ANATOMY OF THE ORBIT The orbit is a socket that protects & accommodates the eye & ocular appendages

Shape: quadrilateral pyramid (base of pyramid: orbital margin; apex: optic canal foramen) The orbit has 4 walls (lat, med, sup, inf) The orbit is ~40mm in height, 40mm in width & 40mm in depth. Volume of it ~30ml. Walls of orbit Lateral orbital wall Function Separates orbit from temporal fossa Zygomatic process of frontal bone Frontal process of zygomatic bone Greater wing of sphenoid bone Superior orbital wall (Orbital roof) Separates orbit from ant cranial fossa Medial orbital wall Separates orbit from ethmoidal sinus Inferior orbital wall Roof of maxilla sinus

Composition

Orbital plate of frontal wall Lesser wing of sphenoid bone

1Frontal process of maxilla (with ant lacrimal crest) 2Lacrimal bone with post lacrimal crest Orbital plate of ethmoidal bone Body of sphenoid bone (posteriorly) Thinnest wall 1, 2 bound the fossa for lacrimal sac

Orbital surface of maxilla Orbital surface of zygomatic bone Orbital surface of palatine bone

Thickest wall Does not communicate with any sinus

Frontal sinus lies above the sup orbital wall. Fossa for lacrimal gland is situated in lat aspect of this wall. Trochlear fossa on med aspect.

Main orbital fissures & foramens Superior orbital fissure Formed by greater & lesser wings of sphenoid bone Largest communication between orbit & medial cranial fossa 1st division of trigeminal (ophthalmic) III cranial nerve (oculomotor) IV cranial nerve (trochlear) VI cranial nerve (abducens) Sup ophthalmic vein empties into sinus cavernosus in brain

Inferior orbital fissure Connects orbit with infratemporal & pterygopalatine fossa

Optic canal (optic foramen) Is a bony channel in sphenoid bone which passes from middle cranial fossa to apex of orbit Optic nerve Ophthalmic artery

Infraorbital artery Infraorbital nerve Zygomatic nerve Inf ophthalmic vein pterygosphenous plexus

Ocular appendages (adnexa) Orbital fascias Eyelids Conjunctiva Lacrimal apparatus of eye

Extraocular muscles

Orbital fascias

Periorbit Bulbar fascia /

Tenors capsule

Tarso orbital fascia

Retrobulbar fat

It lines inner surface of orbit. Its tightly bound to bone only at orbital margin & around fissures & foramen. It is a dense CT which encloses the entire eyeball except for cornea & posterior segment of eye where optic nerve exits the eye. Anatomically it lies between sclera &bulbar conjunctiva. It connects the orbital margin with the orbital surfaces of tarsal plates (lie frontally) When eyelids are closed, its like the 5th orbital wall which separates orbit from external environment. This wall is mobile. It fills the space behind eyeball. It lies deeply in the orbit.

Eyelids Functions: Eyelids protect eye from injury & excessive light During blinking they distribute tears all over ocular surface There are lateral angle & medial angle (round in form) connection of eyelids. Medial angle is separated from the eyeball by a triangle zone which is named lacrimal lake or lake of tears. 2 structures: 1. Semilunar fold (plica semilunaris) vertical medial fold (remnants of 3rd eyelid of birds) 2. Caruncula lacrimalis red small swelling (cutaneous remnants) They took part in normal tear drainage. Eyelid margins are ~30mm in length & 2mm in thickness. Each eyelid margin has the ant & post ribs which bound the intermarginal space between them. This space contains 2 or 3 rows of eyelashes & excretory ducts of glands. Each eyelid consists of 4 layers:

Skin (external layer) is very think & doesnt have SC fat Muscular layer includes 2 muscles which are antagonists a. Muscularis orbicularis oculi is a broad flat striated muscle with orbital, palpebral & lacrimal parts [Inn: VII cranial nerve] i. Orbital portion (largest part) has analytical form & it goes near orbital margin. It closes the eyelids firmly (strongest part) during injury or excessive light. ii. Palpebral portion is very thin & it passes under skin of eyelids. It copies the shape of eyelid. This portion is responsible for closing the eyelids during normal blinking & during sleeping. iii. Lacrimal portion is very small & is attached to posterior lacrimal crest. It surrounds lacrimal sac posteriorly. It helps to drain tears from lacrimal sac into nasolacrimal duct during blinking. b. Muscularis levator palpebrae superioris for opening the eyelids. It originates from optic foramen & goes under sup orbital wall & is divided into 3 parts: Superficial portion inserts into skin of sup eyelid & has parasympathetic innervations by III cranial nerve. Middle portion inserts into tarsal plate on sup eyelid & has sympathetic innervations. Deep portion inserts into sup conjunctival fornix & has parasympathetic innervations (III cranial nerve)

Tarsal plates (sup & inf) provide rigidity to both eyelids They consists of dense fibrous CT. They include Meibomian glands. They are sebaceous glands which are embedded into matrix of each tarsus. We can see them when eyelids are everted (vertical grayish cylinders). They are filled with lipid secretions which is an important component of lacrimal film.

Palpebral conjunctiva is tightly bound to tarsal plates & lines inner surface of eyelids Skin & muscular layer

Facial artery Superficial temporal artery Tarsal plates & palpebral conjunctiva Lateral palpebral artery Medial palpebral artery Sensory nerve supply Sup eyelid Lacrimal nerve Infratrochlear nerve Inf eyelid Infraorbital nerve Conjunctiva is a thin transparent mucous membrane that attaches the eyeball to eyelids. Functions: Produces mucous component of lacrimal film It has a lot of immunological defense mechanisms that protect ocular surface from infection 3 parts (histologically): Blood supply: Sensory nerve supply: Lateral palpebral Lacrimal nerve Palpebral conjunctiva (4th layer of eyelid) is tightly bound to artery Infratrochlear tarsal plates. nerve It is formed by stratified columnar epithelium. Medial palpebral artery Infraorbital nerve

Blood supply (depends on layers of eyelids)

Fornixial conjunctiva is a transitional zone between palpebral & bulbar conjunctiva. It forms inf & sup (deeper) conjunctival fornices (depressions) Stratified columnar epithelium but this part is mobile dt subconjunctival CT. Bulbar conjunctiva covers ant part of eyeball except for cornea. Its formed by stratified squamous epithelium.

Ant conjunctival
arteries

Long post ciliary

nerves

Lacrimal apparatus of eye Function: Produces & drains tears Main lacrimal gland Lies in same fossa & is divided by muscle levator palpebrae superioris into large BS: Lacrimal artery orbital part & small palpebral part. NS: Lacrimal nerve, The glands excretory ducts enter lat part of sup conjunctival fornix. facial nerve It produces tears only by reflex (emotional stress, irritation of cornea, conjunctiva, nasal epithelium) Lie between palpebral & fornixial conjunctiva. Additional lacrimal Produce tears constantly ~0.5-1ml per day. glands Small openings on med part of each eyelid margin Lacrimal puncture / points (sup & inf) Tears go into canal Lacrimal canals / ducts ~10mm long each & has a vertical & a horizontal component. (sup & inf) Sup & inf lacrimal canals usually unite forming common lacrimal canal before entering lacrimal sac. Lies in fossa for lacrimal sac Lacrimal sac It is 12mm long & is protected by medial palpebral ligament anteriorly & by lacrimal part of muscularis orbicularis oculi posteriorly. 15-20mm long. Nasolacrimal duct Its protected by bony nasolacrimal canal. Both duct & canal empty into inf meatus of nasal cavity. 3, 4, 5, 6 collecting portion (drains tears)

Extraocular muscles All muscles except for inf oblique originate around optic foramen & finally they insert into sclera. Name Innervation Function III Elevation, adduction Sup rectus muscle III Depression, adduction Inf rectus muscle III Adduction Med rectus muscle VI Abduction Lat rectus muscle IV Depression, abduction Sup oblique muscle inserts into sup lat quadrants of eye 16mm away from cornea III Elevation, abduction Inf oblique muscle originates from inf orbital wall lat to entrance of nasolacrimal canal. It goes under the eyeball & inserts into inf lat quadrant of eye 16mm away from cornea

EYEBALL Eyeball is situated in interior part of orbit 3 coats: 1. Fibrous coat (external): cornea & sclera 2. Uveal tract (middle): iris, ciliary body, choroid 3. Inner layer: retina They surround intraocular contents (lens, vitreous body, initial part of optic nerve, ant & post chambers filled with aqueous humor) Fibrous coat protects ocular tissue & provides attachment of extraocular muscles. Cornea meets sclera at region known as limbus (transition zone between transparent cornea with white sclera, 1-1.5mm in width, sensory nerve plexus & vascular net lie here) Cornea forms 1/6 of circumference of fibrous coat. Its composed of 5 layers: Corneal epithelium which is stratified (5-6 layers of cell), squamous non-keratinized epithelium, with very high regenerative capacity Ant limiting membrane (Bowmans membrane) consists of randomly arranged (irregular) collagen fibers Corneal stroma (majority of cornea) includes collagenous lamella oriented parallel to each other & parallel to corneal surface & keratocytes (modified fibroblasts) between them Post limiting membrane (Descemets membrane) consists of irregular collagen fibers. It is elastic in contrast with ant limiting membrane & can resist adverse factors (physical, chemical, biological)

Corneal endothelium is a simple squamous epithelium with low regeneration. It plays role in maintaining normal corneal hydration & its transparency. Injury to this lead to corneal edema. Main function: refraction of light Characteristics: spherical, smooth, shining, wet, avascular with very high sensitivity Souces of nourishment: 1. Lacrimal film which covers cornea 2. Aqueous humor of ant chamber 3. Ant ciliary arteries lying at limbus by diffusion Innervation: Long & short posterior ciliary nerve lying at limbus zone Sclera forms the principal parts of fibrous coat. It looks white externally & is relatively avascular. Function: protects ocular tissues, maintains shape of eye 3 layers: 1. Episclera contains episcleral arteries 2. Stroma composed of irregular collagen fibers & fibrocytes between them 3. Laminar Fusca is dark, brown, dt pigment deposition

Sclera is not transparent. Uveal tract consists of iris, ciliary body & choroid. Iris is ant part of uveal tract. Iris is a thin contractile disc analogue to diaphragm of the camera. Iris separates ant & post chambers which communicate through pupil. Pupil is an opening in the central part of iris. Function: Pupil regulates amount of light entering the eye by changing its diameter. Pupil size depends on state of contraction of muscles sphincter & dilator. 4 layers (histologically): Ant border layer (external) fibroblasts, melanocytes & a few collagen fibers Stroma irregular collagen fibers, sensory nerve endings & capillaries Sphincter papillary muscle lies within stroma around the pupil. Parasympathetic innervations (III cranial nerve) Contration miosis (sleeping, convergence, illuminated condition) Dilated papillary muscle lies behind stroma in peripheral of iris. It lies radially. It has sympathetic innervations, producing mydriasis (dark condition, emotional stress) Post pigment epithelium Blood supply of iris: Ant ciliary arteries & long posterior ciliary arteries which anastomose Sensory NS: Long & short posterior ciliary nerves. Ciliary body is a ring of tissue 5-6mm in width. Triangle on cross section, ring on frontal section. It extends from sclera spure (site of sclera where ciliary body is attached) anteriorly to ora serrata posteriorly. Ora serrata transitional zone between ciliary body & choroi - transitional zone between neurosensory retina (10 layers of cell) & inactive retina (2 layers of cell) 2 parts: Ant portion, 2mm in width is corona ciliaris / pars plicata It includes 70-80 radially arranged folds known as ciliary processes which produce aqueous humor. Other part, 4mm in width is orbicularis ciliaris / pars plana Histologically, ciliary body consists of ciliary muscle, vascular layer, basal lamina, ciliary epithelium & internal limiting membrane. Ant 2/3 of ciliary body is occupied by ciliary muscle which includes outer longitudinal fibers, middle radial fibers & inner circular fibers. Majority of muscles are supplied by parasympathetic NS. Main functions (2): 1. Production of aqueous 2. Accommodation Blood supply & NS: same as iris Choroid is the posterior portion of uveal tract which extends from ora serrata anteriorly to optic nerve margin posteriorly. Its a thin highly pigmented vascular loose CT. Function: nourish outer layers of retina Its made up of short posterior ciliary nerves No sensory nerve endings in choroid as well as in retina.