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Superior View of Contents of Left Orbit

Surgical Correlation

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Superior view of contents of left orbit. The orbital plate of the frontal bone and periorbita have been removed to expose contents of the orbit. The eyeball or globe occupies the anterior half of the orbit while the extraocular muscles, fat, and neurovascular elements populate the posterior half. The latter structures enter the apex of the orbit through the optic canal (for the optic nerve and ophthalmic artery) and the superior orbital fissure (for the oculomotor, trochlear, ophthalmic, and abducens nerves, and the superior ophthalmic vein). A superficial strata of extraocular muscles can be seen: superior oblique muscle follows the medial wall, lateral rectus muscle follows the lateral wall, and the levator palpebrae superioris muscle courses forward between these to the upper eyelid. The superior rectus muscle lies deep to the levator, and the medial rectus muscle lies deep to the superior oblique. The recti muscles attach in common to the annulus of Zinn or tendinous ring at the orbital apex. The optic, oculomotor (both superior and inferior divisions), abducens, and nasociliary nerves and the ophthalmic artery pass through this ring to enter the orbit while the frontal, lacrimal, and trochlear nerves and the superior ophthalmic vein do not. The ophthalmic artery, a branch of the internal carotid artery, enters the orbit with the optic nerve and gives rise to the lacrimal artery before crossing the optic nerve, in company with the nasociliary nerve, toward the medial side of the orbit. It gives rise to the posterior ciliary, supraorbital, and posterior and anterior ethmoidal branches. The latter pass through foramina on the medial wall of the orbit to supply ethmoid and sphenoid sinuses before entering the nasal cavity. The ophthalmic nerve typically gives rise to its "NFL" branches (nasociliary, frontal, lacrimal), which then enter the orbit through the superior orbital fissure. The lacrimal nerve courses along the lateral wall of the orbit (near the superior border of the lateral rectus) to the lacrimal gland. After passing through the annulus of Zinn, the abducens nerve enters the medial surface of the lateral rectus. Between this muscle and the optic nerve is the location of the ciliary ganglion, a parasympathetic ganglion that conveys postganglionic parasympathetic fibers (via short ciliary nerves) to the smooth muscle sphincter pupillae and ciliary muscles of the eyeball. Near this area, long ciliary nerve branches arise from the nasociliary nerve and follow along the course of the optic nerve to the eyeball where they provide sensory innervation. The frontal nerve courses forward in the orbit superficial to the levator palpebrae superioris and superior rectus muscles before dividing into the supraorbital (the larger of the two) and supratrochlear branches. At the apex of the orbit, the trochlear nerve bends medially (medial to the frontal nerve) to enter the superior border of the superior oblique muscle. The superior ophthalmic vein provides the principal venous drainage from the orbit and empties into the cavernous sinus. (Image courtesy of AL Rhoton, Jr.) 

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