The document discusses the anatomy of the orbit, including its bones, walls, openings, spaces, and relations to surrounding structures. It describes the dimensions of the orbit, noting variations among populations. Various parts of the orbit are described in more detail, such as the apex, walls, foramina, and fissures. Common pathologies affecting the orbit are summarized such as proptosis, cellulitis, and cavernous sinus thrombosis. Imaging and examination findings for orbital conditions are also outlined.

1. Presenter
Dr. Vinit Kamble
Moderator
DR. B.P.SINHA

2.  Walls
 Apex
 Openings
 Spaces
 Relations
 Blood vessels
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3.  Dimensions- conical or quadrangular bony
pyramidal in shape which connect ACF and
maxillary sinus below
 Depth- 42 mm on medial ,50 mm on lateral
side
 Height- 35 mm
 Intermargimal dist.-25mm on medial wall
100mm on lateral
 Width- 40mm parts- Apex /notch of pyramid
 Base- ante. Most quadrangular
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4. Sketch of orbit by Dr Sanjay Shrivastava
Frontal
Ethamoid
Zygomatic
Lesser and Greater
wing of Sphenoid
Maxillary
Lacrimal
Palatine
Optic Foramen
Sup Orbital Fissure

5.  7 BONES USED IN FORMATION OF
ORBITAL CAVITY
 ROSTRUM OF SPHENOID
,PERPEND..PLATE OF ETHMOID, FRONTAL
, MAXILLA ,PALATINE, ZYGOMATIC,
LACRIMAL BONES
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6.  Orbital index - height/width x 100
 It is 83 to 89 in CAUCASIANs and
<83 in NIGROEs , >89 in orientals
 Ratio of orbital vol/globe vol=4.1: 1
 Vol 29 ml
 Ant- quadrangular called BASE
 Post -notch called APEX
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7.  Lateral wall of each orbit lies at angle 45
degree to medial wall
 Lateral wall of both orbit 90 degree to
each
other
lateral wall seprate orbit from from MCF and
muscular temporal foss ante.
WALLS – medial , lateral , floor, roof
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8.  4 walls meet at SUP. INTERNAL, SUP.
EXTERNAL, INF. INTERNAL , INF. EXTERNAL
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9.  Roof- is formed by the orbital plate of frontal
bone and lesser wing of sphenoid
 Floor- is formed by the maxillary bone- orbital
plate and maxillary process of zygomatic bone
and orbital process of palatine bone
 Medial wall- is formed by the lacrimal and
ethamoidal bone, frontal process of maxillary
bone and body of sphenoid
 Lateral wall- is formed by the greater wing of
sphenoid and zygomatic bone
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10.  Trangular in shape, formed by frontal bone
 Anteriorly and behind by lesser wing of
sphenoid
 Ante.ro lateral- fossa for lacrimal gland
 Above – frontal lobe of cerebrum+ meninges
 Below – LPS, SR,SO,LACRIMAL GLAND, 4th
CN , FRONTAL NERVE , PERIORBITAL
TISSUE.
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11.  M/C - involved in blow out fracture and
invaded by tumour of maxillary antrum
 Seen in X ray orbit P/A view.
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12.  Quadrilateral
 Formed by- from front to back frontal
process of maxilla , lacrimal bone, body of
sphenoid, orbital plate of ethmoid,
Lacrimal fossa anteriorly with ant. Lacrimal
crest of maxillary bone and post lacrimal
crest of lacrimal bone infe. By NASO
LACRIMAL CANAL
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13.  Medial to lacrimal fossa lie – ant. Ethmodal
sinus in upper part , middle meatus of nose
in lower part ,
Lacrimal fossa consist – sac + fascia
Post.- to post lacrimal crest consist Horners
muscle , septum orbitale, ligament of medial
rectus
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14.  Consist that is towards nose Ethmoid air
sinus , middle meatus of nose , sphenoid
 air sinus
 Orbital surface of medial wall- superior
obligue in upper part , MR- middle part
 In bet. Superior obligue muscle and MR
 consist ant ethmoidal nerve , post ethmoidal
 nerve, infratrochler nerve
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15.  Thinnest wall , ethmoiditis, with orbital or
preseptal cellulitis in child , eroded by cyst,
 Neoplasm, fracture during orbitomy operation
or surgery, injury
 Haemorrhage m/c due to injury to ethmoidal
vessels
 Xray P/A view recquired for diagnosis
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16.  Trangular , ant. relation- zygomatic bone
 with groove which transmit zygomatic
 nerve and vessels
 Post . Relation – greater wing of sphenoid,
 Origin to LR muscle , seprated from roof
 by sup orbital fissure and from floor
 by infe orbital fissure
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17.  Protect post half of eyeball
 Palpation of retro orbital mass is eazy
through lateral wall
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18.  Annulus of zinn giving rise to origin to extra
ocular muscles
 Optic canal- 6 to 11 mm at 4to 5 yr
 Part of superior orbital fissure
 Optic canal -transmit optic nerve and
ophthalmic artery , lateral wall is shortest
 Gret. And lesser wing of sphenoid form sup
orbital fissure..divided in to lateral,
medial,inferior
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19.  It is post notch of pyramid types-
 1] orbital end is vertically oval
 2] center- circular
 3] cranial end- horizontally oval
 Optic nerve glioma and meningioma show
 Enlargement of optic canal seen best in x
ray
 P/A VIEW
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20.  IN ORBITAL APEX SYNDROME - IT IS
VISUAL LOSS FROM OPTIC
NEUROPATHY, OPHTAHLMOPLEGIA,
 MULTIPLE CRANIAL NERVE
INVOLVEMENT consist
 SOFS/Rohon Duvigneaud syndrome,
THS/unilateral, CST/bilateral diag. from
HRCT,MRI
 Involve 3,4,5,6 CN with optic nerve
dysfunction
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21. Sketch of Apex of Orbit by Dr Sanjay Shrivastava
Sup Orbital Fissure
Annulus of Zinn
Med Rectus Muscle
Inf Rectus Muscle
Lat Rectus Mus
LPS
Sup Oblique Mus
Optic Nerve

22.  Optic canal- optic nerve with meninges and
ophthalmic artery connect orbit to MCF
 Superior orbital fissure-
Outside tendinous ring – structures passing
outside are:
Lacrimal nerve –V1
Frontal nerve -V2
Trochlear nerve
Superior and inferior veins
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23.  Inside tendinous ring- structures passing inside
the ring are -
Oculomotor (3rd cranial nerve) upper division
Nasociliary nerve
Abducent nerve (6th cranial nerve)
Oculomotor lower division (3rd cranial nerve)
Inferior orbital fissure-inferior ophthalmic vein
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24.  Foramen rotandum - maxillary nerve
 Superior orbital notch-supraorbital nerve and
vessels
 Infra orbital foramen-infraorbital nerve and
artery
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25.  Subperiostial space
 Peripheral orbital space
 Central space
 Tenons space
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26.  Space bet orbital bone and periorbita
 Tumour arising from bone seprate periorbita
 to orbital rim
 Dermoid, epidermoid cyst,mucocele,myeloma,
 hematoma, fibrous dysplasia are seen in this
space
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27.  Bounded peripherally by periorbita, 4 extra
 Ocular muscle, with intermuscular septa
 Tumour in this space produse proptosis
 E.g malig lymphoma, capiilary haemangioma,
 Pseudotumour, neoplasm of lacrimal gland
 Contents- SO,IO,LPS, LACRIMAL FRONTAL,
 TROCHLEAR, LACRIMAL GLAND
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28.  RETROBULBAR SPACE/ MUSCULAR CONE
 Ant- by tenons capsule or fascia bulbi
 Periphery-rectus muscles and intramus. Septa
 Contents- optic nerve , meninges, 3RD ,6th
,opthalmic artery, ciliary ganglion, central
 Fat, sup ophtha. Vein
 Cavernous haemangioma,neurofibroma,neuro-
 -lemoma ,meningioma,optic nerve glioma
 Treat- lateral orbitomy
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29.  Tenons capsule, envelop globe from limbus
 To optic disc , inner face lies in contact with
sclera
outer face of fascia bulbi lies in contact with
orbital fat, subconjuctival space anter.
Lower part of fascia bulbi is thick takes in
Formation of sling / hammcock on which globe
rest called as suspensory liga of
LOCKWOOD
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30.  Frontal sinus
 Sphenoidal sinus
 Maxillary sinus
 Ethamoidal air cells
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31.  Eyeball, extra ocular muscles, muller muscles
 Optic nerve, occulomotor,trochlear,abducent,
 Trigeminal,fat,fascia, lacrimal sac gland
 Ophthalmic artery, and its branches
 Orbital fascia, reticular tissue
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32.  Proptosis
 Exophthalmos- endrocrinal
 Enophthalmos
 Pseudoproptosis-slight prominence of eyes like
myopia, paralysis of extra ocular muscles,
obese people, mullers stimulation by cocain
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33.  Abnormal protrusion of eye ball is called
proptosis or exophthalmos.
 The term exophthalmos is reserved for
prominence of the eye secondary to thyroid
disease
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34. 24-Nov-14 Dr. Kavita Kumar 34

35.  Abnormal protrusion of globe
 It may be Unilateral or Bilateral
 Unilateral – caused by orbital cellulitis,
idiopathic orbital inflammatory disease,
thrombosis of orbital vein, arterio-venous
aneurysms, tumors of structures of orbit ,
orbital haemorrahge , emphysema.
 Bilateral – endocrine exophthalmos ,
cavernous sinus thrombosis , symmetrical
orbital tumors, oxycephaly - diminished orbital
volume
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38.  Dermoid and epidermoid cyst
 Capillary haemangioma
 Optic nerve glioma
 Rhabdomyosarcoma
 Leukaemias
 Metastatic neuroblastoma
 Plexiform neurofibromatosis
 Lymphomas
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40.  Metastases – (of malignancy) from breast,
lung, GIT
 Cavernous haemangiomas
 Mucocele
 Lymphoid tumors
 Meningiomas
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41. Types of Proptosis
 Axial proptosis - eye is pushed directly
forwards – lesions situated in optic nerve
and central space
 Non axial- situated elsewhere in orbit
pushes eye in opposite direction
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42. Extra conal lesions Intra conal lesions Muscular disorders
Dermoid cyst Cavernous haemangioma Thyroid
ophthalmopathy
Rhabdomyosarcoma Optic nerve glioma Pseudo tumor
Extension of nasal
/sinus diseases
Meningioma Cysticercosis
A-V malformations Lymphoproliferative
disorder
Rhabdomyosarcoma
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43.  Static- as seen usually in congenital causes
 Increasing – fast- as in cases of
Rhabdomyosarcoma, neuroblastoma,
haemopoetic
 Gradual- as in cases of meningiomas
 Pulsatile- as in cases of carotid cavernous
fistula
 Intermittent- as in cases of orbital varicosity
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44.  Impaired mobility
 Diplopia
 Papilloedema
 Optic atrophy
 Hertel exophthalmometry – measures more
than 18 mm
 Difference in two eyes of more than 2 mm is
considered positive
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45. • Careful history recording
• Systemic examination
• ENT examination
• Biochemical and haematological investigations
• Imaging of bony structures- plain x ray
• Imaging of soft tissues –CT scan, MRI
• Vascular study- orbital venography, carotid
angiography, MR angiography, digital
subtraction angiography
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46.  Definition: Purulent inflammation of the cellular
tissue of the orbit
 Causes of Orbital Cellulitis:
Spread of infection from neighbouring
structures like nasal sinuses, eyelids, eyeball
(like in case of panophthalmitis) facial erysiplas
etc
Also due to deep penetrating injuries (specially
in cases of retained Foreign body) and
metastatic infection in cases of pyaemia
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47.  Two types- pre septal cellulitis and orbital
cellulitis
 Pre septal –structures anterior to orbital
septum, characterized by erythema, chemosis,
conjunctival discharge without restriction of
ocular movements and visual impairment
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48.  Orbital – behind orbital septum,
characterized severe pain, fever,
diminution of vision (due to retrobulbar
neuritis or compression of optic nerve and
/or its blood supply), massive swelling of
lids, chemosis, proptosis, restriction of
ocular movements, diplopia, an abscess
may form pointing somewhere in the skin
of the lid near the orbital margin or fornix
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49.  Panophthalmitis
 Extension into brain through meninges ,
cavernous sinus thrombosis may develop
 In diabetic patients fungal superinfection may
develop
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50.  Culture and sensitivity of pus, if present and of
blood
 Treatment –Broad spectrum Intravenous
antibiotics , and anti inflammatory
 If abscess has formed – Incision and Drainage
under cover of antibiotics
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51.  Due to extension of thrombosis from various feeding
vessels
 Superior and inferior ophthalmic vein enter in front
 Superior and inferior Petrosal sinus leave from
behind
 Cavernous sinus communicates with facial veins,
lateral sinus, jugular vein, Mastoid emmisary vein-lateral
sinus- superior petrosal sinus
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52.  Cavernous sinus on one side communicates
with other side through transverse sinus
 Because of connection with mastoid through
mastoid emmisary vein, mastoid tenderness is
diagnostic feature of cavernous sinus
thrombosis

53.  Orbital veins - as in cases of eryiepelas, septic
lesion of face, orbital cellulitis , infective
condition of face, mouth, nose, sinuses
 Furuncle of upper lip – dangerous area of face
 Metastatic infection or septic condition
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54.  Patient may present with symptoms and signs
of Orbital cellulitis, there is sever supra-orbital
pain
 Systemic features – headache, fever ,altered
sensorium, vomiting and cerebral symptoms
 Transference of symptoms and signs to other
eye (bilateral orbital cellulitis with which it may
be confused is very rare clinical condition).
Mastoid edema and tenderness is present.
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55.  In case of infection spreading to other eye, the
first sign is involvement of lateral rectus of
other eye
 Papilloedema

56.  Emergency
 Broad spectrum Intra Venous antibiotics
 Anti coagulants
 Neurophysicians to be consulted
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57.  Endocrine exophthalmos : Graves
Ophthalmopathy (dysthyroid eye disease) is
the commonest cause of uniocular or bilateral
proptosis in age groups between 25 and 50
years
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58.  Consists of Exophthalmos, and all signs of
thyrotoxicosis (i.e. tachycardia, muscular
tremors and raised BMR)
 In early stage the presentation may be
unilateral, becomes bilateral. Palpabral
aperture is wide open due to lid retraction
(Dalrymple sign). Upper lid fail to follow
downward movement of eye (von Graefe sign)
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59.  Lid retraction
 Lid lag (upper and lower
 Infrequent blinking and incomplete closure of lids (Stellwag
sign)
 Lid edema
 Exophthalmos
 Conjunctival congestion over the insertion of recti muscles
and chemosis
 Convergence insufficiency (Mobius sign) and Diplopia
 Raised intraocular tension may be present
 Superior limbic keratopathy
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60.  Grade 0 – No signs or symptom
 Grade 1 – Only sign (lid retraction)
 Grade 2 – Soft tissue involvement (Chemosis)
 Grade 3 – Proptosis (which may be minimum
<23, moderate , marked >28)
 Grade 4 – Extraocular muscle involvement
 Grade 5 – Corneal involvement
 Grade 6 – Sight loss
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61.  Is proptosis with external ophthalmoplegia
 Usually seen in middle aged people , it is of
insidious onset, typically assymetrical limiting
upward movement and abduction due to
swollen, pale edematous, infiltrated ocular
muscles . There is irreducible exophthalmos
with risk of exposure keratitis , globe
dislocation mechanical compression of optic
nerve and ophthalmic vessels
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62.  Disease is self limiting with intermissions and
relapses, usually not affected by any treatment
. Spontaneous resolution may take place which
rarely is complete
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63.  Short term oral steroid therapy (with dose of
40-60 mg) with radiotherapy (1000 rad ) are
effective in controlling soft tissue inflammation
 Exposed cornea should be protected by doing
tarsorrhaphy in less severe cases , by orbital
decompression in more severe cases. Lateral
tarsorrhaphy may also be needed.
 Residual muscle palsy is dealt with muscle
adjustment surgery.
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64. • Type – I : Characterized by symmetrical mild
proptosis with lid retraction usually associated
with thyrotoxicosis
• Type – II : Characterized by extreme
exophthalmos, compressive neuropathy and
extraocular muscle involvement. This form may
be associated with any state of thyroid function,
but usually with hypothyroidism, seen after
thyroidectomy.
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65.  Due to edema, lymphocytic infiltration anf
fibrosis of orbital contents and extra-ocular
muscles
 Lid retraction is due to contraction of Muller
muscle
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