Orbit anatomy

20,693 views
20,118 views

Published on

A clinical perspective in conjunction with anatomy of orbit

Published in: Health & Medicine, Technology
3 Comments
21 Likes
Statistics
Notes
No Downloads
Views
Total views
20,693
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
1,403
Comments
3
Likes
21
Embeds 0
No embeds

No notes for slide

Orbit anatomy

  1. 1. ANATOMY OF ORBIT Rajvin Samuel Ponraj
  2. 2. Development of orbit <ul><li>Develops from mesenchyme by ossification </li></ul><ul><li>6 th to 7 th week laying down of bones </li></ul><ul><li>starting with maxilla bone around the </li></ul><ul><li>Optic vesicle </li></ul><ul><li>During this time optic vesicle 170 degree apart rotates anteriorly </li></ul>
  3. 3. Developmental Anomalies : <ul><li>Craniosynosotosis : </li></ul><ul><li>Brachycephaly </li></ul><ul><li>Oxycephaly </li></ul><ul><li>Scophocephaly </li></ul><ul><li>Trigonocephaly </li></ul>
  4. 4. <ul><li>Craniosfacial dysostois / Crouzon’ syndrome </li></ul><ul><li>Proptosis – shallow orbits </li></ul><ul><li>Hypertelorim - wide separation </li></ul><ul><li>of orbits </li></ul><ul><li>V pattern exotropia </li></ul>
  5. 5. <ul><li>Oxycephaly-syndactlye / Apert’ syndrome : </li></ul><ul><li>Flattened occiput , steep forehead , </li></ul><ul><li>supra orbital ridge </li></ul><ul><li>Midfacial hypoplasia , </li></ul><ul><li>parrot beak nose </li></ul>
  6. 6. Bones of Orbit Frontal Ethmoid Sphenoid Lacrimal Palatine Maxillary Zygomatic
  7. 7. Dimensions - orbit <ul><li>30 ml –volume </li></ul><ul><li>35 mm vertically , </li></ul><ul><li>40 mm horizontally </li></ul><ul><li>45 degree between lateral wall </li></ul><ul><li>and sagital plane </li></ul><ul><li>23 degree between visual </li></ul><ul><li>and orbital axis </li></ul>
  8. 8. Boundaries of Orbit <ul><li>Roof </li></ul><ul><li>Floor </li></ul><ul><li>Side walls </li></ul><ul><li>Orbital apex </li></ul>
  9. 9. <ul><li>Roof of orbit </li></ul><ul><li>Frontal bone [Orbital plate] & lesser wing of sphenoid </li></ul><ul><li>Separated from frontal sinus and anterior </li></ul><ul><li>cranial fossa above </li></ul><ul><li>Lacrimal gland fossa and trochlear fossa </li></ul><ul><li>behind orbital rim </li></ul>
  10. 10. <ul><li>Orbital roof anomaly / fracture </li></ul><ul><li>CSF pulsation pulsatile </li></ul><ul><li>exophthalmos </li></ul><ul><li>Orbital meningocele / encephalocele </li></ul>
  11. 11. <ul><li>Medial wall </li></ul><ul><li>Body of sphenoid </li></ul><ul><li>Ethmoid </li></ul><ul><li>Lacrimal </li></ul><ul><li>Maxilla[frontal </li></ul><ul><li>process] </li></ul>
  12. 12. <ul><li>Orbital cellulitis </li></ul><ul><li>Extremely thin wall </li></ul><ul><li>Prone for damage & sinusitis spread </li></ul><ul><li>Infection across Orbital cellulitis </li></ul>
  13. 13. <ul><li>Floor of orbit </li></ul><ul><li>Maxilla </li></ul><ul><li>Zygomatic </li></ul><ul><li>Palatine </li></ul><ul><li>Triangular segment </li></ul><ul><li>-- thinnest </li></ul><ul><li>Inferior orbital groove </li></ul>
  14. 14. <ul><li>Blow out fractures </li></ul><ul><li>Fragile barrier to maxillary </li></ul><ul><li>sinus </li></ul><ul><li>Due to trauma eyeball collapse </li></ul><ul><li>into Maxillary sinus </li></ul>
  15. 15. Le fort’s fracture Type 2 - Pyramidal Type 3 - Craniofacial dissociation
  16. 16. <ul><li>Lateral wall </li></ul><ul><li>Greater wing –sphenoid </li></ul><ul><li>Orbital surface – </li></ul><ul><li>Frontal process of zygomatic </li></ul><ul><li>Inferiorly – inf orbital fissure </li></ul><ul><li>Medially – sup orbital fissure </li></ul>
  17. 17. <ul><li>Behind Zygomatic sphenoidal suture </li></ul><ul><li>lateral orbitotomy of greater wing </li></ul><ul><li>( thin wall ) cancellous bone </li></ul><ul><li>middle cranial fossa </li></ul><ul><li>dura matter </li></ul>
  18. 18. <ul><li>At frontal sphenoidal suture </li></ul><ul><li>-- meningeal foramen </li></ul><ul><li>Site of anastomosis of Lacrimal artery and </li></ul><ul><li>meningeal artery collaterals </li></ul><ul><li>Periosteal elevation at this site Brisk bleeding </li></ul>
  19. 19. <ul><li>Orbital apex </li></ul>
  20. 20. <ul><li>Orbital apex syndrome </li></ul><ul><li>/ Tolosa - hunt syndrome : </li></ul><ul><li>Damage to structures at apex 2 nd, 3 rd, 4 th ,6 th nerves </li></ul><ul><li>Symptoms : visual loss, ophthalmoplegia </li></ul><ul><li>periorbital & facial pain </li></ul>
  21. 21. <ul><li>Other causes: </li></ul><ul><li>Inflammatory </li></ul><ul><li>Infectious </li></ul><ul><li>Neoplastic </li></ul><ul><li>Iatrogenic / traumatic </li></ul><ul><li>Vascular </li></ul>
  22. 22. <ul><li>Superior orbital fissure syndrome </li></ul><ul><li>/ Rochon – Duvigneaud syndrome : </li></ul><ul><li>Lesion anterior to orbital apex excluding optic nerve pathology </li></ul>
  23. 23. Contents of orbit <ul><li>Eye ball </li></ul><ul><li>Orbital fat </li></ul><ul><li>Connective tissue system </li></ul><ul><li>Blood vessels </li></ul><ul><li>Nerves </li></ul><ul><li>Extraocular muscles </li></ul>
  24. 24. Eyeball - Applied anatomy: <ul><li>Proptosis : </li></ul><ul><li>Dystopia </li></ul><ul><li>Enophthalmosis </li></ul><ul><li>Ophthalmoplegia </li></ul>
  25. 25. Connective tissue system <ul><li>Periorbita </li></ul><ul><li>Orbital septum </li></ul><ul><li>Tenon’s capsule </li></ul>
  26. 26. <ul><li>Periorbita : </li></ul><ul><li>Loosely attached to orbital bone </li></ul><ul><li>Attached firmly to </li></ul><ul><li>Arcus marginalis </li></ul><ul><li>Trochlea </li></ul><ul><li>Lateral orbital tubercle </li></ul><ul><li>Optic foramen </li></ul><ul><li>Orbital fissures </li></ul><ul><li>Dura and optic canal margins </li></ul>
  27. 27. <ul><li>Orbital septum : </li></ul><ul><li>Interconnecting / circumferential radial webs of fascial system </li></ul><ul><li>support and transmit forces in trauma </li></ul><ul><li>Compressive optic neuropathy following trauma </li></ul>
  28. 28. <ul><li>Anterior fascial system </li></ul><ul><li>Formed by condensation of fibrous septa </li></ul><ul><li>Lockwood lig, </li></ul><ul><li>whitnall sup susp lig </li></ul><ul><li>Lacrimal lig </li></ul><ul><li>Intermuscular septum </li></ul><ul><li>Posterior Fascial system Incompletely </li></ul><ul><li>formed </li></ul>
  29. 29. <ul><li>Tenon’s capsule </li></ul><ul><li>Dense elastic , vascular </li></ul><ul><li>Extent : from perilimbal sclera to optic </li></ul><ul><li>nerve meninges with bursa within </li></ul><ul><li>Sleeve like extensions for </li></ul><ul><li>extra ocular muscles continues as </li></ul><ul><li>fibrous capsule along its length </li></ul>
  30. 31. Surgical spaces in orbit : <ul><li>Sub periosteal space </li></ul><ul><li>Peripheral space </li></ul><ul><li>Central space </li></ul><ul><li>Tenon’s space </li></ul>
  31. 32. Extra ocular muscles <ul><li>4 rectal muscles </li></ul><ul><li>2 oblique muscles </li></ul><ul><li>Two lid retractors </li></ul><ul><li>To serve in eyeball movements in the orbital cavity </li></ul>
  32. 33. Arterial supply
  33. 34. Venous drainage
  34. 35. Optic nerve Intra orbital part = 25 mm out of 4 cm Enclosed in three meningeal sheaths At apex surrounded by recti muscles , Central retinal artery and vein pierces optic nerve 1.25 cm behind optic nerve Relations: superiorly ophthalmic artery sup ophthal vein nasociliary nerve inferiorly nerve to medial rectus
  35. 36. Oculomotor nerve Divides at anterior part of cavernous sinus before Entering sup orbital fissure Sup division Sup rectus LPS Inf division Medial rectus Inf rectus Inf oblique And motor root relay at ciliary ganglion sphincter pupillae , ciliary muscle
  36. 37. Trochlear nerve Runs medially from lateral wall of cavernous sinus Above Levator palpebral sup Then supplies orbital surface of Superior oblique
  37. 38. Abducent nerve Running inferior lateral to 3 rd nerve then supplies ocular surface of lateral Rectus
  38. 39. Trigeminal nerve <ul><li>Three terminal branches of ophthalmic division: </li></ul><ul><li>Frontal nerve supratrochlear </li></ul><ul><li>supraorbital </li></ul><ul><li>Lacrimal nerve Sensory and secretomotor </li></ul><ul><li>fibres to lacrimal gland tru </li></ul><ul><li>zygomaticotemporal nerve </li></ul>
  39. 40. <ul><li>Nasociliary nerve: </li></ul><ul><li>Communicating branch to sensory root of ciliary ganglion </li></ul><ul><li>Long ciliary nerves - dilator pupillae </li></ul><ul><li>Posterior and anterior ethmoidal branches </li></ul><ul><li>Infratrochlear nerve </li></ul>
  40. 41. <ul><li>THANK YOU </li></ul>

×