Thyroid Related Eye Disease
Thyroid Related Eye Disease - Anatomy

 


 

    Eyelid and Orbital Anatomy

      Orbit 

       

        Orbit

      Orbital volume  and dimensions:  = 30 cc, 35(Height) x 45(Width) x 45 mm(medial wall depth), globe 25 x 25 mm

      Bones: (F)rontal, (M)axillary,(Z)ygomatic, (L)acrimal, (E)thmoid, (P)alatine, (S)phenoid

      • Roof
        • Bones
          • Frontal
          • Lesser wing of sphenoid
        • Contents
          • lacrimal gland fossa
          • trochlea 4mm posterior to margin for superior oblique tendon
          • Supraorbital notch/foramen
        • Clinical Correlations
          • subperisteal abscess
      • Medial wall
        • Bones
          • Maxillary
          • Lacrimal
          • Ethmoid - thinnest
          • Sphenoid
        • Contents
          • lacrimal sac fossa
          • cribiform plate is medial to anterior orbit at the level of fronto-ethmoidal suture
        • Clinical Correlations
          • Nasoclacrimal duct obstructions./tumors/DCRs
          • Medial wall fractures
          • subperisteal abscess
          • Orbital cellulitis/proptosis from ethmodial extension
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        • Floor

          • Bones
            • Maxillary- second thinnest, thins posteriorly
            • Zygoma
            • Palatine
          • Contents
            • infraorbital foramen
            • inferior oblique origin
            • slopes 20 degrees down
            • suspensory ligament of eyeball
          • Clinical Correlations
            • subperiosteal abscess
            • blow-out fractures
        • Lateral wall
          • Bones
            • Zygomatic bone
            • Greater wing of sphenoid
          • Contents
            • lateral orbital tubercle is 11mm below F-Z suture,
              • serves as attachment of check ligament of lateral rectus
          • Clinical Correlations
            • Tripod fractures
            • Ruptured globes
            • Lateral tarsal strips
            • adjacent to middle cranial fossa, temporal fossa, and pterygopalatine fossa

        Clinical Correlations

         

        • The medial orbital walls are nearly parallel and are 25 mm apart
        • The orbit is widest not at its entrance, but 1 cm from the orbital rim

         

        Holes & Fissures

         

        Fissures

        • Superior orbital fissure (SOF):
          • 22 mm long
          • separates greater wing of sphenoid from lesser wing of sphenoid
          • transmits third, fourth, sixth and V1 AND SYMPATHETIC FIBERS
          • lateral rectus origin separates into superior and inferior divisions
            • Superior division transmits lacrimal, frontal and trochlear nerves
            • Inferior division transmits superior and inferior divisions of CN III, nasociliary branch of CN V, CN IV, superior ophthalmic vein, and sympathetic nerve plexus
            • Venous system: superior ophthalmic vein
        • Inferior orbital fissure (IOF)
          • Located between lateral orbital wall and the orbital floor
          • Transmits V2 ( maxillary) , pterygoid nerves  nerve arising from pterygopalatine ganglion
          • infraorbital nerve (a branch of V2) enters the infraobital groove and infraorbital canal for sensation to lower eyelid, cheek, upper lid, upper teeth
          • Venous system inferior ophthalmic vein
        • Holes/Notches/Canals
          • Nasolacrimal canal Nasolacrimal canal
            • lacrimal sac fossa to the inferior meatus
            • separates greater wing of sphenoid from lesser wing of sphenoid
            • transmits third, fourth, sixth and V1 AND SYMPATHETIC FIBERS
            • lateral rectus origin separates into superior and inferior divisions
              • Superior division transmits lacrimal, frontal and trochlear nerves
              • Inferior division transmits superior and inferior divisions of CN III, nasociliary branch of CN V, CN IV, superior ophthalmic vein, and sympathetic nerve plexus
              • Venous system: superior ophthalmic vein
            • Supraorbital foramen/notch
              • transmits blood vessels
              • supraorbital nerve
              • Anterior/posterior ethmoidal foramen: transmits ethmoidal blood vessels and nerve
              • Zygomatic foramen: transmits zygomaticofrontal and zygomaticotemporal nerves, zygomatic artery
              • Nasolacrimal duct (NLD): exits into inferior meatus
              • Infraorbital canal: transmits infraorbital nerve (V2)
            • Ethmoidal foramina
              • anterior ethmoidal artery
              • posterior ethmoidal artery
              • allows infections and neoplasms to enter to orbit from the sinuses
            • Optic Canal
              • 8-10 mm long
              • located within the less wing of sphenoid
              • separated from SOF by OPTIC STRUT
              • Transmits. Ophthalmic nerve, ophthalmic artery, sympathetic nerves
              • Optic foramen is 6.5 mm wide: it may be enlarged in the presence of optic nerve glioma; 1 mm of asymmetry between right and left is abnormal

               

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      Anophthalmos

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      Eyelid Laxity

      Lacrimal System

      Thyroid Disease

      Anatomy

      Eyelift

      Blepharospasm

      Coronal Brow

      Evaluation

      Ectropion

      Congenital Blocked

      Graves

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      Entropion

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      Lid Retraction

      Motility Photos Wrinkles Direct Brow Punctal Plugs Floppy Eyelid Dacryocystitis Decompression
      References References Mechanism In-Direct Brow Restasis Trichiasis Lacrimal Trauma Treatments

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