by natives and Europeans alike,
as powerless. At times, however, the native (or British) agent has
real influence, mostly personal: as in the case of Mirza Hassan Ali
Khan, C.I.E., our late agent at Shiraz. We want English Consuls to
protect us and our trade, say the merchants, and then the opening of
the Karūn River: without these Persia as a mart is closed to English
enterprise, and becomes the monopoly of Russia.
 GLOSSARY OF PERSIAN WORDS,
Having the transliteration of the Oriental scholar Johnson affixed in
parentheses to most words. Where no parentheses occur, the same
way of writing the word as that scholar is employed.

Abba, Abbah (abā).—A long, sleeveless, square-cut cloak,

generally of camel-hair—much worn by priests.
Ab-i-Rūkhni (ābi rukni).—The Spring of Rukhni (Rooknabad,
Moore).
Ab Khori (āb khūrī).—A watering bit.
Achōn (ākhūn).—A schoolmaster.
Agha, Aga (āghā).—A lord, a master.
Ahū (āhū).—An antelope.
Aid-i-no rūz (aidi naw roz).—New Year’s Day.
Alangū.—A bangle (of glass).
Aleph, Alef (alaf).—A grain, grass, or forage-seller.
Alhamdulillah (al hamdu li’llāh).—Thank God. Praise to
God.
Alkalūk, Alkalōok (alkhálik).—An inner quilted tunic.
Alū Balū (ālū bālū).—A cherry.
Alū Bokhara (ālū Bokhara).—A kind of small acid plum.
Amān, Amaun (amān).—Mercy!
Anderūn (andarūn).—The harem. Women’s quarters.
Asp-i-no-zin (aspi naw zīn).—A horse just fit for the saddle.
Badinjon (bādinjān).—The aubergine or brinjal.
Badragha (badraka).—A riding out with a departing guest.
Baggali (baghalī).—Native glass bottles.
Bakkal (bakkāl).—A general dealer.
Bamiah.—The ladies’-finger (a vegetable).
Bala khana (bālā khāna).—An upper room, hence balcony.
Bander (banda).—Literally, a slave. I (by courtesy used).
Bazaar (bāzār).—A collection of shops (the road between
which is usually covered).
Bazaar kabob (bāzār kabāb).—Minced and seasoned meat
toasted.
Bāzārcha buland.—The lofty bazaar.
Bazū-band (bāzū-band).—An armlet (generally containing a
talisman).
Bazzaz.—A shopkeeper.
Belli (balē).—Yes.
Bero (bi-ro).—Go! (Imperative).
Berūni (birūni).—The outer (or men’s) apartments.
Bezun (bi-zan).—Beat! (Imperative).
Bhuta (bota).—Camel-thorn, brushwood.
Bismillah (bismi’llāh).—In the name of God!
Borio (būrīy).—A kind of coarse matting.
Brilliān (biryān).—Minced and spiced meat sold cooked in
the bazaar.
Bulbul (pronounced Bull Bull).—A nightingale.
Būrak.—A small meat pie.
Butcha, Batcha (bacha).—Child! (Mode of addressing
servants, equivalent to the Anglo-Indian, boy!)
Cafsh-dooz. See Kafsh-dooz.
Cah (See Kah).—Cut straw.
Cajaweh. See Kajaweh.
Calaat. See Kalaat.
Calam-i-Rumi. See Kalam-i-Rumi.
Canaāt. See Kanaat.
Canjar. See Kanjar.
Caravanserai. See Karavanserai.
Chadūr (chādar).—An outer woman’s veil.
Chai (chā).—Tea (used throughout Russia and the East).
Chargāt (chargāt).—A square headkerchief.
Chehel sitoon (chihal-sitūn).—“The Forty Columns.”
Chekmeh-dooz (Chakmah dūz).—A boot-maker.
Chenar (chanār).—A plane-tree.
Cherragh (charāgh).—A lamp (in form and principle that of
the early classic one).
Chick (chīgh).—A fly blind.
Chillaw (chulāw).—Plain boiled rice.
Chocolah (chaghāla).—Green fruit when very small.
Chuppao (chāpū).—A raid on horseback.
Chupper (chār pā).—A mounted post (a quadruped), posting.
Chupperkhana (chār pā khāna).—A posting-house.
Colah. See Kolah.
Coorjin. See Koorjīn.
Coorshid. See Kūrshid.
Cossib. See Kossib.
Danah (dahanah).—A curb-ring bit.
Dar (dār).—A gallows, the execution pole.
Delak (dallāk).—A barber, a bath attendant.
Delleh.—A kind of weasel (? Mustela sarmatica).
Deyeereh (dayyīrah).—A tambourine.
Dilgoosha (dil-ku-shāy).—“Heartsease,” name of a garden at
Shiraz.
Dolma (dūlmah).—A kind of sweet or flavoured pudding of
rice or meat.
Doogh (dogh).—Buttermilk, curds and water.
Dozd (duzd).—A thief.
Dozd gah (duzd-gāh).—A place of thieves.
Dubbeh (dabbah).—A repented and repudiated bargain.
Dyah (dāya).—A wet nurse.
Fal (fāl).—A lot, an omen (sortes), pronounced fahl.
Farnoose (fānūs).—A cylindrical lantern.
Farrash, Ferash (farāsh).—A carpet-spreader.
Farrash (ferash)-Bashi.—Lit. chief carpet-spreader.
Farsakh.—A distance of from three and a half to four miles,
the hour’s march of a loaded mule, the parasang of
Xenophon.
Farsh.—A carpet of any kind.
Fellak, Fellek (fallak).—A pole having a noose attached to
hold the feet for the application of “the sticks” (or
bastinado).
Feramoosh-khana (farāmush khana).—The (lit.) house of
forgetfulness, a masonic lodge.
Fizinjan (fizinjān).—A dish flavoured with condensed
pomegranate juice and pounded walnuts.
Furder Insh’allah (fardā Insh’allāh).—“Please God to-
morrow.”
Gelas (gelās).—A white-heart cherry.
Gelim (gilīm).—A common kind of carpet.
Germak (garmak).—A small early melon.
Gezanjabine (gazangubīn).—Manna, or nougat.
Gheva (gewa).—A summer shoe described at p. 190.
Gholam (ghulām).—A mounted servant, lit. a slave, an
irregular cavalry-man.
Goja (gaujah).—A small green plum.
Gōmpezah (gōmbeza).—A dome.
Goor Khur (gor khar).—The wild ass.
Gūl (gul).—A flower.
Gūl Anar (guli nār).—Pomegranate flower.
Gūl-i-Soorkh (guli surkh).—The moss rose from which the
attār is made.
Gūmrūk (gumruk).—A custom-house.
Gūmrūkji (gumruk-chi).—A custom-house officer, or farmer
of customs.
Gunge (ganj).—A treasure.
Gungifeh (ganjīfa).—Playing cards.
Hakim (hakīm).—A physician.
Hakim-bashi (hakīm bashi).—The chief physician.
Hammal (hammāl).—A porter.
Hammam (hammām).—A bath similar to the Turkish bath.
Harrh (harr).—Rabid.
Hassin or Hasseen (hasīn).—A pan.
Hassir (hasīr).—A kind of fine matting.
Hauz (hawz).—A tank generally of stone and raised above
the ground-level.
Henna (hinnā).—A vegetable dye used on hair, hands, and
feet.
Hindiwana (hinduwānah).—A water-melon.
Hissam u Sultaneh (Husām us Sultana).—The Sharp Sword
of the State (a title that was given to the late uncle of the
Shah).
Hoojrah (hajrah).—An office, or bureau.
Huc (hak).—A share, the dervishes’ cry.
Hukhm (hukm).—An order.
Imād-u-Dowlet (Imad ud Dawla).—A title, viz. the Pillar of
the State.
Imam (imām).—A saint.
Iran (Īrān).—Persia.
Istikhbal (istikbāl).—A riding out to meet an arriving guest or
personage.
Istikhara (istiharat).—Omens (taking), chances.
Itizad-u-Sultaneh (Itizād us Saltanah).—A title, viz. the
Support of the State.
Jai-sheer (jayshīr).—Wild celery.
Jejim (jājim).—A thin kind of travelling carpet.
Jika (jīgha).—A jewel worn on the head by women. The royal
hat ornament of feathers and diamonds.
Jūl (jall).—A portion of horse-clothing.
Jūniver (jānwār).—A wild animal, an animal.
Kabab or Kabob (kabāb).—A roast or toasted meat.
Kaffir (kāfir).—An infidel (a term of reproach).
Kafsh.—A shoe.
Kafsh-dooz (kafsh-doz).—A shoe- or slipper-maker.
Kafteh-bazi (kaftār).—Pigeon-flying.
Kah (kāh).—Cut straw.
Kah gil (kāh gil).—Clay and straw mixed for plastering.
Kahtam (khātam).—Inlaid work like Tonbridge ware.
Kajaweh (kajāwa).—A covered horse pannier.
Kalaat (khalat).—A robe (or other token) of honour.
Kalam-dan (kalamdān).—A pen-case.
Kalam-i-Rumi (kallami-Rumi).—Lit. Turkish cabbage.
Kali (kālī).—A carpet having a pile.
Kalian, Kallian, Calian (kalyūn, kalyān).—A water-pipe or
hubble-bubble.
Kallehpuz (kallapaz).—Sheep’s head- and trotter-boiler.
Kanaat, Kanat, Canaāt (kanāt).—An underground channel
for irrigating.
Kanara (kanāra).—A side carpet.
Kanjar (khanjar).—A curved dagger.
Karavanserai (karavān-serai).—A public rest-house for
caravans; a khan.
Karbīza (kharbuza).—A melon.
Karkool (kakūl).—A long lock of hair by which Mahommed is
supposed to draw the believer up into paradise.
Kashang.—A beau, lit. beautiful.
Kawam.—A prefect.
Keeal (kayal).—A cucumber.
Keesa, Keeseh (kisa).—A hair glove used in the bath.
Keisi (kayzi ?).—Dried apricots.
Kemmerbund (kamar-band).—A belt, or sash.
Kendil (kindīl).—A votive offering of peculiar shape, generally
of copper or other metal.
Kenneh (? kannah).—A camel- or sheep-tick.
Ketkhoda (kat-khudā).—The head-man of a parish or village.
Khan (Khān).—A conferred title, which descends to all
children—now very common: in the second generation
equal to Esquire.
Khānum (khānam).—A lady.
Khok ber ser um (khāk bar sar-am).—Ashes on my head.
Kholar (? kolar).—A kind of wine of Shiraz.
Khyat (khayyāt).—A tailor.
Kohl.—Black antimony, eye paint.
Kolah (kulah).—A hat.
Kolajah (kulījah).—An outer coat for men or women.
Koompezeh, Kumbiza (kumbīza).—A species of cucumber.
Koorisht (khūrish).—A savoury dish, a ragout.
Koorjin, Coorjin (khwur-chīn).—Saddle-bags.
Kosh guzeran (khwush guzārān).—A free liver.
Kossib, Cossib (kasb).—A craftsman.
Kotol.—An effigy.
Kotul (kutal).—A mountain pass, lit. a ladder.
Kummer, Kammer (kammah).—A straight hiltless sword or
dirk, with a broad blade.
Kūmrah (khumra).—A wine (or other) jar.
Kūrbāghah.—A frog.
Kūrshid (khūrshīd).—The sun with rays of light.
Kūrsi (kūrsī).—A small platform used to cover a fire-pot, a
chair.
Kuttl-i-aum (katli ām).—A general massacre.
Lahaf (lihāf).—A quilted coverlid.
Lallah (lālā).—A male nurse.
Lanjin, Lanjeen.—An earthen pan.
Latifeh (latīfeh ?).—A courtezan, a Persian court card.
Lodah, Lodeh (lawda).—A pannier for grapes.
Lūti (lūtī).—A buffoon, a scamp, a thief.
Machrore (makrūh).—Lit. detestable, but yet not illicit; things
not to be eaten, but yet not unclean; i. e. not an unlawful
thing, but one which had better be avoided.
Maidān (maydān, mīdān).—The public square. A distance
about a furlong.
Makhmūn shud um (makhmūn shudam).—I am deceived.
Mallagh (?).—A tumbler pigeon, a summersault.
Mambar (mimbar).—A pulpit.
Mangal (munkul).—A brazier.
Mash’allah (Māshā’llah).—Lit. What God pleases! A phrase
used when praising, to avoid evil eye.
Mast (māst).—Curdled milk (Turkish, yaourt).
Maund (man).—A Persian weight of nearly seven, or nearly
fourteen pounds.
Meana (miyāna).—The middle. The middle tube of the water-
pipe.
Mehdresseh (medresseh; Arabic, madrasat).—A college.
Mejlis (majlas).—An assembly, a reception.
Mil, Meel (mayl).—A column, a watch-tower.
Mir-achor (mīr-ākhur).—Master of the horse, the.
Mir-shikar (mīr-shikār).—Chief huntsman, the.
Mirza (mīrzā).—One who can write, a clerk, a secretary, a
gentleman. As an affix equals “Prince.”
Moaalim (mwallīm).—A schoolmaster.
Modakel (mudākhil).—Illicit percentage, “cabbage.”
Mohulla (mahallah).—A street, a parish.
Monajem (munajjam).—An astrologer.
Mor (muhr).—A seal, a piece, as at draughts, etc.
Mūlla, Moollah (mūllā).—A priest.
Mūnshi, Moonshee (munshī).—A secretary, a clerk.
Murshed (murshid).—A chief of dervishes, or of a sect or
guild.
Mūschir (mushīr al mulk).[38]—The principal revenue officer
of Fars.
Mūshtahed (Mujtahid).—A teacher of law.
Must (mast).—Lit. drunk. The state of excitement of the
camel, etc.
Mutlub (matlab).—The pith, or meaning (of a letter).
Naib (naīb).—A deputy, a post-house keeper.
Naksh.—A kind of embroidery. See p. 131.
Nammad (namad).—A felt (of various kinds).
Nammak (namak).—Beauty of a brunette, high colour.
Narghil (nārjīl).—A cocoa-nut, a kind of water-pipe.
Nawalla (?).—Balls of flour given to horses and camels.
Nazir (nāzir).—A steward.
Neh (nay).—A reed, a spear, a flute.
Neh-peech (nay-pīch).—The flexible tube of a water-pipe.
Nejis (najīs).—Unclean.
Nober (nawba).—First-fruits.
Noker (nawkar).—A servant.
Nuffus (nafs).—Breath.
Ootoo (atw).—An iron.
Ootoo kesh (atw-kash).—An ironer.
Orūssēe (ūrūsī).—Lit. Russian, i. e. foreign. A Russian (-
shaped), i. e. foreign shoe, a raisable window, a room
having a raisable window, etc.
Paleng (palank).—A panther.
Pallikee (pālkī?).—A mule pannier to ride in.
Pane (pa-in).—Dried horse-dung.
Peilewan, Pehliwan (pahlevān).—A wrestler.
Peish-kesh (pīsh-kash).—An offering to obtain favour (a
nominal present).
Peish Khidmut (pīsh khidmat).—A head table-servant.
Peish-waz (pīsh-wāz).—Lit. a going out to meet.
Perhān, Perahān (pīrahan).—A shirt (for man, woman, or
horse).
Pider-sag (pidar sag).—Son of a dog! (Lit. O dog-fathered
one!)
Pillaw, Pilaw (palāw).—Rice boiled with butter.
Pūlad (pūlād).—Art steel-work. Damascened iron.
Rammal (rammāl).—A conjuring mountebank and finder of
treasure, a diviner. See p. 120.
Rangraz (rang-rez).—A dyer.
Rassianah (rāziyānah).—Anise plant, the.
Reich-i-Baba (rīsh-i-Baba).—A grape called “Old man’s
beard.”
Reis-i-Seem (rais).—Lit. master of the wire, i. e. Telegraph
superintendent.
Resht-i-Behesht (Risht-i-Bihisht ?).—Glory or brightness of
heaven.
Rivend (rīwand).—Rhubarb.
Roseh Khana (rosah-khānah).—A prayer-meeting, etc.
Rubanda (rū-band).—A (face) veil.
Rushwah (rishwat).—Lit. manure, i. e. a bribe.
Ryot (ra-īyat).—A subject, a tiller of the earth, a villager.
Sag.—A dog, a cur, a term of abuse.
Sahib (sāhib).—Lit. owner; Sir, Mr. (to an European).
Sāle ab (sayl ab).—Rise of the waters.
Sandalli (sandalī).—A chair.
Sang.—Lit. a stone, i. e. a weight.
Sangak.—A kind of bread. See p. 334.
Santoor, Santūr (santīr or santūr).—Harmonicon.
Sarhang.—A colonel.
Segah (sīgha).—A concubine.
Ser-andaz (sar-andāz).—That (carpet) laid over the head (of
the room).
Ser-Kashik-ji-bashi (sar-kashīkchi bāshī).—Chief of the
guard.
Seroff (sarrāf).—A banker, a money-changer.
Shah (Shāh).—The King.
Shahzadeh (Shāh-zāda).—Lit. born of a King, i. e. Prince (or
descendant of a Prince or King).
Shargird-chupper (shāgird-chāpār).—A posting guide.
Shatir (shātir).—A running footman.
Shatrunj (shatrang).—Chess.
Shatur.—A wrinkle.
Sheera (shīra).—Condensed grape sugar.
Shemr (Shimar).—The slayer of the martyr Houssein.
Sherbet (sharbat).—Syrup—generally fruit syrup—syrup and
water.
Sherbet-dar (sharbat-dār).—A servant who makes ices, etc.
Shikari (shikārī).—A huntsman.
Shireh-Khana (? shīra-khāna).—A wine-factory.
Shitūr (shatūr).—A wrinkle (of a carpet, etc.).
Shub-kolah (shab-kulah).—A night-hat (or cap).
Shukker para (shakar-pāra).—A kind of very sweet apricot
(lit. a lump of sugar).
Shul-berf (shal [?] bāf).—Loosely woven.
Shulwar (shalwār).—Trousers, breeches, petticoats.
Shuma (shumā).—You.
Soorki, Sorki (sākī).—(Classical) a cupbearer.
Sufrah.—A sheet of stuff or leather spread on ground to dine
off.
Sungak. See Sangak.
Syud, Seyd (sayyid).—A descendant of Mahommed.
Tager (tājir).—A merchant.
Takhja (tākchah).—A recess in the wall a yard from the
ground, a niche.
Takht.—A throne, a bedstead, a sofa, a platform.
Takht-i-Nadir (takhti-Nadir).—Backgammon. (Nādir Shah’s
favourite game.)
Takht-i-Pul.—A kind of backgammon.
Takht-rowan (takhti-ravanda).—Lit. a flowing or running bed,
i. e. a horse-litter.
Talár (tālār).—A lofty verandah, an arched room open at one
end.
Tamasha (tamāsha).—A show, a sight, a spectacle.
Tannoor, Tannūr, Tandoor (tannūr).—An oven.
Tarr (tār).—A guitar-like banjo.
Tatar (Turkish).—A gholam, a post rider, a courier.
Tazzia (Ta-ziyah).—The religious dramas or miracle plays.
Tazzie (tāzi).—A greyhound.
Teleet (? talīt).—A mixture of grass and cut straw for horse
feed.
Telism (tilism).—A talisman.
Teriak (tiryak).—Opium.
Teriakdan (tiryak-dan).—An opium pill-box.
Teriakmali (tiryak-māli).—Rubbing (i. e. preparation of)
opium.
Terkesh-dooz (tarkash-doz).—A quiver-maker, a saddler.
Toman, Tomaun (tomān).—Ten kerans (7s. 6d.), a gold coin.
Toolah (tūla).—A sporting dog.
Toorbesah, Toorbiza (turbuza).—A radish.
Tootoon (tūtan).—Tobacco for the chibouque.
Tūmbak (tumbak).—A kind of drum.