Anatomy of the Orbit

The structures of the orbit, unlike much of the intracranial space or the nose, contain soft tissue structures designed to tolerate some degree of displacement/compression. It is critical for surgeons to be aware of the leniency with which orbital structures can be safely manipulated during orbital and skull-based surgery to optimally preserve functionality. Life-changing surgical complications, such as vision loss due to hemorrhage, ischemia, or direct damage to the optic nerve, ocular surface, eyelids, and extraocular muscles, may arise from injury. The tolerance for intraoperative manipulation, especially in instances of an already-compromised blood supply (e.g., sphenoid wing meningioma) is an important consideration. Dynamic retraction of orbital contents is essential, so that the eye may periodically reperfuse during surgery. Herein, we discuss the orbital anatomy knowledge vital for working in the orbit and when the orbit is used as a conduit to the intracranial space.