Lecture 4 Orbital Vasculature

What is the main blood supply to the eye?

Ophthalmic artery

Where does the ophthalmic artery branch from?

ICA

Is there lymphatics in the orbital cavity?

No, except for lacrimal gland

What makes up the wall of the Cavernous Sinus?

CN III, CN IV, CN V1, CN V2

What is in the lumen of the Cavernous Sinus?

CN VI, ICA

What structure is anterior to the Pituitary gland?

Optic Chiasm

What runs around the Common Carotid Artery?

Sympathetic plexus

What bones make up the orbit?

Frontal, Zygomatic, Maxillary, Ethmoid, Sphenoid, Palatine, Lacrimal

What are the branches of the Ophthalmic Artery?

11 Branches

2 Ocular, 2 Orbital, 7 Branches

What are the 2 Ocular branches from Ophthalmic Artery?

Central Retinal Artery

Ciliary Arteries

What are the 2 Orbital branches of Ophthalmic artery?

Muscular Arteries, Lacrimal Artery

Where does the CRA pierce the optic nerve?

Pierces the dural sheath 5-15 mm posterior to sclera

What side does the CRA merge in the Optic Disc?

Nasal side, nasal to CRV

What comes from the Ciliary Arteries?

Short posterior ciliary arteries (20)

Long posterior ciliary arteries (2)

What does the LPCA supply/

Uvea anterior to equator

What does the SPCA supply?

Arterial circle of Zinn

Choroid posterior to Equator

What makes up the Circle of Zinn-Haller?

MPCA-medial (long) posterior ciliary arteries

LPCA- Lateral (long) posterior ciliary artery

ICA- Internal Carotid Artery

OA- Ophthalmic Artery

CZ- Circle of Zinn-Haller

CAR- Central Artery of Retina

Short posterior ciliary arteries- Col. Br

What are branches of Muscular Arteries?

Medial and Lateral trunk

Muscular arteries to RECTUS muscles branch to Anterior Ciliary Arteries

How many branches doe Anterior Ciliary Arteries have?

2 for each “rectus muscle” EXCEPT Lateral Rectus (one)

7 anterior ciliary arteries in total

What do Anterior Ciliary Arteries give rise to?

Major arterial circle of Iris

Anterior Conjunctival arteries

What are the branches of Lacrimal Artery?

Superior/Inferior lateral palpebral arteries

Zygomatic artery and branches

What are the Extra-Orbital branches of Ophthalmic artery?

Supraorbital artery

Posterior/Anterior Ethmoidal Artery

Recurrent Meningeal Artery

Medial Palpebral Arteries

Supratrochlear Artery (Terminal branch)

Dorsonasal Artery (Terminal Branch)

What does the Supraorbital Artery supply?

Scalp, Upper Eyelid

What anastomoses with Supraorbital Artery/

Supratrochlear artery and Superficial Temporal Artery (ECA)

What does the Anterior Ethmoidal Artery supply?

Anterior and MEDIAL ethmoidal air sinuses

Sphenoid sinuses

NASAL CAVITY and SKIN of nose

What does the Posterior Ethmoidal Artery supply?

Posterior ethmoidal and Sphenoid air sinuses

What does the Recurrent Meningeal artery supply?

Middle Cranial Fossa

***Posterior through SOF

What does the Medial Palpebral Arteries supply?

Part of eye lid

****Anastomose with lateral palpebral arteries

What are these arteries?

See Picture

What is the Palpebral Vasculature?

Lacrimal Artery (Lateral Part of Palpebrum)

Ophthalmic Artery (Medial part of Palpebrum)

What are the palpebral branches of Lacrimal Artery (Superior Lateral Palpebral Artery)?

Peripheral Palpebral Artery

Marginal Palpebral Artery

What are the Branches of Inferior lateral Palpebral Artery?

Peripheral Palpebral Artery

Marginal Palpebral Artery

What are the branches of Superior Medial Palpebral Artery? (Ophthalmic)

Peripheral Palpebral Artery

Marginal Palpebral Artery

What are the branches of Inferior Medial Palpebral Artery (Ophthalmic)

Peripheral palpebral artery

Marginal palpebral artery

What comes from Nasofrontal Artery?

Supratrochlear Artery

Dorsonasal Artery

What are the 2 terminal branches of Ophthalmic artery?

Dorsonasal

Supratrochlear

What does the Supratrochlear artery supply?

Skin of Medial Forehead and Scalp

What does Supratrochlear artery anastomose with?

Supraorbital A.

Contralateral Supratrochlear A.

Anterior temporal artery

What does the Dorsonasal Artery supply?

Lacrimal Sac

What does the Dorsonasal Artery anastomose with?

Angular artery

What is the Angular artery?

Facial artery

***Changes name at ala of nose

What does the Infraorbital artery branch from?

Maxillary artery

What are the 2 terminal branches of ECA?

Maxillary artery

Superficial Temporal artery

What does the Superficial Temporal artery supply?

Lateral region around the orbit.

What does the ECA/ICA anastomoses with? (orbit)

ICA

• Supraorbital A

• Supratrochlear A

• Lacrimal A

ECA

• Angular A

• Infraorbital A

• Anterior Temporal Branch of Superficial Temporal A.

What are important characteristics of Venous Drainage in Orbit?

NO VALVES

Freely anastomose

Tortuous

Direct blood flow due to posture/gravity

What drains the retina?

Central Retinal Vein

Where does the Central Retinal Vein drain to?

Superior Ophthalmic vein or Cavernous sinus

What drains Bulbar Conjunctiva?

Anterior Ciliary Veins

Where do Anterior Ciliary Veins drain to?

Muscular veins to Superior/Inferior Ophthalmic Vein (depending if superior/inferior muscular veins)

What drains lower cheek and lower eyelid?

Infraorbital Vein

Where does Infraorbital Vein drain to?

Pterygoid Venous Plexus

What is the largest vein in the orbit?

Superior Ophthalmic Vein

What two veins make up the Superior Ophthalmic Vein?

Supraorbital and Angular Vein

What vein is the floor of the orbit?

Inferior Ophthalmic Vein

What drains to Inferior Ophthalmic Vein?

IR, IO, LR, Lower Conjunctiva, Lacrimal Sac, Lower vortex veins.

Where does IOV drain to?

Pterygoid venous plexus, SOV, or Cavernous sinus

What is found outside of Common Annular Tendon?

SOV, LN, FN, CN IV, IOV

What drains the Anterior face?

Angular and Facial Veins

Do the tunics of the eye have lymphatic drainage?

NO

Fibrous tunic (Sclera and Cornea)

Vascular Tunic (Uvea, iris, Ciliary body, Choroid)

Neural Tunic (retina)

What in the orbit contains lymphatics?

Conjunctiva, Lacrimal Gland, Eyelids

Where does lymph from Medial Half of Orbit drain to/

Submandibular Lymph Nodes

Where does lymph from Lateral half of Orbit drain to

Preauricular lymph nodes