Identify the elements of the bony orbit on a skull or x-ray.

Indicate the structures lying superior, inferior, medial and lateral to the
eyeball and the position of the eyeball relative to the bony orbit.

Horizontal CT

Orbit lies:
Lateral to nasal cavity and
paranasal sinuses
Medial to infratemporal fossa

Coronal CT

Orbit lies:
Inferior to cranial cavity
Above maxillary sinus

Eyeball is oriented anteroposteriorly but orbits are angled outward

Trace the flow of blood into and out of the orbit and orbital
structures.
Supratrochlear a.
Supra-orbital a.

Lacrimal gland

Sup. Ophthalmic v.
Inf. Ophthalmic v.

Ant. ethmoidal a.
Cavernous sinus
Post. ethmoidal a.

Lacrimal a.

Facial v.

Ophthalmic a.

Internal carotid a.

Retromandibular v.

Pterygoid plexus

Identify the extra-ocular muscles.

Side view
Levator palpebrae
Superior oblique
Optic nerve

Superior rectus

Lateral rectus (cut)

Inferior oblique
Inferior rectus
Medial rectus
SO

LP
LP

MR

IO

SR

LP

SO

SR

SR
SO

LR
MR
IR

IO

LR

LR

MR

IR
IR

Frontal views

IO

Indicate the nerve supply to each.

Supratrochlear n.

Supra-orbital n.

Lacrimal n.
Infratrochlear n.

Ethmoidal nn.

Lacrimal n.

Frontal n.

V1

VI
Long ciliary nn.
Nasociliary n.

V2

II

Short ciliary nn.

Ciliary ganglion

V3

II

III

Frontal n. (cut)

III

IV VI

IV
VI

Sensory nerves are branches

of the ophthalmic division
of the trigeminal- V
1

Motor nerves are branches of

cranial nerves III, IV, and VI

Contrast the common clinical test for extra-ocular muscle function with
the action of the individual muscles.
SO

LP

Lateral & medial rectus pull eyeball medial &

laterally, respectively

SR

LR

MR

IR

Actions of individual extraocular muscles:

Because of different axis of orbit & eyeball, superior

& inferior rectus muscles pull the eyeball medially as
well as elevate and depress it

IO

Because of their oblique course, the superior &

inferior oblique pull the eyeball laterally as well as
down and up
Pure elevation is produced by the superior rectus &
inferior oblique acting together
Pure depression is produced by IR & SO

Contrast the common clinical test for extra-ocular muscle function with
the action of the individual muscles.

Clinical tests:
The best method to test eye motion is ask
the patient to follow your finger drawing a
large H pattern in the air a few feet from
their face. The two legs of the H will
isolate and test the motion of the
superior/inferior rectus pair and
inferior/superior oblique pair. The center
part of the H will test the medial and
lateral muscles.
Obliques are unique and involve
adduction of globe prior to elevation and
depression

Predict the functional deficit resulting from damage to each nerve.

This patient has a damaged right trochlear nerve (IV). The right superior oblique muscle is
paralyzed. Note that movements to the right are not affected, but movements down and,
especially, down and to the left result in asymmetrical eye movements. The right eye is not
able to move down and in.

There is a very cool web site that allows you to simulate the eye motions expected from
lesions to different cranial nerves and different eye muscles. Check it out at
http://cim.ucdavis.edu/Eyes/Version1/eyesim.htm

Follow the course of autonomic nervous supply to the orbital

structures, indicating the pre- and post-ganglionic
sources of innervation.
To Eyeball:
Preganglionic parasympathetic axons from EdingerWestphal nucleus travel in CN III to ciliary ganglion
After synapsing in ciliary ganglion, postganglionic axons
travel to constrictor of the pupil and ciliary body via
short ciliary nerves

Preganglionic sympathetic axons from T1-T2 enter

sympathetic chain and ascend to the superior cervical
ganglion (SCG)
After synapsing in the SCG, postganglionic axons join
the plexus on the internal carotid artery and enter the
orbit via its ophthalmic branch
In the orbit, these axons travel with the nasociliary
nerve. Some pass through the ciliary ganglion and
enter the eyeball via short ciliary nerves. Others enter
via long ciliary nerves. These innervate the dilator of
the pupil.
Other sympathetic postganglionic axons contribute to
the innervation of the levator palpebrae muscle

Follow the course of autonomic nervous supply to the orbital

structures, indicating the pre- and post-ganglionic
sources of innervation.
Innervation of the lacrimal gland:
Arises from facial nerve
Takes pathway involving several nerves

Greater petrosal n.

N. of pterygoid canal formed from:

parasympathetic preganglionic axons in
greater petrosal n. that will synapse in
pterygopalatine ganglion
Sympathetic postganglionic axons from
SCG cells that will pass through ganglion

Facial n.
Lacrimal n. (V1)

Deep petrosal n.

V2
N. of pterygoid canal

Pterygopalatine ganglion
Pterygopalatine ganglion