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Dr.

Azza Zaki
Dr. Azza Zaki
It is pyramidal in shape, having a base, an apex & 4 walls.
Base: has 4 margins.
Apex: Optic canal.
4 Walls:
Roof
1- Orbital plate of frontal b. 2-Lesser wing of sphenoid
b.

Floor
1- Orbital surface of maxilla 2-Zygomatic bone
Orbital process of palatine b.

Medial wall
1- Lacrimal bone 2-Orbital plate of ethmoid b.Body of
sphenoid b.

Lateralwall
1- Zygomatic b. 2-Greater wing
Dr. Azza Zaki of sphenoid b
The orbital cavity communicates with the:
 Anterior cranial fossa via ant. and post. ethmoidal
foramina
 Middle cranial fossa via optic canal and the superior
orbital fissure
 Infratemporal fossa via inferior orbital fissure
 Nasal cavity via nasolacrimal canal
At the meeting of the medial wall &the roof, there are:
 Optic canal (optic nerve, ophthalmic artery & meninges)
 Posterior ethmoidal foramen
 Anterior ethmoidal foramen
 There are 2 fissures related to lateral wall:
 Superior orbital fissure (between lesser & greater wing of
sphenoid, pass through it: lacrimal, frontal, trochlear, superior
division of oculomotor, nasociliary, inferior division of
oculomotor , abducent nerves & ophthalmic veins)
 Inferior orbital fissure (between greater wing of sphenoid and
maxilla, passes through it: infra-orbital artery, maxillary nerve
, zygomatic nerve & emissary vein between inf. ophthalmic v.
& pterygoid plexus of veins.
Dr. Azza Zaki
 The eyeball.
 The extra-ocular
m.
 Vessels:
 Ophthalmic
artery &veins.
 Nerves:
 Sensory:
 optic , Ophthalmic
& its branches(
lacrimal,frontal &
nasociliary)
and zygomatic
 Motor: 3,4,6
 Ciliary ganglion
 Lacrimal
apparatus
 Orbital fat Dr. Azza Zaki
There are 4 recti ,2
obloquies & the levator
palpebrae superioris.
1-Levator palpebrae
superioris
2- Superior rectus 1 6
3- Inferior rectus 2
4-Lateral rectus 5
4
5-Medial rectus
3
6- Superior oblique 7
7-Inferior oblique
Intra-ocular:
 Dilator pupillae
 Constrictor pupillae
 Ciliary muscle
Dr. Azza Zaki
Origin:
roof of the orbit in front of the
optic canal
Insertion :
superficial lamella: front of
superior tarsus & skin of upper
eyelid &deep lamella: upper
border of superior tarsus &
superior fornix of conjunctiva
Action:
elevation of upper eyelid and
sup. fornix of conjunctiva
Nerve supply:
sup division of oculomotor n.&
smooth muscle by sympathetic
fibers from ( SCSG). Dr. Azza Zaki
Recti Muscles
Origin:
common tendinous
ring, according to
their position (the
lateral rectus m.
arises by 2 heads)
Insertion:
into the sclera, 6mm
from the limbus
(corneo-scleral
junction)
Dr. Azza Zaki
Superior Rectus
 Action:
 Elevation , adduction

& intortion of eye.


 Nerve supply:

 Superior division of

oculomotor.

Dr. Azza Zaki


Inferior Rectus

Action:
depress, adduct &
extort the eye
Nerve supply: inferior
division of oculomotor
nerve.
Lateral rectus :
Abduct the eye &
supplied by abducent
nerve
Medial rectus:
Adduct the eye &
supplied by inferior
division of oculomotor
Dr. Azza Zaki
Superior Oblique
 origin:
 Body of the sphenoid
 Insertion:
 its tendon passes
through the trochlea,
inserted into the sclera
behind the equator of
eyeball
 Action:
 directs the cornea
downwards and laterally
(depression. abduction
and intortion)
 Nerve Supply:

Trochlear n.
Dr. Azza Zaki
Inferior Oblique
Origin:
anterior part of the floor of the
orbit
Insertion: runs laterally and
upwards, inserted into the sclera
behind the equator of the eyeball
Action:
directs the cornea upwards and
laterally (depress, abduct & extort
the eye).
Nerve Supply:
inferior division of oculomotor n.
Dr. Azza Zaki
S
S R
O
M
R

L
R
Dr. Azza Zaki
Action of the extra- ocular

muscles
About the vertical (X) axis the eye moves from
side-to-side
 Temporal displacements =  Abduction
 Nasal displacements =  Adduction
  
 About the horizontal (Y) axis the eye moves
up and down

 Downward displacements:  Depression
 Upward displacements:  Elevation
  
 About the anterior-posterior, or sagittal (Z)
axis the eye rotates

 Temporal rotations of the superior cornea: 
Extorsions Dr. Azza Zaki
The rod going through the The horizontal rod going
cornea represents the visual through the cornea represents
axis. The horizontal rod with the visual axis. The vertical
the arrow represents the rod with the arrow at the top
horizontal axis. As the eye represents the vertical axis. As
turns around the horizontal the eye turns around the
axis, the visual axis sweeps vertical axis, the visual axis
along the vertical plane. sweeps along the horizontal .
Elevation& depression Adduction & abduction
Dr. Azza Zaki
 The third plane of
action are 
Intortion and
extortion refer to
rotation around
the visual axis, as
illustrated below. 
Intortion refers to
a nasal rotation
from the 12 o'clock
position.  Extortion
refers to a
temporal rotation
from the 12 o'clock
position.
 intortion or Dr. Azza Zaki
Anterior
view

Posterior
view

Dr. Azza Zaki


Dr. Azza Zaki
Dr. Azza Zaki
Dr. Azza Zaki
Direct elevation:
Superior rectus &
inferior oblique.
Direct depression:
Inferior rectus &
superior oblique
Abduction or medial
rotation:
Medial rectus, superior
and inferior recti.
Abduction or lateral
rotation:
Lateral rectus, superior
& inferior oblique Dr. Azza Zaki
Actions of Extra-Ocular M. Assuming That Each
one Acting Alone

L M L M

Dr. Azza Zaki


Muscl action action action testing
e position
LR abductio abduction
n
MR adductio adduction
n
SR intortion adducti up and out
elevatio on
IR depressi adducti down and
n
on extortion on out
IO abducti up and in
extortio elevatio on
SO intortion abducti down and
n n
depressi on in
on
Dr. Azza Zaki
Anatomical
Action

Clinical
Testing

Dr. Azza Zaki


 Innervation of the Extraocular Muscles
 Medial, Inferior & Superior Rectus;
Inferior Oblique:   Oculomotor nerve
(III)
 Superior Oblique: Trochlear nerve (IV) 
 N.B.:  tendon of superior oblique
passes through the trochlea
 Lateral Rectus: Abducent nerve (VI) 
 N.B.:  action of lateral rectus is
abduction (abducent)
Dr. Azza Zaki
Dr. Azza Zaki
Intra-Ocular Muscles
 The muscles of the iris:
1- sphincter pupillae: circular in shape and are
arranged around the margin of the pupil.
 Action: constrict the pupil in the presence of
bright light.& during accomodation.
 Nerve supply : parasympathetic

fibers from the oculomotor nerve


(short ciliary branches of ciliary
ganglion.
2- dilator pupillae:
 Radial fibers
 Action:
 Dilate the pupil in the presence

of light of low intensity & excessive


sympathetic stimuli as in fear.
 Nerve supply : sympathetic
Dr. Azza Zaki fibers along long
The Ciliary Muscle
 Action:
 Pulls the ciliary body
forward. Relax the
suspensory ligament
and lens becomes more
convex. This increases
the refractive power of
the lens.
 Nerve supply:
 Parasympathetic fibers
from the oculomotor
after synaping in the
ciluiary ganglion. Dr. Azza Zaki
Ophthalmic artery:
Branches:
 Central a. of the
retina
 Muscular

 Posterior ciliary

 Anterior ciliary

 Lacrimal

 Supratrochlear

 Supraorbital

 Dorsal nasal Dr. Azza Zaki


 It is an end
artery, so
thrombus of it
leads to
blindness.
Branches:
 Sup.&inf. Nasal

 & sup.&inf.
Temporal.

Dr. Azza Zaki


 Superior ophthalmic
vein
 Inferior ophthalmic
vein.
 The 2 veins
communicate with
facial vein anteriorly
 & end posteriorly in
the cavernous sinus.
 The inf. Ophthalmic
vein communicate
with pterygoid
plexus of veins by
emissary vein Dr. Azza Zaki
Sensory :
Optic nerve:
for vision.
Ophthalmic n.:
for general
sensation.
Zygomatic n.
Motor: 3,4,6
nerves
Ciliary ganglion.
Sympathetic
fibers: from
sup. Cervical Dr. Azza Zaki
Dr. Azza Zaki
 Formed of axons of ganglion cells
of the retina & pierces the sclera
medial to the center of the eyeball
 Runs backwards and medially
and leaves the orbital cavity
through the optic canal.
 Ends in the optic chiasma,
medial to the termination of ICA
• The intraorbital part is sinuous,
to allow free movement of the eyeball
Structures crossing optic n.
from lateral to medial:
 Ophthalmic artery
 Nasociliary nerve
 Superior ophthalmic vein

Dr. Azza Zaki


 the opthalmic artery runs below
and lateral to the optic nerve (and
within its meningeal sheath)
 The nerve is pierced by the central
artery and vein of the retina, 12
mm behind the eyeball
 The nerve surrounded by
meninges &subarachnoid space
contains CSF ,
 So rise in CSF pressure will
compress the retinal veins &
cause bulging of the optic disc
(papilledema).
 section of optic nerve leads to
total blindness of one eye.
Dr. Azza Zaki
Branches:
Lacrimal:
Enters the orbit through the sup orbital
fissure (outside the common tendinous
ring)
Runs forwards and lateral, above the
lateral rectus receives a communication
from the zygomatico-temporal nerve
(which carries secretory fibers to the
lacrimal gland)
Supplies the lacrimal gland
Gives palpebral branches to the lateral
part of upper eyelid
Frontal: Runs forwards beneath
the roof, above the levator palpabrae
superioris & has 2 branches:
Supratrochlear &
supraorbital Dr. Azza Zaki
Nasociliary Nerve

Branches:
Communicating branch
to the ciliary ganglion
Long ciliary n. to dilator
pupillae m.
Posterior ethmoidal n.
Infratrochlear n.
Anterior ethmoidal n.

Dr. Azza Zaki


Position:
In the posterior part of the
orbit on the lateral side of
the optic n. Suspended from
the nasociliary n
Roots: 1- parasympathetic:
Preganglionic
parasympathetic via the
nerve of the inf. oblique
(oculomotor) postganglionic
short ciliary nerves supply
sphincter pupillae & ciliary
muscles.
2-Sympathetic:
postganglionic from the
Dr. Azza Zaki
plexus around the int.
 Divides into superior
and inferior divisions
 Both divisions enter
the orbit through the
superior orbital
fissure (inside the
common tendinous
ring)
 The superior division
supplies:
 superior rectus
 levator palpebrae
superioris
 The inferior division
supplies:
 Medial rectus Dr. Azza Zaki
The nerve to inferior oblique carries the parasympathetic
root to the ciliary ganglion
These parasympathetic fibers arise from the Edinger
Westphal nucleus in the midbrain
The postganglionic fibers supply the constrictor pupillae
and the ciliary muscle
In complete paralysis:
The eye cannot be moved downward,
upward or inward.
External ( lateral) strabismus (squint).
 Diplopia .
Drooping of the upper eyelid
(ptosis).
 dilated fixed pupil non reactive
to light.
loss of accomadation.
Dr. Azza Zaki
Trochlear nerve
 Arising from posterior surface of
the lower level mid brain.
 Supply superior oblique muscle.

Dr. Azza Zaki


Abducent Nerve
 Enter the eye inside the common
tendinous ring.
 Supply lateral rectus muscle.
 Responsible for turning the eye
laterally.
 If cut leads to medial squint
(strabismus)

Dr. Azza Zaki


Lacrimal gland
Lacrimal ducts
Conjunctival sac
Lacrimal puncta
Lacrimal
canaliculi
Lacrimal sac
Nasolacrimal
duct:
open into inferior
meatus of the Dr. Azza Zaki
Divided into
orbital &
palpebral
parts by
tendone of
levator
palpebrae
superioris
muscle.
Dr. Azza Zaki
Lacrimal sac:
•It lies in the lacrimal
groove behind the medial
palpebral ligament.
•Its upper end is blind
•Its lower end is
continuous with the
nasolacrimal duct.
Nasolacrimal duct:
It end in the inferior
meatus of the nose.
Dr. Azza Zaki
parasympathetic supply:
Originates from: nucleus lacrimalis of facial nerve in pons
Then along nervus intermedius.
Preganglionic parasympathetic: Greater superficial petrosal
branch of facial nerve
Greater petrosal nerve unit with deep petrosal nerve to form
nerve of pterygoid canal, which relay in pterygopalatine
ganglion then along zygomatic branch of maxillary nerve.
 postganglionic parasympathetic: zygomaticotemporal
branch, then along lacrimal nerve to the gland.
Postganglionic sympathetic via deep petrosal from internal
carotid plexus.
Dr. Azza Zaki
Dr. Azza Zaki
Dr. Azza Zaki
Dr. Azza Zaki
Dr. Azza Zaki
Orbital Fascia

Medial &
lateral
check
ligaments
&
suspensor
y

Dr. Azza Zaki


Dr. Azza Zaki
References
 Gray_s_Anatomy_Student_edition.par
t2.
 Color_Netter_Atlas_of_Human_Anatomy
.
 Snell clinical anatomy for medical
students 7th ed.
 Clinically oriented anatomy 5th ed
Keith Moore

Dr. Azza Zaki

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