Orbital Anatomy: By-Dr. Kawshik Nag, Resident, Ophthalmology, Phase-A Chittagong Medical College

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Orbital Anatomy

By- Dr. Kawshik Nag,


Resident,
Ophthalmology, Phase-A
Chittagong Medical College.
Anatomy Of Orbit
 Quadrangular truncated
pyramidal in shape.

 Bounded by-
• Superiorly- Anterior cranial
fossa
• Medially- Nasal cavity and
ethmoidal air sinuses
• Inferiorly- Maxillary sinus
• Laterally- Middle cranial fossa
and Temporal fossa.
Dimensions
 Volume: 30cm3

 Rim: Horizontally- 4cm


Vertically- 3.5cm

 Intra orbital width: 2.5cm

 Extra orbital width: 10cm

 Depth: Medially- 4.2cm


Laterally- 5.0cm

 Ratio of vol. of orbit : vol. of


globe: 4.5:1
Bony Orbit
Seven bones make
up the bony orbit :

 Frontal bone
 Zygomatic Bone
 Maxillary bone
 Ethmoid bone
 Sphenoid bone
 Lacrimal bone
 Palatine bone
Walls Of The Orbit
 The bony orbit has four
walls:

 Medial wall
 Lateral wall
 Roof
 Floor
Medial Orbital Wall
The medial wall is
formed from front to
back by the:

 Frontal process of maxilla


 Lacrimal bone
 Orbital plate of the ethmoid
bone
 Body of the sphenoid bone.
Medial Orbital Wall
Clinical applications:

• It is the thinnest wall of the orbit, so it is frequently fragmented as a


result of indirect blow out fractures and during orbitotomy operations.

• Frequently eroded by chronic inflammatory lesions, neoplasms, cysts.

• Medial wall provide alternate access route to the orbit through sinus.

• Haemorrhage can occur due to trauma to ethmoidal vessels.

• Accidental lateral displacemet of medial wall causes traumatic


hypertelorism.
Lateral Orbital Wall
 Thickest and strongest.

 Formed by two bones:


• Zygomatic
• Greater wing of sphenoid.
Lateral Orbital Wall
Clinical applications:

• The anterior half of globe is not covered by bone on lateral side.


Hence, palpation of retrobulbar tumours is easier from the lateral
side.

• The zygomatico-sphenoid suture is an important landmark in creating


the flap in lateral orbitotomy.

• It is the strongest portion of the orbit and needs to be sawed open in


lateral orbitotomy.

• Since lateral wall is almost devoid of foramina, bleeding is less.


Roof Of Orbit
 Underlies frontal sinus and
anterior cranial fossa.

 Formed by-
• Orbital plate of frontal bone
• Lesser wing of sphenoid.

 Triangular.

 Faces downwards and slightly


forwards.
Roof Of Orbit
Clinical applications:
• Thin and periorbita peels away easily.

• Objects piercing upper eyelid penetrate roof and damage frontal


lobe.

• In old age roof may be absorbed so that periorbital and duramater


comes into contact.

• Any trauma of dura mater and CSF escapes into orbit or nose or
both.
Floor Of Orbit
 Shortest orbital wall.

 Formed by:
• Maxillary bone- medially
• Zygomatic bone- laterally
• Palatine bone- posteriorly.

 Triangular in shape.

 Bordered laterallly by inferior


orbital fissure and medially by
maxilloethmoidal sinus.

 Overlies maxillary sinus.


Floor Of Orbit
Clinical applications:
• Commonly involved in Blow
out fractures of the orbit.
Infra orbital vessels and
nerves almost always
involved.

• Diplopia is the main


symptoms of blow-out
fracture.

• Easily invaded by tumors of


Figure- Mechanism of blow-out fracture
the maxillary antrum. from displacement of the globe itself into
the orbital walls. The globe is displaced
posteriorly, striking the orbital walls and
forcing them outward.
Base Of Orbit
 The anterior open part.
 Bounded by four orbital
margins-
• Superior orbital margin
• Inferior orbital margin
• Medial orbital margin
• Lateral orbital margin.

 It gives attachment to the


septum orbitale.
Apex Of Orbit
 Orbital apex is the posterior
end of the orbit.

 Four orbital walls converge.

 Two orifices:
• Optic Canal
• Superior orbital fissure
Optic Canal
 It connects the orbit to the
middle cranial fossa.

 It transmits:
• Optic Nerve
• Ophthalmic artery.
Superior Orbital Fissure
 Structure passing:
 Upper lateral part:
• Lacrimal and frontal nerves
• Trochlear nerve
• Superior ophthalmic vein
• Recurrent branch of
ophthalmic artery.
 Middle part:
• Superior and inferior divisions
of occulomotor nerve
• Nasociliary branch of
ophthalmic division of
trigeminal nerve.
• Abducent nerve.
 Lower medial part:
• Inferior ophthalmic vein.
Superior Orbital Fissure
Clinical applications:

• Radiographic enlargement of superior orbital fissure may


accompany pathologic processes,
 Aneurysm
 Meningioma
 Choroidoma
 Pituitary adenoma
 tumours of orbital apex.
• When idiopathic inflammation involves the superior orbital fissure,
the “Tolosa Hunt syndrome” which is painful ophthalmoplegia
results.
Periorbita
 Periorbita refers to periosteum
lining the orbitlal surface of the
bones of orbit.
 Loosely adherent to the bones.
 Fixed firmly at-
• Orbital margins
• Suture lines
• Various fissures and foramina
• Lacrimal fossa.
 Applied Anatomy-
• Surgery in the orbital roof in
the areas of fissures and
suture lines may be
complicated by cerebrospinal
fluid leakage.
Orbital Fascia
 It is a complex interwoven thin
connective tissue membrane
joining the various intraorbital
contents.

 Parts-
• Fascia bulbi,
• Muscular sheaths,
• Intermuscular septa,
• Membranous expansions of
the extraocular muscles,
• Ligament of Lockwood.
Extraocular Muscles
 Voluntary Muscles:
• Superior rectus
• Inferior rectus
• Medial rectus
• Lateral rectus
• Superior oblique
• Inferior oblique
• Levator palpebrae superioris.

 Involuntary Muscles:
• Superior tarsal or Muller’s
muscle,
• Inferior tarsal muscle.
Surgical Spaces In Orbit
 Orbit is divided into 4 surgical spaces-
• Subperiosteal space
• Peripheral orbital space/ Extraconal space
• Central orbital space/ Intraconal space
• Subtenon’s space
Surgical Spaces In Orbit
 Importance of these spaces-

• Most of the orbital tumours tends to remain with in a space in which


they are formed unless they are large or malignant or represents an
infiltrative process such as pseudotumour.
Subperiosteal Space
 Lies between orbital bone and
periorbita.

 tumours arising from bone


separates periorbita from
bone.

 Here periorbita acts as a


effective barrier against spread
of tumour to eye.
Subperiosteal Space
 tumours in this space are-
• Dermoids cyst
• Epidermoid cyst
• Mucocele
• Subperiosteal abscess
• Osteomatous tumour
Peripheral Orbital Space
 Known as extraconal space.

 Lies between periorbita at


periphery, extraocular muscles
and their intermuscular septa
internally and orbital septum
anteriorly.

 Posteriorly it merges with


central space.

 tumours in this space are


usually approached by anterior
orbitotomy and sometimes by
lateral orbitotomy.
Peripheral Orbital Space
 tumours in this space produce eccentric proptosis.

 tumours in this space are-


• Malignant Lymphoma
• Capillary haemangioma of childhood
• Intrinsic neoplasm of lacrimal gland
• Pseudotumours.
Central Orbital Space
 Known as muscle cone/ retro-
orbital space/posterior space/
intraconal space.

 Bounded by-
• Anteriorly tenon’s capsule
• Posteriorly by 4 recti and
intermuscular septa.

 In posterior part, space


become continuous with
peripheral space.
Central Orbital Space
 tumours of this space-
• Cavernous haemangioma of adults
• Solitary neurofibroma
• Neurolemoma
• Nodular orbital meningiomas
• Optic nerve glioma.

 Produce axial proptosis.

 tumours are approached through lateral orbitotomy.


Subtenon’s space
 Space around eyeball between
sclera and tenon’s capsule.

 Pus collection in this space is


drained by incision on tenon’s
capsule through conjunctiva.
Contents Of The Orbit
 Eyeball
 Fascia: Orbital and bulbar.
 Muscles: Extraocular.
 Vessels:
• Ophthalmic artery
• Superior and inferior ophthalmic
vein
• Lymphatics.
 Nerves: Optic,Oculomotor,
Trochlear, Abducent, Branches of
ophthalmic nerves and
sympathetic nerves.
 Ciliary ganglion
 Lacrimal gland and lacrimal sac
 Orbital fat.

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