Introduction

Pyramidal cavities with the

apex directed behind at the
optic canal and base
represented by the orbital
margin
Medial walls of both orbits
are parallel and separated by
nasal cavities
Lateral walls meets with
each other at right angle
Provides movements of the
eye ball which occupies the
anterior third of the orbit
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Contents

Eyeball
Muscles of the orbit (extraocular muscles)
Orbital and bulbar fascia
Vessels: ophthalmic artery, superior and inferior
ophthalmic vein
Nerves: optic, oculomotor, trochlear and abducent,
branches of ophthalmic and maxillary nerves
Lacrimal gland
Orbital fat

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Visual and orbital axis

Visual axis: line passing
through the center of
anterior and posterior
poles of the eyeball
Orbital axis: line
passing through the
optic canal and the
center of the base of the
orbit
Visual and orbital axis
make an angle of 20-300
with each other
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Orbital fascia
Also called periorbita
Makes the periosteum of the
bony orbit
Loosely attached with the bone
so that can be easily stripped
Anteriorly: continuous with
the periosteum lining the bones
around the orbital margin
Posteriorly: continuous with
the dural sheath of the optic
nerve
Over the inferior orbital fissure,
there is gap in the periorbita
which is bridged by connective
tissue with some smooth
muscle fibers called orbitalis
muscle
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Contd

Orital fascia forms the

orbital septum: extensions at the
upper and lower orbital margin
attached to the peripheral margin
of the corresponding tarsal plantes
lacrimal fascia: bridges the
lacrimal groove

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Bulbar fascia
Also known as fascia bulbi or
Tenons capsule
Forms a membranous sheath
around the eyeball extending
from optic nerve to the sclerocorneal junction
Separated from the sclera by the
episcleral space within which
the eyeball can freely rotate
Different structures pierce the
fascia:
Cilliary vessels and nerves around
the optic nerve
Tendons of the extraocular muscles

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Contd
Gives numerous extensions
Tubular sheath around each tendon
Medial check ligament: from the
sheath of the medial rectus muscle and
is attached to the lacrimal bone
Lateral check ligament: from the
sheath of the lateral rectus and is
attached to the zygomatic bone

Both check ligaments are connected

below by the Tenons capsule which
become thick and is named
suspensory ligament of eye or
suspensory ligament of Lockhood
Is expanded in middle and blends with
the sheath of the inferior rectus and
inferior oblique muscles

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Extraocular muscles
Are involuntary and voluntary
Involuntary muscles are
Superior tarsal muscle: derived
from the intermediate fibers of the
levator palpabrae superioris and
assists in elevation of upper eye lid
Inferior tarsal muscle: extends
from the sheath of inferior rectus
and inferior oblique muscle to
inferior tarsal plate and possibly
assists in depression of lower eye
lid.
Orbitalis: bridges across the
inferior orbital fissure. Its functin is
unknown

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Voluntary muscles
Four recti:

Superior
Inferior
Medial
lateral

Two oblique
Superior
inferior

Levator palpabrae
superioris
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Recti muscles
Origin: from the common
tendinous ring
Common tendinous ring
encloses the optic canal and
the medial part of superior
orbital fissure

Insertion: into the sclera a

little behind the sclerocorneal junction

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Oblique muscle

Superior oblique
Origin: sphenoid bone superomedial to the common
tendinous ring
Insertion:
1st passes forward
Forms rounded tendon which passes through the
fibro-cartilaginous pulley attached to the
depression of the frontal bone present on the
anteromedial angle of the roof
muscle then changes the direction, passes
backwards, downwards and laterally below the
superior rectus muscle
Inserted into the sclera behind the equator
between superior and lateral rectus

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12

Contd..

Inferior oblique:
Origin: orbital surface of the
maxilla in the floor of the
orbit slightly lateral to the
lacrimal groove
Insertion:
Passes backward, upwards and
laterally below the inferior
rectus and deep to the latearl
rectus
Inserted close to the superior
oblique little below and behind
the latter

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Nerve supply
All voluntary muscles are supplied by
oculomotor nerve (3rd cranial nerve)
except lateral rectus and superior rectus
Lateral rectus by abducent nerve (6th
cranial nerve)
Superior rectus by trochlear nerve (4th
cranial nerve)
LR:6, SO:4
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Action
The movements of the eyeball are
Around the transverse axis: elevation and
depression
Around the vertical axis: adduction and abduction
Around the anteroposterior axis: intortion and
extortion
Intortion: when the upper margin of the cornea (12
oclock position) rotates medially
Extortion: when the upper margin of the pupil rotates
laterally

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Contd
Inf.Oblique

12

Sup.Rectus

Med.Rectus

Lat.Rectus

Sup.Oblique

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Inf.Rectus

16

Contd

Combined movement:
Conjugate movement: when both eyes move
in same direction
Disjugate movement: when both eyes move in
opposite direction
convergence and divergence: when both eye move
in around vertical axis

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Contd

Weakness or paralysis of a muscle causes

squint or strabismus which may be
concomitant or paralytic
Concomitant squint is non-paralytic and
congenital due to imbalance in the action of
opposing muscles. There is no diplopia

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Contd

Inf.Oblique

Med.Rectus

Lat.Rectus

Sup.Oblique

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Sup.Rectus

Inf.Rectus

False image on paralyzed

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Blood vessels of the orbit

Ophthalmic artery:
branch of cerebral part of the
internal carotid artery
Arise when internal carotid artery
emerges through the cavernous
sinus medial to the anterior clinoid
process close to the optic canal
Appears in the orbit through optic
canal, lying inferolateral to the optic
nerve
Both optic nerve and artery lie
within the same dural sheath
Within the orbit, artery pierces the
dural sheath, winds the lateral side
of the optic nerve and passes
forward and medially above the
optic nerve
At the medial angle of eye, the
artery divides into two terminal
branches, the supra-trochlear and
dorsal nasal
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Branches
Central artery of retina:
arise below the optic nerve within the
dural sheath
Runs forward within dural sheath, pierces
the optic nerve behind the eyeball to
enter the substance of the optic nerve
Runs forward within the substance of the
optic nerve and supplies the retina
This artery is an end artery and
obstruction of it leads to total blindness

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Contd.

Lacrimal artery:
arise after the ophthalmic artery
pierces the dural sheath
Runs along the lateral wall of the
orbit
Branches:
To lacrimal gland
Latearl palpebral branch to
supply the eyelid
Two zygomatic branch: which
appears on the face and temple
through zygomaticofacial and
zygomaticotemporal foramen of
the zygomatic bone
Recurrent memingeal artery:
runs backwards to enter the
middle cranial fossa through
superior orbital fissure and
anastomoses with the middle
meningeal arteries
Muscular branch to muscles of
the orbit

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Contd

Other branches arising from the

main trunk
Posterior (long and short) cilliary
arteries: pierce the sclera to supply
the choroid and iris
Anterior cilliary arteries: also
supply the eyeball and are derived
from arteries that supply the
muscles of the orbit
Supratrochlear and supraorbital
arteries: supply the skin of the
forehead
Anterior and posterior ethmoidal
arteries: supply the ethmoidal
sinus, nasal septum and lateral
wall of nasal cavity
Medial palpebral arteries: to eyelid
Dorsal nasal artery: supplies the
upper part of nose and
anastomoses with the facial artery
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Nerves of the orbit

Optic nerve:
runs backwards and medially,
enters the middle cranial fossa
through the optic canal.
within the middle cranial
fossa, optic nerves unite to
form optic chiasma
It is covered by the three
meninges of the brain with
subdural and subarachnoid
spaces.
Therefore, the nerve is likely to
undergo atropy in prolonged
increase of CSF pressure

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Contd

Oculomotor nerve: enters through the

superior orbital fissure and supplies all
the extraocular muscles except
superior oblique and lateral rectus
Trochlear nerve: enters through the
superior orbital fissure and supplies the
superior oblique muscle
Abducent nerve: enters through the
superior orbital fissure and supplies the
lateral rectus muscle

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Contd

Branches of ophthalmic
division of trigeminal
nerve
Lacrimal nerve: smallest
branch
Frontal nerve: largest
branch
Nasocilliary nerve
All these three branches enter
the orbit through superior
orbital fissure

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Contd

Lacrimal nerve:
Runs forwards along the
upper border of lateral
rectus
Receives communications
from the
zygomaticotemporal nerve
Ends in the lateral part of
the upper eyelid
Supplies the
lacrimal gland,
upper eyelid and
conjunctiva

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Contd.

Frontal nerve
Runs forward on the superior
surface of the levator
palpebrae superioris
beneathe the roof of the orbit
At the middle of the orbit, it
divides into
Supratrochlear nerve
Supraorbital nerve

Both division winds around

the supraorbital margin and
Supplies the
conjunctiva,
upper eyelid and
skin of the forehead and
scalp

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Contd.

Nasocilliary nerve
Within the orbit, it crosses
the optic nerve from
lateral to medial side
Runs along the medial wall
of the orbit between the
superior oblique and the
upper border of the medial
rectus
Ends by dividing into
anterior ethmoidal nerve and
infratrochlear nerve

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Contd.

Branches
Communicating branch to ciliary
ganglion
Long ciliary nerve: 2 or 3 number,
pierces the sclera and supply the
cornea, iris and the ciliary body.
it also provide sympathetic fibers to
supply the dilator pupillae

Posterior ethmoidal nerve: to ethmoidal

and sphenoidal sinus
Infratrochlear nerve: to medial part of
the eye and adjacent part of the nose
Anterior ethmoidal nerve:
appears in the anterior cranial fossa
through anterior ethmoidal foramen.
Then enters the nasal cavity aperture
present on the side of crista gali.
It provides branches to the nasal septum
and lateral wall of nasal cavity.
Then appears on the face as external
nasal branch to supply skin of the nose as
far as the tip of the nose
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Ciliary ganglia
Peripheral parasympathetic
ganglia with multipolar neurons
Situated near the apex of the
orbit between optic nerve and
lateral rectus
Topographically connected with
the nasociliary nerve but
functionally with the oculomotor
nerve
It has motor, sensory and
sympathetic roots

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Contd..
Motor root:
from nerve to inferior oblique (branch
of oculomotor nerve)
carry preganglionic fibers from the
Edinger Westphal nucleus and relay
on the ganglion
postganglionic fibers pass through
short ciliary nerve to supply sphincter
pupillae and ciliaris muscle

Sympathetic root: from internal

carotid plexus which carry
postganglionic fibers from the
superior cervical ganglion
The fibers do not interrupt in it and
supply the dilator pupillae

Sensory root: comes from the

nasociliary nerve
It contains sensory fibers from the
eyeball.
The fibers do not relay in the ganglion
Concerned with the pain, temparature
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and touch sensation of eyeball

32

Contd.

Branches: from anterior

margin 8-10 short ciliary
nerves arise which on
reaching the sclera
divides into 15-20
branches
Pierce the sclera around
the optic nerve and
Runs between the sclera
and choroid to supply the
target structures.

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