The Eye and Orbit

The temporomandibular joint | Main Anatomy Index | The nasal cavity

The Eye and Orbit

• The orbit (eye socket) appears as a bony recess in the skull when it is viewed from anteriorly.
• It almost surrounds the eye and their associated muscles, nerves and vessels, together with the lacrimal apparatus.

• The orbit is shaped somewhat like a four-side pyramid lying on its side, with its apex pointing posteriorly and its base anteriorly.

The Orbital Margin

• The frontal, maxillary and zygomatic bones contribute equally to the formation of the orbital margin.

• The supraorbital margin is composed entirely of the frontal bone.
• At the junction of its medial and middle thirds is the supraorbital foramen (sometimes a notch), which transmits the supraorbital nerves and vessels.

• The lateral orbital margin is formed almost entirely of the frontal process of the zygomatic bone.

• The infraorbital margin is formed by the zygomatic bone laterally and the maxilla medially.

• The medial orbital margin is formed superiorly by the frontal bone and inferiorly by the lacrimal crest of the frontal process of the maxilla.
• This margin is distinct in its inferior half only.

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The Walls of the Orbit

• Each orbit has four walls: superior (roof), medial, inferior (floor) and lateral.
• The medial walls of the orbit are almost parallel with each other and with the superior part of the nasal cavities separating them.
• The lateral walls are approximately at right angles to each other.

The Superior Roof of the Orbit (p. 703)

• The superior wall or roof of the orbit is formed almost completely by the orbital plate of the frontal bone.
• Posteriorly, the superior wall is formed by the lesser wing of the sphenoid bone.

• The roof of the orbit is thin, translucent, and gently arched. This plate of bone separates the orbital cavity and the anterior cranial fossa.

• The optic canal is located in the posterior part of the roof.

The Medial Wall of the Orbit (p. 703)

• This wall is paper-thin and is formed by the orbital lamina or lamina papyracea of the ethmoid bone, along with contributions from the frontal, lacrimal, and sphenoid bones (L. papyraceus, "made of papyrus" or parchment paper).

• There is a vertical lacrimal groove in the medial wall, which is formed anteriorly by the maxilla and posteriorly by the lacrimal bone.
• It forms a fossa for the lacrimal sac and the adjacent part of the nasolacrimal duct.

• Along the suture between the ethmoid and frontal bones are two small foramina; the anterior and posterior ethmoidal foramina.
• These transmit nerves and vessels of the same name.

The Inferior Wall of the Orbit (p. 703)

• The thin inferior wall of the orbit or the floor is formed mainly by the orbital surface of the maxilla and partly by the zygomatic bone, and orbital process of the palatine bone.

• The floor of the orbit forms the roof of the maxillary sinus.

• The floor is partly separated from the lateral wall of the orbit by the inferior orbital fissure.

The Lateral Wall of the Orbit (pp. 703, 705)

• This wall is thick, particularly its posterior part, which separates the orbit from the middle cranial fossa.
• The lateral wall is formed by the frontal process of the zygomatic bone and the greater wing of the sphenoid bone.

• Anteriorly, the lateral wall lies between the orbit and the temporal fossa.

• The lateral wall is partially separated from the roof by the superior orbital fissure.

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Muscles of the Orbit

Levator Palpebrae Superioris Muscles (p. 715)

• This is a thin, triangular muscle that elevates the upper eyelid.
• It is continuously active except during sleeping and when the eye is closing.

• Origin: roof of orbit, anterior to the optic canal.
• Insertion: this muscle fans out into a wide aponeurosis that inserts into the skin of the upper eyelid. The inferior part of the aponeurosis contains some smooth muscle fibres that insert into the tarsal plate.
• Innervation: the superior fibres are innervated by the oculomotor nerve (CN III), and the smooth muscle component is innervated by fibres of the cervical sympathetic trunk and the internal carotid plexus.

Illnesses involving the Levator Palpebrae Superioris (p. 715)

• In third nerve palsy, the upper eyelid droops (ptosis) and cannot be raised voluntarily.
• This results from damage to the oculomotor nerve (CN III), which supplies this muscle.

• If the cervical sympathetic trunk is interrupted, the smooth muscle component of the levator palpebrae superioris is paralysed and also causes ptosis.
• This is part of Horner's syndrome.

The Rectus Muscles (p. 715)

Click here for a schematic of the attachment of the muscles to the eye.

• There are four rectus muscles (L. rectus, straight), superior, inferior, medial and lateral.

• These arise from a tough tendinous cuff, called the common tendinous ring, which surrounds the optic canal and the junction of the superior and inferior orbital fissures.
• From their common origin, these muscles run anteriorly, close to the walls of the orbit, and attach to the eyeball just posterior to the sclerocorneal junction.

• The medial and lateral rectus muscles attach to the medial and lateral sides of the eyeball respectively, on the horizontal axis.
• However, the superior rectus attaches to the anterosuperior aspect of the medial side of the eyeball while the inferior rectus attaches to the anteroinferior aspect of the medial side of the eye.

The Oblique Muscles

The Superior Oblique Muscle (p. 715)

• This muscle arises from the body of the sphenoid bone, superomedial to the common tendinous ring.
• It passes anteriorly, superior and medial to the superior and medial rectus muscles.
• It ends as a round tendon that runs through a pulley-like loop called the trochlea (L. pulley).
• After passing though the trochlea, the tendon of the superior oblique turns posterolaterally and inserts into the sclera at the posterosuperior aspect of the lateral side of the eyeball.

The Inferior Oblique Muscle (p. 715)

• This muscle arises from the maxilla in the floor of the orbit.
• It passes laterally and posteriorly, inferior to the inferior rectus muscle.
• It inserts into the sclera at the posteroinferior aspect of the lateral side of the eyeball.

Nerve Supply of the Muscles of the Orbit (pp. 715-6)

• Three cranial nerves supply the muscles of the eyeball; the oculomotor (CN III), trochlear (CN IV) and abducent (CN IV) nerves.
• All three enter the orbit via the superior orbital fissure.

• The trochlear nerve supplies the superior oblique muscle.
• The abducent nerve supplies the lateral rectus muscle.
• The oculomotor nerve supplies everything else.

• A mnemonic that is used is this formula for this strange sulfate: SO₄(LR₆)₃

Actions of the Muscles (pp. 716-7)

• The six muscles rotate the eyeball in the orbit around three axes (sagittal, horizontal and vertical).
• The action of the muscles can be deduced by their site of insertion on the eyeball.

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The Orbital Vessels

• The orbital contents are supplied chiefly by the ophthalmic artery.
• The infraorbital artery, the continuation of the maxillary, also contributes blood to this region.

• Venous drainage is through the superior orbital fissure to enter the cavernous sinus.

The Ophthalmic Artery (p. 716)

• This artery arises from the internal carotid artery as it emerges from the cavernous sinus.
• It passes through the optic foramen within the dural sheath of the optic nerve and runs anteriorly, close to the superomedial wall of the orbit.

The Central Artery of the Retina (pp. 716-7)

• This is the one of the smallest but most important branches of the ophthalmic artery.
• It arises inferior to the optic nerve until it approaches the eyeball.
• It then pierces the optic nerve and runs within it to emerge through the optic disc.
• The central artery of the retina spreads over the internal surface of the retina and supplies it.

The Ophthalmic Veins

The Superior Ophthalmic Vein (p. 719)

• The superior ophthalmic vein anastomoses with the facial vein.
• It has no valves and blood can flow in either direction.
• It crosses superior to the optic nerve, passes through the superior orbital fissure and ends in the cavernous sinus.

The Inferior Ophthalmic Vein (p. 719)

• This begins as a plexus on the floor of the orbit.
• It communicates with the inferior orbital fissure with the pterygoid plexus, crosses inferior to the optic nerve, and ends in either the superior ophthalmic vein or the cavernous sinus.

The Optic Nerve

Click here to go to the optic nerve entry in cranial nerves.

• This is the second cranial nerve (CN II) and is the nerve of sight.

Click here for a diagram on entry of nerves of the orbit into the orbital cavity.

Click here for a diagram on the branches of the ophthalmic nerve (CN V¹)

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