MUSCLES OF THE ORBIT
DR.S.MELANI RAJENDRAN
7 Voluntary muscles:
Levator palpebrae superioris
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
3 Involuntary muscles :
Superior & Inferior tarsal muscles
Orbitalis
Eye lid muscle:
Levator palpabrae superioris –
triangular sheet of muscle,
involuntary part(Muller’s muscle).
EXTRINSIC MUSCLES OF THE
ORBIT
7 Voluntary muscles:
Levator palpebrae superioris
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
3 Involuntary muscles :
Superior & Inferior tarsal
muscles
Orbitalis
Eye lid muscle:
Levator palpabrae superioris –
triangular sheet of muscle,
EXTRAOCULAR MUSCLES
The extraocular muscles act on the eyeball
and produce movements of the eye ball
EXTRAOCULAR MUSCLES
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
FEATURES OF SOME MUSCLES
Largest muscle –Medial
rectus
Strongest muscle-medial
rectus
Smallest muscle-Inferior
oblique
Longest muscle-Superior
oblique
Muscle that passes through
the pulley- Superior oblique
Muscle that has 2 heads-
lateral rectus.Between its 2
heads,passage of
nasociliary nerve
RECTI MUSCLES
Origin:All recti arise from the
common tendinous ring(Tendon
of Zinn).
Insertion: Into the sclera in front
of the equator of the eyeball and
behind the limbus in a spiral
manner(Spiral line of Tillaux)
INSERTION OF THE RECTI
Behind the sclero-
corneal junction
Medial rectus -
5.5mm
Inferior rectus -
6.5mm
Lateral rectus-7mm
Superior rectus-7.5.
(Along the spiral line
of Tillaux)
SPIRAL OF TILLAUX
OBLIQUE MUSCLES
SUPERIOR OBLIQUE:
Longest extrocular muscle
ORIGIN:
Undersurface of lesser
wing of the sphenoid
Nearer the optic foramen
medial and above
the tendinous ring.
Passes forwards above the
medial rectus upto the
superior orbital margin.
Forms a rounded tendon.
Passes through the pulley
attached to trochlear
notch.
Then turns backwards
laterally & downwards
below superior rectus.
Insertion: Into the
superolateral part of the
sclera behind the
equator.
INFERIOR OBLIQUE
Origin: From the
maxilla in the floor of
the orbit, lateral to
nasolacrimal notch.
Course: Passes
backwards and
laterally below the
inferior rectus.
Insertion: Lower
lateral quadrant of
the sclera behind
equator
NERVE SUPPLY
Superior oblique – Trochlear nerve (SO4)
Lateral rectus – Abducent nerve(LR6)
Rest of the muscles – Oculomotor nerve.
Inner fibres of levator palpabrae superioris
( Muller’s muscle) by Sympathetic fibres.
MOVEMENTS OF EYEBALL
Axes of movement-
Transverse Axis –
Elevation, depression
Vertical Axis–
Adduction,abduction
Anteroposterior Axis–
Intortion, Extortion
Convergence and
divergence
ACTIONS OF EXTRAOCULAR
MUSCLES
IO SR
LR MR
SO IR
MOVEMENTS OF EYEBALL
IO SR
Elevation:SR,IO
Depression:IR,SO
Medial
rotation:MR,SR,IR
Lateral
LR
rotation:LR,IO,SO MR
Intortion:SO,SR
Extortion:IO,IR
Adduction:MR of both
sides
Abduction:LR of same
SO IR
side,MR opposite side
CONJUGATE MOVEMENTS
Both eyes move in same
direction
MOVEMENTS AROUND AXIS
Around transverse
axis:Elevation :50
degrees
Depression:50 degrees
Around vertical
axis:medial rotation or
adduction:50 degrees
Lateral rotation or
abduction:50 degrees
SMOOTH EXTROCULAR
MUSCLES
Superior tarsal
muscle
Inferior tarsal
muscle
Orbitalis
Supplied by
sympathetic fibres
from superior
cervical ganglion
LEVATOR PALPEBRAE SUPERIORIS
Origin: Undersurface of
lesser wing of the
sphenoid above the
common tendinous
ring.
Course: Passes
anteriorly beneath the
roof of the orbit above
the superior rectus.
Close to the orbital
margin ends in an
aponeurosis.
INSERTION & NERVE SUPPLY
The aponeurosis divides
into three slips.
These are inserted into
1. Skin of upper eyelid,
2. Superior tarsal plate and
3. Superior conjunctival fornix
respectively from above
downwards.
The fibres inserted in the
tarsal plate is composed of
smooth muscle fibres –
Muller’s muscle. (PTOSIS)
Voluntary fibres-superior division of
oculomotor nerve.
Inner fibres of levator palpabrae
superioris
( Muller’s muscle) by Sympathetic
fibres.
APPLIED ANATOMY
Ptosis
Strabismus (squint) – paralysis of individual muscles
L.rectus – Internal , paralysed side affected
M.rectus – external, sound side affected
Sup & inf Rec – diplopia on looking up & down
Sup. Oblique – diplopia on looking down(double vision)
Inf. Oblique - diplopia on looking up
SQUINT
OPHTHALMIC ARTERY
OPHTHALMIC ARTERY
A branch of the internal
carotid artery, given off
immediately after the ICA
has left the cavernous sinus.
It traverses the optic canal
with the optic nerve and
enters the orbit.
Crosses the optic nerve
superiorly from lateral to
medial side.
While crossing,it is
accompanied by nasociliary
nerve and superior
ophthalmic vein
Runs along the medial
margin of orbit
Ends at the medial
end of upper eyelid by
dividing into – Supra
trochlear and Dorsal
nasal arteries.
OPHTHALMIC ARTERY -
BRANCHES
BRANCHES – IN OPTIC CANAL
1.Lacrimal artery:
arises laterally to the optic
nerve, supplies the
lacrimal gland, the
the lateral sides of the
upper eyelid.
2. Central artery of retina
Enters the optic nerve and
supplies the retina. It is an
end artery
WHILE CROSSING THE OPTIC NERVE
3. Supra orbital artery
4. Long and short posterior
ciliary arteries
5. Muscular branches
IN THE MEDIAL MARGIN OF ORBIT
6. Posterior ethmoidal
artery
7. Anterior ethmoidal
artery
TERMINAL BRANCHES
8. Dorsal nasal artery
9. Supra trochlear artery
OTHER ARTERIES
Forehead- supratrochlear
–
Ophthalmic artery
Supraorbital-Ophthalmic
artery
Upper and lower eye lids –
anastomoses between
medial and lateral
palpebral artery-
Nose_dorsal nasal artery
Lacrimal artery-lacrimal
gland,zygomatic
branches,lateral palpebral
branches
ARTERIAL SUPPLY OF EYELID
Infraorbital
artery(Max)-
palpebral. Nasal ,
labial branches-
lower eye lid,side
of nose,upper lip
Mental
artery(Max)-chin
COMMUNICATION BETWEEN EXTERNAL AND
INTERNAL CAROTID ARTERIES
OPHTHALMIC ARTERY -
BRANCHES
NERVE SUPPLY
Superior oblique – Trochlear nerve (SO4)
Lateral rectus – Abducent
nerve(LR6)
Rest of the muscles – Occulomotor
nerve.
Inner fibres of levator palpabrae superioris
( Muller’s muscle) by Sympathetic fibres.
THE OCULOMOTOR NERVE
• Nuclei – in the
midbrain at superior
colliculus level.
• Main motor nucleus
• Accessory
parasympathetic
nucleus
(Edinger-Westphal
nucleus)
FUNCTIONAL COMPONENTS OF
OCULOMOTOR NERVE
General somatic efferent fibres (GSE) – arise from main
nucleus & supply muscles of eyeball including levator
palpebrae superioris, EXCEPT Superior oblique & Lateral
rectus
General visceral efferent fibres (GVE) – arise from
Edinger-Westphal nucleus & supply sphincter pupillae &
ciliaris muscles thru’ ciliary ganglion
Emerges in the base of brain at interpeduncular fossa
medial to the crus cereberi between posterior cerebral &
Superior cerebellar arteries
Pierces the duramater at the occulomotor trigone
close to posterior clinoid process.
Traverses the cavernous sinus.
Divides into superior
and inferior branches
before entering the
orbit.
These enter via the
superior orbital
fissure and lie within
the common
tendinous ring.
DISTRIBUTION OF 3RD NERVE
Branch to inferior oblique
gives a communicating
twig to ciliary ganglion.
This carries preganglionic
parasympathetic fibres.
These fibres are derived
from Edinger Westpal
nucleus in the midbrain.
The postganglionic fibres
arise from the ganglion &
supplies the sphincter
pupillae & Ciliaris muscle.
Responsible for light &
acommodation reflexes.
APPLIED SIGNIFICANCE
Oculomotor nerve palsy:
Eye is fixed in lateral & downward rotation—Lateral
squint (unopposed action of Lat rect & Supr obliq).
Pupil dilated due to unopposed action of dilator pupillae –
supp by symp fib accompanying nasociliary nerve
Loss of accomodation
Drooping of upper eyelid / Ptosis due to paralysis of
Levator palpebrae superioris
Diplopia & Mild proptosis
TROCHLEAR NERVE
Arises from the tectum
of the midbrain at
Inferior collicular level.
Nerve fibres from the
nucleus pass posteriorly
around the central grey
matter to reach the
posterior surface of
midbrain.
Decussates with nerve
of opposite side.
CONNECTIONS OF TROCHLEAR
NERVE
With Cerebral hemispheres
With visual cortex
With 3rd, 6th & 8th cranial nerves thru’
Medial longitudinal fasciculus
\
Winds round the crus cerebri & emerges lateral to it
between posterior cerebral & superior cerebellar arteries.
Most slender cranial nerve, Only cranial nerve that
emerges from the posterior surface of midbrain
Runs forwards in middle cranial fossa.
Pierces the dura & runs in the the lateral wall of
cavernous sinus.
Enters orbit through Superior orbital fissure.
In the orbit, it ascends
and turns medially,
Crossing above the
levator palpebrae
superioris to enter the
Upper border of the
superior oblique
muscle.
APPLIED SIGNIFICANCE
Trochlear nerve palsy:
Superior oblique is the only depressor of eyeball in
adduction, hence in this palsy, eye is extorted &
elevated due to unopposed action of Inferior oblique
Diplopia
THE ABDUCENT NERVE
Nucleus lies
beneath floor of
upper part of IV
ventricle, close to
midline beneath
the facial colliculus
in the lower pons.
FUNCTIONAL COMPONENTS OF
ABDUCENT NERVE
General somatic efferent (GSE) fibres arise from
Abducent nucleus & supply only Lateral rectus
muscle of eyeball
Arises from the brainstem between the pons and the medulla
opposite pyramid.
Passes through the
cavernous sinus.
Enters the orbit via the
superior orbital fissure
within the common
tendinous ring.
It supplies the lateral
rectus muscle.
DISTRIBUTION OF ABDUCENT NERVE
Entirely motor in function
Supplies only Lateral rectus muscle of eyeball,
which rotates eyeball laterally
ABDUCENT NERVE PALSY
Paralysis of Lateral rectus : Medial or
Convergent squint, due to unopposed action of
Medial rectus Diplopia.
OPHTHALMIC NERVE
Arises as one of
the divisions of
trigeminal
ganglion in the
middle cranial
fossa at cavum
trigeminale.
Before entering the
orbit, in the lateral
wall of cavernous
sinus it divides into 3
branches-
The Nasociliary
nerve.
The Lacrimal nerve.
The Frontal nerve.
THE LACRIMAL NERVE
Receives a branch
from the zygomatic
nerve, which carries
parasympathetic
postganglionic
fibres for lacrimal
gland.
Ends by supplying
the conjunctiva &
lateral part of the
upper eyelid.
THE FRONTAL NERVE
About midway across the
orbit, divides into 2
terminal branches-
The Supratrochlear
nerve: Supplies the
conjunctiva and the skin
of the upper eyelid &
the lower medial part of
the forehead.
The Supra-orbital nerve:
Supplies the upper
eyelid, conjunctiva,
forehead & the middle
of the scalp.
THE LACRIMAL NERVE
Receives a branch
from the zygomatic
nerve, which carries
parasympathetic
postganglionic
fibres for lacrimal
gland.
Ends by supplying
the conjunctiva &
lateral part of the
upper eyelid.
BRANCHES
The Long Ciliary nerves:
Sensory to the eyeball,
but may also contain
sympathetic fibres.
The Posterior Ethmoidal
nerve: Supplies posterior
ethmoidal cells & the
sphenoidal sinus.
The Infra trochlear
nerve: Supplies the
medial part of the upper
& lower eyelids, lacrimal
sac, skin of the upper
half of the nose.
CILIARY GANGLION
• It is a parasympathetic
ganglion of the
Oculomotor nerve.
• It is associated with the
Nasociliary nerve.
Situation: At the apex of
orbit, between the optic
nerve & tendon of lateral
rectus.
PARASYMPATHETIC ROOT
Arises from Infr oblique branch
of III nerve
Contains pre-ganglionic
parasympathetic fibres from
Edinger-Westphal nucleus.
Fibres relay in the ganglion
New Post-ganglionic fibres from
ganglion pass via short ciliary
nerves & supply Sphincter
pupillae & Ciliaris muscle
SENSORY ROOT
Given by nasociliary
nerve to the
ganglion.
Passes through the
ganglion without
relay.
Carries sensory fibres
and travels along the
short ciliary nerves.
Responsible for the
sensory innervation of
the eyeball.
THE SYMPATHETIC ROOT
Contains post
ganglionic sympathetic
fibres from the superior
cervical ganglion.
They continue along
the short ciliary nerves.
They distribute to the
ciliary ganglion via the
sensory root.
They innervate the
dilator pupillae muscle.
OPTIC NERVE
OPTIC NERVE
Second cranial
nerve. It is not a
true cranial nerve
Origin-ganglionic
layer of the retina
CLINICAL ANATOMY
Damage to optic
nerve-total
blindness
Damage to optic
tract-Homonymous
hemianopia
