Chapter 1

A thorough understanding of the anatomy of the eye, orbit, visual pathways, upper cranial nerves, and central pathways for the control of eye movements is a prerequisite for proper interpretation of diseases having ocular manifestations. Furthermore, such anatomic knowledge is essential to the proper planning and safe execution of ocular and orbital surgery. Whereas most knowledge of these matters is based on anatomic dissections, either postmortem or during surgery, noninvasive techniques—particularly magnetic resonance imaging (MRI), ultrasonography, and optical coherence tomography (OCT)—are increasingly providing additional information. Investigating the embryology of the eye is clearly a more difficult area because of the relative scarcity of suitable human material, and thus there is still great reliance on animal studies, with the inherent difficulties in inferring parallels in human development. Nevertheless, a great deal is known about the embryology of the human eye, and—together with the recent expansion in molecular genetics—this has led to a much deeper understanding of developmental anomalies of the eye.

The Orbit (Figures 1–1 and 1–2)

The orbital cavity is schematically represented as a pyramid of four walls that converge posteriorly. The medial walls of the right and left orbit are parallel and are separated by the nose. In each orbit, the lateral and medial walls form an angle of 45°, which results in a right angle between the two lateral walls. The orbit is compared to the shape of a pear, with the optic nerve representing its stem. The anterior circumference is somewhat smaller in diameter than the region just within the rim, which makes a sturdy protective margin.

Figure 1-1

Anterior view of bones of right orbit.

Figure 1-2

Medial view of bony wall of left orbit.

The volume of the adult orbit is approximately 30 mL, and the eyeball occupies only about one-fifth of the space. Fat and muscle account for the bulk of the remainder.

The anterior limit of the orbital cavity is the orbital septum, which acts as a barrier between the eyelids and orbit (see Eyelids later in this chapter).

The orbits are related to the frontal sinus above, the maxillary sinus below, and the ethmoid and sphenoid sinuses medially. The thin orbital floor is easily damaged by direct trauma to the globe, resulting in a “blowout” fracture with herniation of orbital contents into the maxillary antrum. Infection within the sphenoid and ethmoid sinuses can erode the paper-thin medial wall (lamina papyracea) and involve the contents of the orbit. Defects in the roof (eg, neurofibromatosis) may result in visible pulsations of the globe transmitted from the brain.

Orbital Walls

The roof of the orbit is composed principally of the orbital plate of the ...

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