Anatomy of the orbit

Anatomy of the orbit
ROLE OF EYE IN ENT

1. Anatomical aspects of ent in relation to eye DR. SATINDER PAL SINGH

2. Anterior view of the skull

3. right orbit shows the 7 bones that contribute to its structure

4. The structures entering through the superior orbital fissure are as follows: Cranial nerves (C.N.) III, IV, and VI Lacrimal nerve Frontal nerve Nasociliary nerve Orbital branch of middle meningeal artery Recurrent branch of lacrimal artery Superior orbital vein Superior ophthalmic vein

5. The structures entering through the inferior orbital fissure are as follows: Infraorbital nerve Zygomatic nerve Parasympathetics to lacrimal gland Infraorbital artery Infraorbital vein Inferior ophthalmic vein branch to pterygoid plexus

6. Osseous relationships of the orbit. (A) Anterior view of the right orbit. (B) Anterior aspect of the right optic canal.

7. (C) Roof of the right orbit viewed from below. (D) Superior aspect of the floor of the anterior cranial fossae that forms the roof of both orbits.

8. (E) Floor of the right orbit viewed from above. (F) Inferior aspect of the roof of the maxillary sinus, which also forms the floor of the orbit.

9. MEDIAL WALL OF ORBIT Stankiewick sign- By pressing the eye check lamina Related to ethmoids Lamina is 2mm above the maxillary ostium Lacrimal bone is smallest and most fragile of the cranial bones.

10. Chandler’s classification of orbital inflammation PRESEPTAL CELLULITIS ORBITAL CELLULITIS

11. 5. CAVERNOUS SINUS THROMBOSIS . 3. SUBPERIOSTEAL ABSCESS 4. ORBITAL ABSCESS .

12. Pathophysiology of the Spread of Infection Direct invasion through compromised bony barriers Retrograde septic thrombophlebitis (ophthalmic vein via the pterygoid venous plexues ). Erosive osteomyelitis ( osteomyelitic bone erosion ).

13. Direct invasion through compromised bony barriers

14. Lateral view of the medial wall of the right orbit.

15. Lacrimal bone Lamina papyracea Posterior ethmoidal foramen Anterior ethmoidal foramen

16. Orbital complications of sinusitis. Computed tomography scan of a patient with a right orbital abscess.

17. Sequence of spread

18.  right orbit shows superficial landmarks

19. A patient with cavernous sinus thrombosis . This immunocompromised diabetic 76-year-old man with fungal sinusitis presented with marked proptosis , chemosis , ophthalmoplegia , and complete visual loss .

20. Axial contrast (CT) scan revealing (A) thrombosis of the superior ophthalmic vein (single arrow) and right cavernous sinus (double arrows) in an 11-year-old who presented with right orbital pain and periorbital edema.

21. Axial (h) and coronal (i) CT of a left anterior ethmoidal mucocele , demonstrating thinning/dehiscence of the fovea ethmoidalis , cribriform plate, and lamina papyracea , and invasion of the medial left orbit.

22. Coronal (j) bone and soft tissue algorithm CT of a left anterior ethmoidal mucocele , demonstrating thinning/dehiscence of the fovea ethmoidalis , cribriform plate, and lamina papyracea , and invasion of the medial left orbit .

23. Coronal CT of an immunocompromised patient with invasive fungal rhinosinusitis . Note the aggressive-appearing morphology, with Invasion of adjacent structures. a hallmark of fungal infection.

24. a patient with large tumor probably arising on the lateral wall of the nose and ethmoids , extending laterally into the maxillary sinus and anteriorly into the soft tissues of the cheek, displacing the eye laterally and superiorly . Coronal CT scan of the same patient showing a large " antroethmoidal " tumor.

25. Frontal sinus trephination Eye moved downward farward laterally

26. Axial ( left) and coronal ( right) T1-weighted contrast-enhanced magnetic resonance images for a patient with progressive vision loss and a large cavernous hemangioma of the left orbital apex ( white arrows).

27. (CT) scan of the orbits of a 35-year-old female a mass in the left orbit that obliterates superior and medial structures of the orbit, compared with normal structures in right orbit. The mass also involves the left ethmoid sinuses.

28. OPTIC NERVE DECOMPRESSION

29. Descending process for /. nasal concha Crest Lacrimal hamulus Groove for lacrimal Articulates with frontal bone Left Lacrimal bone

30. The Lacrimal Apparatus

31. Landmarks for dcr Anterior lacrimal crest Posteroir lacrimal crest Lacrimal fossa Medial canthus Medial palpebral ligament

32. Graves Disease Exophthalmos Proptosis and diplopia Corneal ulceration from exposure and Keratopathy Visual loss from optic neuropathy. Fusiform swelling of muscles COCA COLA SIGN During endoscopic orbital decompression for treatment of Graves orbitopathy , the maxillary sinus serves as the gateway to the orbital floor. Successful endoscopic decompression depends on the creation of a wide maxillary antrostomy .

33. Dalrymple’s sign -retraction of upper lid Von Graefe’s sign - lid lag Gifford’s sign- difficulty in eversion of lid Stellwag’s sign- infrequent blinking

34. Extraocular muscle enlargement marked with white arrow in coronal soft tissue CT scan ( A) and axial CT scan (B). Note the orbital apex crowding.

35. Children are more susceptible to orbital complications of RS due to the thinness of their sinus walls and bony septa, greater bony porosity, open suture lines, and larger vascular foramina. Pediatric patients with orbital infections caused by sinusitis can present with decreased visual acuity, gaze restriction, diminished pupillary reflex, and proptosis . The severity of these infections can range from eyelid edema, to abscess of the orbital soft tissues to cavernous sinus thrombosis. Cavernous sinus thrombosis occurs because of retrograde spread of orbital infection through the valveless orbital veins and is a life-threatening condition.

36. FACIAL NERVE PARALYSIS Incomplete closer of eye results in Epiphora Exposure keratitis Bells phenomenon ( eyeball turn up and out) Crocodile tears ( gustatory lacrimation )

37. Sjogren’s syndrome Xerostomia Keratoconjunctivitis sicca Rhinitis sicca OTITIC HYDROCEPHALUS Dilplopia Papilledeoma and otic atrophy Nystagmus

38. Trauma part Naso -orbital fractures Telecanthus , due to lateral displacement of medial wall of orbit. Peri orbital ecchymosis Orbital haematoma FRACTURE OF ZYGOMA (TRIPOD FRACTURE) Step deformity of infraorbital margin Oblique palpebral fissue Restricted ocular movments Diplopia Periorbibal Emphysema

39. Fractures of orbital floor Also known as Blow out fractures Ecchymosis of lid, conjunctiva and sclera Enophthalmos with inferior displacement of eyeball Diplopia due to Inferior rectus trapped Tear drop sign on WATER’S VIEW. Infraorbital / Trasnantral reduction of fracture.

40. Fractures of maxilla Le Fort I (transverse) fracture Le Fort II (pyramidal) fracture Le Fort III (craniofacial dysjunction )

41. traumatic facial palsy of a child with complete facial paralysis owing to Bell’s palsy, top row. results 2 months after middle cranial fossa decompression of the labyrinthine segment and geniculate ganglion of the facial nerve , bottom row.

42. CSF RHINORRHOEA

43. SLEEP APNEA Primary open angle glaucoma P.O.A.G. Due to decreased oxygenation of optic nerve during sleep apnea. LABYRINTHITIS Vestibular imbalance Nystagmus COGAN’S SYNDROME Episodic vertigo Interstitial keratitis SNHL - ve serology for syphilis.

44. Juvenile nasopharyngeal angiofibroma Frog-Face Deformity It extend to inferior orbital fissure and destroy Apex of orbit. Enter the orbit via Superior orbital fissure

45. Nasopharyngeal carcinoma Squint and diplopia due to C.N. VI m/c. Ophthalmoplegia C.N. III, IV and VI Reduced corneal reflex invasion of C.N. V through F. Lacerum . Exophthalmos and blindness due to direct invasion of C.N. II. C.N. IX, X and XI Jugular foramen syndrome

46. Optic canal and superior orbital fissure.

47. Ct (C) and mri (D) demonstrati ng direct skull base and orbital invasion of an adenoid cystic carcinoma . Note the intrinsic T2 hyperintensity of the lesion, unusual among sinonasal soft tissue malignancies .

48. OCULOMOTOR (III) NERVE DAMAGE AT REST LATERAL STRABISMUS DUE TO PARALYZE MEDIAL RECTUS PTOSIS-DROOPING EYELID

49. ABDUCENS (VI): AT REST MEDIAL STYLABISMUS (CROSS-EYED) DUE TO DAMAGE/PARALYZE LATERAL RECTUS A. ABDUCENS ( VI) NERVE DAMAGE

50. WAllenberg syndrome (Pica) Vertigo, nausea and vomiting Horner’s syndrome Dysphaiga Dysphoina Ataxia with tendency to fall to involved side Loss of pain and temperature sensations on same side of face and contralateral sides of limibs .

51. GARDENIGO SYNDROME EAR DISCHARGE (S.O.M.) DIPLOPIA(C.N. VI paralysis) RETRO-ORBITAL PAIN (C.N. V involve) LATERAL SINUS THROMBOPHLEBITIS Papilledema Blurring of disc margins Retinal hemorrhage Crowe-Beck test

52. ALLERGIC RHINITIS EDEMA OF LIDS CONGESTION COBBLESTONE CONJUNCTIVA ALLERGIC SHINERS (dark circles under the eyes)

53. Usher’s syndrome Hearing loss Retinitis pigmentosa RACOON SIGN Ecchymosis around eye’s in case of head injuries

54. VAN DER HOEVE SYNDROME osteogenesis imperfecta otosclerosis and blue sclera

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