THE ORBITAL CAVITY

- quadrilateral pyramid
- apex is directed posterioly , medially , slightly
upward

DIMENSIONS
- volume of orbit = 30 cc in adults
* RIM
horizontally = 40mm
vertically = 35 mm
DEPTH
* medially = 42 mm
* laterally = 50 mm
- 45 degree between lateral and sagital plane
- 23 degree between visual and orbital axis

ORBITAL MARGINeORn lateral wall

* supraorbital margin = frontal bone
* infraorbital margin = laterally ----> zygomatic bone
medially ----> maxilla
* lateral margin = frontal process of zygomatic bone
zygomatic process of frontal bone
* medial margin =
above = maxillary process of frontal bone
below = frontal process of maxilla
CLINICAL

1. infeiror orbital margin

- at junctin of lateral 2/3rd and meidal 1/3 small
depression origin of infeiror oblique
- prone to fracture --> disruption of IO --> diplopia
2. lateral orbital margin
- narrowest and weakest part is the frontozygomatic
suture ---> prone for separation following blunt
trauma
3. lateral orbital margin
- lateral orbital rim is recessed on its deep aspect =
0.75 cm above the rim margin to accomodate the
lacrimal gland ---> prone to fracture

ROOF
- separates it from ant cranial fossa and frontal sinus
BONES
- orbital plate of frontal bone
- lesser wing of sphenoid
LANDMARKS
1. FOSSA FOR THE LACRIMAL GLANDLOCATION:
behind the zygomatic process of the frontal bone
CONTENTS:
lacrimal gland
some orbital fat (accessory fossa of RochonDuvigneaud)

2. TROCHLEAR FOSSA (FOVEA)

LOCATION:
4 mm from the orbital margin
CONTENTS:
insertion of tendinous pulley of Superior Oblique
SURFACE ANATOMY:
Palpable just within the supero-medial angle

3. SUPRAORBITAL NOTCH:
LOCATION:15 mm lateral to the superomedial
angle
TRANSMITS:
Supraorbital nerve
Supraorbital vessels
SURFACE ANATOMY:
At the junction of lateral 2/3rd and medial 1/3rd
About two finger breadth from the medial plane

4. OPTIC FORAMEN:
- leads from middle cranial fossa to apex of orbit

- 8 12 mm
LOCATION:
Lies medial to superior orbital fissure
at the apex

Present in the lesser wing of sphenoid

TRANSMITS:
Optic nerve with its meninges
Ophthalmic artery
CLINICAL
- optic nerve glioma or meningioma may lead
to unilateral enlargement of optic canal
5. cribra orbitalia
- apertures on medial side of ant portion of
lacrimal fossa
- for veins from diploe to the orbit
- best marked in fetus and infant
6. frontosphenoidal suture
- between frontal and lesser wing of sphenoid
- usually obliterated in adults

CLINICAL
** orbital roof anomaly / fracture

CSF pulsation ------> pulsatile exophthalmos

** Laterally- greater wing of sphenoid

Anteriorly- superior orbital margin ---->
So, fractures tend to pass towards medial side --->
At junction of the roof and medial wall, the suture
line lies in proximity to cribriform plate of ethmoid
--->
rupture of dura mater --->
CSF escapes into orbit/nose/both
** Since the roof is perforated neither by major
nerves nor by blood vessels, so it can be easily
nibbled away in transfrontal orbitotomy.

FLOOR
- Shortest orbital wall
- Roughly triangular
BONES
Orbital plate of maxilla (major)
Orbital surface of Zygomatic bone (anterolateral)
Orbital plate of Palatine bone

Bordered laterally by inferior orbital fissure and

medially by maxilloethmoidal suture
Overlies maxillary sinus
LANDMARKS
1. INFERIOR ORBITAL NOTCH
4 mm inferior to the inferior orbital margin
Transmits
Infraorbital nerve
Infraorbital vessels
CLINICAL SIGNIFICANCE
**BLOW OUT FRACTURES:
- Fractures of the orbital floor
- Infraorbital nerves and vessels are almost
invariably involved

LATERAL WALL
Formed by1. Zygomatic bone
2. Greater wing of sphenoid
- Thickest orbital wall
Separates orbit from-

Middle cranial fossa

Temporal fossa
- At an angle of about 90 with each other
LANDMARKS
1.LATERAL ORBITAL TUBERCLE OF WHITNALL:
4-5 mm behind the lateral orbital rim
11 mm inferior to the frontozygomatic suture line
* Gives attachment to:
-

Check ligament of lateral rectus

Lockwoods ligament
Lateral canthal tendon
The aponeurosis of the levator palpebrae superioris
Orbital septum
Lacrimal fascia

2. zygomatic groove
- from ant end of inferior orbital fissure to a foramen
in zygomatic bone
contents
- zygomatic nerve , vessels
CLINICAL

** in resection of maxilla , the whitnall's tubercle is

spared , otherwise
---> damage to lockwood's ligament ---> infeiror
dystopia of eyeball ---> diplopia
**Lateral wall protects only the posterior half of the
eyeball, hence palpation of retrobulbar tumours is
easier.
** Frontal process of zygoma & zygomatic process of
frontal bone protect the globe from lateral traumaknown as facial buttress area.
** Just behind the facial buttress area, is the
zygomaticosphenoid suture, which is the preferred
site for lateral orbitotomy.

MEDIAL WALL
- Thinnest orbital wall
BONES
1. Frontal process of Maxilla
2. Lacrimal bone
3. Orbital plate of Ethmoid
4. Body of the sphenoid
LANDMARKS
1. LACRIMAL FOSSA:
Formed by:

frontal process of maxilla

lacrimal bone
Boundaries:
Anterior- anterior lacrimal crest
Posterior- posterior lacrimal crest
DimensionsLength 14 mm
Depth 5 mm
Continuous below with bony nasolacrimal canal
ContentLacrimal sac
ANTERIOR LACRIMAL CREST*upward continuation of the inferior orbital margin
Ill defined above but well marked below
Surface anatomyPalpable along the medial orbital margin (anteriorly)
POSTERIOR LACRIMAL CREST*downward extension of the superior orbital margin
Surface anatomyPalpable along the medial orbital margin, posterior
to the lacrimal fossa

*significant landmarks in lacrimal sac surgery

FRONTO ETHMOIDAL SUTURE LINE
- Marks the approximate level of ethmoidal sinus
roof
- Breach of this suture may open the frontal sinus, or
the cranial cavity
- Anterior and posterior ethmoidal foramina are
present in the suture line
Anterior ethmoidal foramen
- 20-25 mm posterior from the anterior lacrimal
crest
- Opens in the anterior cranial fossa at the side of
the cribriform plate of ethmoid
Transmitsanterior ethmoidal nerve & vessels
Posterior ethmoidal foramen
- 32-35 mm posterior from anterior lacrimal crest
7 mm anterior to the anterior rim of optic canal
Transmits
posterior ethmoidal nerve & vessels

Webers suture

- Lies anterior to lacrimal fossa

- Also known as sutura longitudinalis imperfecta
- Runs parallel to anterior lacrimal crest
- Branches of infraorbital artery pass through this
groove to supply the nasal mucosa
- Bleeding may occur from these vessels during DCR
surgeries
MEDIAL WALL CLINICAL
** orbital cellulitis
thin wall ---> prone for damage and sinusitis
infection spread across ----> orbital cellulitis
** medial wall is extremely fragile ( presence of
ethmoidal air cells and nasal cavity )

** accidental lateral displacement of medial wall -->

traumatic hypertelorism
*medial wall provides alternate access route to the
orbit through the sinus
** tumors of nasal cavity can breach the lamina
papyracea to involve the orbit
** lacrimal bone can be easily penetrated during
endoscopic DCR

SURGICAL SPACES IN ORBIT

1. sub periosteal space

- Between orbital bones and the periorbita
- Limited anteriorly by strong adhesions of periorbita
to the orbital rim
2. peripheral space
Bounded:
- peripherally by periorbita
- internally by the four recti with their intermuscular
septa
- anteriorly by the septum orbitale
- Posteriorly, it merges with the central space
CONTENTS:
Peripheral orbital fat
* Muscles
Superior oblique
Inferior oblique
Levator palpebrae superioris
* Nerves
Lacrimal
Frontal
Trochlear
Anterior ethmoidal
Posterior ethmoidal

* Veins
Superior ophthalmic
Inferior ophthalmic
* Lacrimal gland
* Lacrimal sac
3. central space
- Also known as muscular cone or retrobulbar space
Bounded:
- Anteriorly by Tenons capsule
- Peripherally by four recti with their intermuscular
septa
- In the posterior part, continuous with the peripheral
orbital space
CONTENTS:
* Central orbital fat
* Nerves
Optic nerve (with its meninges)
Oculomotor
Superior and inferior divisions
Abducent
Nasociliary
Ciliary ganglion
* Vessels
Ophthalmic artery
Superior ophthalmic vein
4. tenon's space
Between the sclera and the Tenons capsule
*Pus collected in this space is drained by incision of

Tenons capsule through the conjunctiva

*Site for drug instillation

ORBITAL CAVITY RELATIONS

* Superiorly Anterior cranial fossa
* Medially - Nasal cavity & Ethmoidal air sinuses
* Inferiorly - Maxillary sinus
* Laterally - Middle cranial fossa & Temporal fossa

SUPERIOR ORBITAL FISSURE

- Also known as Sphenoidal fissure
- Lateral to the optic foramen at the orbital apex
- comma-shaped gap between the roof and the
lateral wall
- Bounded by- Lesser and greater wings of the
sphenoid
- 22 mm long
- Largest communication between the orbit and the
middle cranial fossa
- Its tip lies 30-40 mm from the frontozygomatic
suture
- Lateral superior part of the fissure is narrower than
the medial inferior part.
- At the junction of the two lies spina recti lateralis
LANDMARK
** Annulus of Zinn

- Spans both superior orbital fissure & the optic canal

- Gives origin to the four recti muscle
CLINICAL
** inflammation of the superior orbital fissure and
apex may result in a multitude of isgns including
ophthalmoplegia and venous outflow obstruction
---> TOLOSA HUNT SYNDROME
** fracture at superior orbital fissure --> involvement
of cranial nerves --> diplopia , opthalmoplegia ,
exophthalmos , ptosis
SUPERIOR ORBITAL SYNDROME ( rochon
duvingneaud syndrome )
** Manner of involvement of nerves may be helpful
in predicting the site and extent of the lesion.
Divisions of IIIrd nerve VIth nerve--->Annulus of
Zinn (Purely intraconal lesion)
IIIrd, IVth and VIth nerve---> Entire length of the
fissure involved
INFERIOR ORBITAL FISSURE
- Also known as sphenomaxillary fissure
- Between floor and the lateral wall
Bounded byMedially- Maxilla and orbital process of palatine
Laterally- Greater wing of the sphenoid
Anterior aspect- closed by Zygomatic bone

Transmits- Venous drainage from the inferior part of the orbit

to the pterygoid plexus
- neural branches from the pterygopalatine ganglion
- the zygomatic nerve
- the infraorbital nerve
- Closed in the living by the periorbita & the Mullers
muscle
- Serves as the posterior limit of surgical
subperiosteal dissection along the orbital floor
CONTENTS OF ORBIT
1. eyeball
2. muscles
- 4 recti
- 2 oblique
- LPS
- muller's muscle
3. nerves
- Sensory- branches of Vth Nerve
- Motor- IIIrd, IVth & VIth Nerve
- Autonomic- Nerves to the Lacrimal gland
- Ciliary ganglion
4. vessels
* arteries

Internal carotid system- branches of ophthalmic

artery
External carotid system- a branch of internal
maxillary artery

* VeinsSuperior ophthalmic vein

Inferior ophthalmic vein
* Lymphaticsnone
5. lacrimal gland
6. lacrimal sac
7. orbital fat , reticular tissue and orbital fascia
8. ciliary ganglion