The superior orbital fissure is a slit-like opening between the greater and lesser wings of the sphenoid that connects the middle cranial fossa with the orbit. It transmits the oculomotor, trochlear, abducent and ophthalmic nerve branches (lacrimal, frontal and nasociliary) and the superior ophthalmic vein.
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| Ossification | Formed as the gap left between the lesser wing (ossifying in cartilage) and the greater wing (ossifying mainly in membrane) of the sphenoid during fetal life. |
Fractures or masses involving the fissure produce superior orbital fissure syndrome, with ophthalmoplegia, ptosis, a fixed dilated pupil and forehead numbness. If the optic nerve is also affected, the picture is called orbital apex syndrome. The fissure is an important route for spread of infection or tumour between the orbit and the cavernous sinus.
Compression of cranial nerves III, IV, V1 and VI at the fissure, usually by a fracture or haematoma, causing paralysis of eye movement, ptosis and forehead numbness.
Superior orbital fissure syndrome plus optic nerve involvement, causing visual loss, from trauma, infection or tumour at the orbital apex.
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