Orbital nerves and vessels

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This is a lecture for R1-R2 ophthalmology residents but could serve as a useful review to ophthalmologists and ophthalmic technicians and assistants.

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Orbital nerves and vessels

  1. 1. Orbital Vessels and Nerve Raed Behbehani , MD FRCSC
  2. 2. Sensory Nerves• V1 mostly.• V2 few branches.
  3. 3. Sensory Nerves
  4. 4. Sensory Nerves
  5. 5. Sensory Nerve* Frontal nerve -->medial canthus, upper lid, eyebrow. * Branches of frontal nerve : Supra-orbital, supratrochlear nv. *Lacrimal nv-->parasympathetic fibers to lacrimal gland.
  6. 6. Sensory Nerves *The Nasociliary nerve--> longposterior ciliary nerve(globe) , senosry fibers through ciliary ganglion, and nasal mucosa, skin at tip of nose. (Hutchinson’s Sign)
  7. 7. Ciliary Ganglion• 1.5 mm Lateral to the apical optic nerve.• Sensory branches from nasociliary nerve.(pass through only).• Parsympathetic fibers from (ciliary body and sphincter pupillae). (synapse)• Sympathetic fibers from ICA for iris dilator muscle. (pass through only)
  8. 8. Ciliary Ganglion
  9. 9. Ciliary ganglion
  10. 10. Maxillary Nerve*V2 (maxillary) nv.enters pterygopalatine ganglion through forman rotundum. *Infra-orbital nv. main bulk continuation. * Sup. Alveloar--> gums,teeth, lateral upper lip
  11. 11. Infra-orbital Nerve• Main continuation of V2.• Infra-orbital groove (surgical land mark)• Provides sensation of lower lid,cheek, medial upper lip.• * Zygomatic branch--> zygomaticomaxillary, and zygomaticfacial to innervate zygoma and lateral orbit.
  12. 12. Pterygopalatine Ganglion (PG)* Parasympatheticganglion of the head andneck.* Greater Palatine nv.->Palatine nerve-> PG->Zygomaticotemporal->Lacrimal nv.
  13. 13. Motor Nerves Oculomotor Oculomotor• Exits brain stem between post- communicating and superior cerebellar artery.• Lateral wall of cavernous sinus and divides into superior and inferior division.• Through SOF through annulus of Zinn.
  14. 14. Oculomotor Nerve
  15. 15. Oculomotor Nerve
  16. 16. Oculomotor Nerve
  17. 17. Trochlear Nerve
  18. 18. Abducens Nerve
  19. 19. Nervus Intermedius * Seperate cranial nv. closely associated with CN VII.* Int. Auditory Meatus--> geniculate ganglion-->Greater Palatine nv.--> PG->Lacrimal gland
  20. 20. Arterial Supply• The internal carotid artery give off the ophthalmic artery.
  21. 21. Ophthalmic Artery• Only ICA branch that enters the orbit.• Aastomoses with ECA branches.• Enters orbit inferolateral to optic nerve.• At orbital Apex Branches: to retina (CRA) and choroid (PCA).• Short PCA : 15-20 from LPCA pierce sclera and supply ONH and choroid.
  22. 22. Muscular Branches
  23. 23. Branches of External Carotid Artery * Orbital circulation has highdegree of collateralization with ECA . * Supra-orbital and Supratrochlear<--> Superficial temporal Art.* Dorsonasal <--> Angular Art.*Ant and Post. Ethmoidal <--> Sphenopalatine * Lacrimal Art. <--> Middle Meningeal Art.
  24. 24. Venous Draiange
  25. 25. Venous Outflow• Valveless veins which drain posteriorly.• The Superior orbital vein (SOV) is a confluence of angular, naso-frontal, and Supra-orbital vein.• Directed from medial to lateral.• Starts near trochlea, medial to SR-- >beneath SR--> Lateral to SR--> SOF.
  26. 26. Inferior Orbital Vein• Drains posteriorly (anastomoses with Supra-orbital vein)--> Inferior orbital fissure--> into Pterygoid venous plexus and Inferior orbital fissure.
  27. 27. Superior Ophthalmic Vein
  28. 28. Cavernous Sinus
  29. 29. Orbital Vasculature• Ophthalmic artery (1st Branch of ICA).• Primary blood supply (small contribution from ECA: maxillary and middle meningeal arteries).• Branches variable.• Ophthalmic artery enters the optic canal.
  30. 30. Branches of Ophthalmic Artery• Central retinal artery (Retina).• Long posterior ciliary arteries (Choroid) ; 1)Short Posterior Ciliary Arteries (15-20) supply choroid and optic nerve head. 2) Long Post Cililary (2) for Iris and Ciliary body.• Lacrimal artery. (gland) recurrent meningeal art. anastomosis• Anterior & Posterior ethmoidal.• Muscular Branches (divides into 2 long anterior ciliary arteries except LR has 1 only).--> anastom with long post. ciliary arteries (supply anterior segment).
  31. 31. Orbital Arterial Supply
  32. 32. Ophthalmic Artery• Supraorbital artery (between levator and periorbita).• Dorsal nasal.• Supratrochlear.
  33. 33. Ophthalmic Art
  34. 34. Maxillary Artery• Infra-orbital artery is the terminal end.• Muscular branches to IR and IO.• Anastomoses with angular artery and inferior palpebral vessels.
  35. 35. Orbital Arterial Supply
  36. 36. Venous Drainage of Orbit
  37. 37. Venous Drainage of Orbit• Valveless superior and inferior ophthalmic veins.• Confluence of the angular, supraorbital, and supratrochlear veins form superior ophthalmic vein.• Inferior ophth vein receives tribuatries from muscular, vortex, and medial and lateral collateral veins.• IOV communicates with pterygoid plexus via IOF.
  38. 38. SOV

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