EYE-SOCKET

From Big Medical Encyclopedia

EYE-SOCKET (orbita) — a deep hollow in a skull, in a cut the eyeglobe with its auxiliary device is located. Pair symmetric education.

Anatomy

Fig. 1. Bone walls of an eye-socket: 1 — lamina orbitalis ossis ethmoidalis; 2 — incisura supraorbitalis; 3 — canalis opticus; 4 — os frontale; 5 — fissura orbitalis sup.; 6 — ala major ossis sphenoidalis; 7 — os zygomaticum; 8 — fissura orbitalis inf.; 9 — crista lacrimalis post.; 10 — crista lacrimalis ant.

At the person has the form of a tetrahedral pyramid, the blunted top a cut is turned to a head cavity, and the wide basis to its front face (fig. 1). Average sizes G.: length of a perednezadny axis (depth) at the adult fluctuates ranging from 4 to 5 cm; horizontal diameter (width) at an entrance to it makes apprx. 4 cm, and vertical (height) usually does not exceed 3,5 — 3,75 cm.

The strongest bone wall of G. is lateral (paries lat.), formed in a front half of malar (os zygomaticum) and partly by a frontal bone (os frontale), and in back — a big wing of a wedge-shaped bone (ala major ossis sphenoidalis). Upper wall of G. (paries sup.) it is formed by generally frontal bone, and only insignificant part in a structure of its back department is taken by a small wing of a wedge-shaped bone (ala minor ossis sphenoidalis). B of the medial interior of an upper wall is put a frontal sinus (sinus frontalis). The upper wall of G. separates contents it from a front cranial pole and, therefore, from a head cavity and a brain. Medial wall of G. (paries med.) it is formed by hl. obr. a sievebone (os ethmoidale), its orbital plate (lamina orbitalis), to a cut the lacrimal bone (os lacrimale) and a frontal shoot of an upper jaw (processus frontalis maxillae), and behind in the depth of G. — a body of a wedge-shaped bone (corpus ossis sphenoidalis) in front adjoin; an upper part of an internal wall is formed by a frontal bone. From all walls of G. medial is the thinnest; it separates G.'s contents from an ethmoidal labyrinth (labyrinthus ethmoidalis). Lower wall of G. (paries inf.) it is formed by hl. obr. the orbital surface of an upper jaw (facies orbitalis maxillae), to a cut the malar, and in back — an orbital shoot of a palatal bone adjoins in the forefront (processus orbitalis sup. palatini); this wall separates G. from a genyantrum (sinus maxillaris).

Almost at the top of G. the opening apprx. 4 mm in the diameter representing the beginning of the bone channel (canalis opticus) 5 — 6 mm long serving for passing of an optic nerve (n. opticus) and an eye artery (a. ophthalmica) to a head cavity is located rounded shape.

In the depth of G. on border between upper and lateral walls there is a big crack — upper orbital (fissura orbitalis sup.), the connecting G.'s cavity with a head cavity (an average cranial hole). Through it there pass nerves of eye (n. ophthalmicus), oculomotor (n. oculomotorius), usually divided into two branches — top and bottom, taking-away (n. abducens), block (n. trochlearis), and also top and bottom orbital veins (vv. ophthalmicae sup. et inf.).

On border between lateral and lower walls of G. the lower orbital crack is located (fissura orbitalis inf.), G. conducting from a cavity in pterygopalatine and infratemporal poles and serving for passing of an infraorbital nerve (n. infraorbitalis) together with the artery of the same name and a vein, skulovisochny (item zygomaticotemporalis), skulolitsevy (n. zygomaticofacialis), a venous anastomosis between G.'s veins and a veniplex of a pterygopalatine pole. On a medial wall of G. lobbies and back trellised openings are located (foramina ethmoidalia ant. et post.), serving for passing of the nerves of the same name, arteries and veins from G. in an ethmoidal labyrinth and a nasal cavity (nervi, arteriae et venae ethmoidales ant. et. post.). In the thickness of the lower wall of G. the infraorbital furrow (sulcus infraorbitalis) passing kpered into the canal of the same name opening on a front face the corresponding opening (foramen infraorbitale) is located; in this channel there passes the infraorbital nerve with the artery of the same name and a vein. On border of upper and medial walls of G. near a first line the bone thorn — spina trochlearis is located.

In upper lateral part G., at once behind its edge, there is a deepening — a pole of the lacrimal gland (fossa glandulae lacrimalis).

The pole of a dacryocyst (fossa sacci lacrimalis) is a bed for a dacryocyst (saccus lacrimalis) and is located between two bone crests — to lobbies (crista lacrimalis ant.), belonging to a frontal shoot of an upper jaw, and back (crista lacrimalis post.), belonging to the lacrimal bone. The pole of a dacryocyst passes into the bone lacrimonasal canal (canalis nasolacrimalis) put in the thickness of a medial wall of a genyantrum and opening in the closing nasal stroke under the lower nasal sink from top to bottom.

G.'s walls are covered by thin, but quite dense periosteum (periorbita).

Fig. 2. Sagittal cut of an eye-socket: 1 — m. levator palpebrae sup.; 2 — conjunctiva palpebrarum; 3 — bulbus oculi; 4 — m. obliquus inf.; 5 — vagina bulbi; 6 — m. rectus inf.; 7 — n. opticus; 8 — m. rectus sup.

G.'s edge corresponding to the quadrangular basis of an orbital pyramid forms a so-called entrance to G. (aditus orbitae). Its borders are determined by the line of an attachment of a tarsoorbitalny fascia (fascia tarsoorbitalis), edge, being interwoven into cartilages a century (see), makes together with them as if a front wall of G. — an orbital partition (septum orbitale). In G.'s cavity there are an eyeglobe, a fascia, muscles, vessels, nerves, the lacrimal gland and a fatty tissue (fig. 2).

The vagina of an eyeglobe — a tenonov a bag (vagina bulbi) with fascial bonds with muscles, a periosteum and G.'s bones is a part of the copular (fascial) device G. (see. Eye ).

The muscular device G. includes 6 muscles of an eyeglobe (4 direct muscles and 2 slanting) and, besides, the muscle raising an upper eyelid (m. levator palpebrae sup.).

Blood supply including also an eyeglobe, it is carried out by a branch internal carotid artery (see) — an eye artery (a. ophthalmica). Veins G. (vv. ophthalmicae sup. et inf.) pour out the blood in a cavernous sine (sinus cavernosus).

Fig. 3. An eye-socket (lateral, a part top and bottom walls nerves are removed, allocated): 1 — glandula lacrimalis; 2 — n. frontalis; 3 — nn. ciliares breves; 4 — n. nasociliaris; 5 — ganglion ciliare; 6 — n. opticus; 7 — n. ophthalmicus; 8 — n. infra trochlearis; 9 — n. supraorbitalis.

Nerves. The main sensory nerve for fabrics G. is the optic nerve (n. ophthalmicus, fig. 3) — the 1st branch trifacial (see). Having departed from a node of a trifacial (ganglion trigeminale) in a head cavity, it gets into G. through an upper orbital crack, and usually within a crack it is branched on 3 main branches: the lacrimal nerve (n. lacrimalis), nasociliary nerve (n. nasociliaris) and frontal nerve (n. frontalis).

Motor nerves of G. (for muscles of an eye) are oculomotor, taking away and block. On an axis G. from a back pole of the eyeball to the visual channel goes optic nerve (see).

In upper outside part G., in a pole of the lacrimal gland, the lacrimal gland (glandula lacrimalis) lies. Between all anatomic educations of G. stated above the fatty tissue (corpus adiposum orbitae) is located.

A radioanatomy

Complete idea of G.'s radioanatomy can be gained by means of a number of standard projections (mental and nasal, frontonasal, side), special projections for the channel of an optic nerve and the lower orbital crack, and also options of laying in slanting projections.

Apply to more detailed research of bone structures of G. X-ray analysis (see) with direct blowup, tomography (see), stereox-ray analysis (see), and also G.'s X-ray analysis after introduction to a vagina of an eyeglobe of high-atomic contrast agents (orbitografiya) or gas (pnevmoorbitografiya).

Fig. 4. The roentgenogram of eye-sockets in a nosopodborodochny projection; 1 — a frontal sinus; 2 — an eye-socket; 3 — an upper contour of an eye-socket; 4 - Medial wall of an eye-socket; 5 - cock crest; 6 — bottom edge of an eye-socket; 7 — a nasal partition; 8 — a trellised labyrinth; 9 — a genyantrum; 10 - frontal bone; 11 - frontal and malar seam.

On the front roentgenogram of G. (fig. 4) the upper contour is formed by a frontal bone and extends from a frontal and malar seam to a projection of a trellised labyrinth. Strongly developed frontal sinus partially is imposed on the image of an eye-socket.

On border between an upper and lateral wall of G. (between small and big wings of a wedge-shaped bone) the upper orbital crack connecting G.'s cavity to an average cranial pole is located. In this projection only a part of an upper orbital crack is visible. Takes part in formation of a lateral wall, except a big wing of a wedge-shaped bone, a malar, a malar shoot of a frontal bone. The enlightenment in the field of the seam connecting these anatomic educations (sutura zygomaticofrontalis) should not be taken for the line of a change. The lower wall is formed by a part of a malar, the orbital surface of a maxillary bone, an orbital shoot of a palatal bone. The wall is very thin and separates G. from a genyantrum.

At a X-ray analysis in a frontonasal projection (without caudal inclination of a tube) shadows of pyramids are projected in an eye-socket or at its bottom edge which at the expense of it can have an indistinct contour.

Fig. 5. The roentgenogram of eye-sockets in side projections: 1 — a frontal bone; 2 — an upper wall of an eye-socket 3 — the Turkish saddle; 4 — a wedge-shaped bosom; 5 — outer (temporal) edge of an eye-socket; 6 — the lower contour of an eye-socket; 7 — a genyantrum.

On the side roentgenogram of G. (fig. 5) the upper wall is presented in the form of an intensive strip, an upper contour a cut wavy, and lower more smooth. The side projection allows to determine depth of. Details are badly distinguishable since in this projection there is an imposing of shadows of both eye-sockets.

Methods of a research. At a research G. examine, a palpation, orbitotonometriya (see), diafanoskopiya (see), ultrasonic and radio isotope researches, a X-ray analysis, an angiography (arterio-and a venografiya) G.

Rentgenol, the research G. shall be conducted at G.'s tumor, unilateral protrusion of an eyeglobe (exophthalmos), retraction of an eyeglobe (enophthalmos), traumatic damages, atrophies of an optic nerve. At suspicion on existence of a foreign body of an eye or G. (see. Foreign bodys, eyes ) it is applied Baltina — Komberg a method (see). At arteriography on the party of the struck orbit enter triyodirovanny radiopaque substance into an internal carotid artery. At a venografiya it is entered into an angular or front facial vein.

Pathology

the Most often meeting a wedge, symptoms of diseases of IV are the exophthalmos, restriction of mobility of an eyeglobe, sometimes with a symptom of doubling (see. Diplopia ), changes from an optic nerve with disturbance of visual functions (see. Congestive nipple , Sight ). Patol. processes in F. can be local or display of any general disease.

Malformations are extremely rare and are, as a rule, combined with malformations of other bones. Most often inborn cysts meet (dermoid, epidermoid and cholesteatomas). They are followed by an anophthalmus and mikroftalmy which diagnosis does not represent difficulties. Dermoid and epidermoid cysts are localized usually in an upper corner of G., grow slowly. The cholesteatoma is localized always in the field of an upper part of an orbit. Nodes of a cholesteatoma are dense, hilly, are sometimes multiple. Treatment of these educations operational. Forecast favorable.

On origins damages divide on direct and indirect. Bone walls of G. quite thin and therefore at injuries are possible damages of various character. Also the combined glaznichnocherepny damages can take place (see. Cherepnomozgovaya injury ).

At a change and shift of walls of G. retraction of an eyeglobe is observed quite often (see. Enophthalmos ). Surgical treatment in such cases pursues the aim — to recover walls of. For this purpose use various synthetics (organic glass, tantalic plates, etc.).

At stupid injuries of a skull as a result of hit of air from adnexal bosoms of a nose emphysema of can develop in orbital cellulose. At the same time protrusion of an eyeglobe and crepitation is noted. Treatment — a compressing bandage.

Disturbance of blood supply. The alternating exophthalmos is characterized by protrusion of an eyeglobe at a ducking down and under the conditions leading to venous stagnation in an eye-socket. The varicosity of eye veins is the cornerstone of a disease. Treatment surgical: bandaging of eye veins.

The pulsing exophthalmos — usually result of an injury of an internal carotid artery. It is characterized, in addition to protrusion of an eye, by its pulsation, feeling of the blowing noise in the head, synchronous with pulse (see. Exophthalmos ).

Inflammatory diseases. Periostitis (see) and osteomyelitis (see) G. most often happen a tubercular origin, the malar preferential is surprised; process is characterized by a dermahemia and morbidity of a bone at a lateral root G. usually with the subsequent burrowing and the involved hem soldered to a bone; treatment specific. The syphilitic periostitis is observed seldom, is surprised most often the upper edge of G. Periostit can develop also as a result of an acute or stupid injury. The periostitis of verkhnevnutrenny edge of G. is observed at distribution of inflammatory process of adnexal bosoms of a nose (hl. obr. frontal).

Inflammatory hypostasis of orbital cellulose can be observed at acute diseases of adnexal bosoms of a nose (see. Antritis , Frontal sinusitis , Etmoidit ).

Thrombophlebitis of veins and phlegmon of.— purulent inflammation of orbital cellulose. Reasons of phlegmon: transition of a purulent inflammation from adnexal bosoms of a nose or suppurative focuses of skin a century and persons, is more rare — transmission of infection from more remote suppurative focuses. Develops most often at first as thrombophlebitis, and around eye veins small abscesses which merge further are formed. Process is more often unilateral. It is very difficult to differentiate thrombophlebitis of veins and G.'s phlegmon. Clinically they are characterized by severe hypostasis a century and conjunctivas of an eye (hemoz), a considerable exophthalmos, sharp restriction of mobility of an eye, severe pains in the area G. and a forehead, fervescence. At G.'s phlegmon the optic nerve often suffers. Treatment: an urgent massive antibioticotherapia, opening with the subsequent drainage of a cavity of an abscess. At timely begun and correctly carried out treatment the forecast favorable.

Tenonit — the inflammation of a vagina of an eyeglobe (a tenonovy bag) — is observed or as an independent disease, or in connection with an inflammation of an eyeglobe. It is characterized by a moderate exophthalmos, pains in G., small reddening and a chemosis of an eye. Reasons: rheumatism, flu and other infections. Treatment of a basic disease is carried out.

Parasitic diseases are very rare. In G. find parasitic cysts (an echinococcus, a cysticercus). Also the filariasis is observed. Cases of a trichinosis G.

Klin are described, the picture is caused by intensity of growth of a parasite, prescription of his stay and localization. Pains in G., an injection of vessels of an eyeglobe, a hyperemia are noted a century. In late stages — falling of sight, shift of an eyeglobe, an exophthalmos. Klien, diagnosis is difficult; treatment surgical.

The endocrine diseases leading to changes of an eye-socket. The endocrine exophthalmos is observed at a bazedovy disease (see. Craw diffusion toxic ) in combination with other symptoms of this disease. The special form of an endocrine exophthalmos is represented by the so-called progressing edematous exophthalmos (an ekzoftalmichesky ophthalmopathy, an ekzoftalmichesky ophthalmoplegia, the giperoftalmopatichesky syndrome, an adenogipofizarny ophthalmotropism, Greyvs's disease) considered as result of disorder of thyritropic hormonal activity of a hypophysis and disturbance of its functional linkages with diencephalic educations. The century and conjunctivas, paresis of eye muscles, frequent a diplopia, disturbance of sensitivity of a cornea, emergence of a keratitis, hypostasis and infiltration of orbital cellulose and muscles with transition to fibrosis is clinically characterized by sharp hypostasis of orbital and periorbital fabrics, considerable protrusion of eyeglobes, hypostasis. Treatment — a roentgenotherapy of area G. and a hypophysis, corticosteroids; at suspicion on the inflammatory nature of a disease — antibiotics.

Tumors. All tumors of G., as a rule, cause «an exophthalmos, and developing near an optic nerve lead to disturbance of visual functions. In diagnosis of tumors of G. the X-ray analysis and a tomography are of great importance; sometimes resort to an angiography.

From benign tumors the cavernous angiomas having the dense capsule meet more often. Also lymphangiomas, fibromas, neurofibromas, an osteoma, a neurinoma, etc. are sometimes observed. From an optic nerve gliomas, from covers of an optic nerve — a meningioma can develop.

Malignant tumors of G. — the sarcomas of various cellular texture developing from vessels, muscles, a periosteum; melanomas, and also crayfish planocellular and bazalnokletochny and adenocarcinomas, coming from the lacrimal gland.

Surgical treatment at G.'s tumors consists in their way simple or osteoplastic at a distance orbitotomies (see), sometimes it is necessary to resort to an ekzenteration of all contents of G. (see. Ekzenteration of an eye-socket ). In the cosmetic purposes perhaps further ekto-prosthetics by synthetics.

Operations

For access to G.'s cavity in the presence of an eyeglobe use two main methods: a simple orbitotomy and a bone orbitotomy with a temporary osteotomy of an outside bone wall of G. (see. Orbitotomy ).

See also Eye , Skull .


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M. L. Krasnov; T. D. Kostyukova (rents.).

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