The lacrimal nerve is the smallest branch of the ophthalmic division of the trigeminal nerve (V1). It enters the orbit through the superior orbital fissure lateral to the frontal nerve and runs along the lateral orbital wall to reach the lacrimal gland. It provides sensory innervation to the lacrimal gland, the conjunctiva of the lateral upper eyelid, and the lateral skin of the upper eyelid. It also carries parasympathetic secretomotor fibres from the zygomaticotemporal branch of V2 to the lacrimal gland.
| Origin | Ophthalmic division of the trigeminal nerve (V1) |
|---|---|
| Course | Enters the orbit through the superior orbital fissure lateral to the frontal nerve, runs along the upper border of lateral rectus to the lacrimal gland, receiving a communication from the zygomaticotemporal nerve that carries parasympathetic secretomotor fibres |
| Sensory |
|
The lacrimal nerve is the last link in the secretomotor pathway to the lacrimal gland: fibres from the superior salivatory nucleus travel in the greater petrosal nerve, relay in the pterygopalatine ganglion and reach the lacrimal nerve through the zygomaticotemporal communication. A facial nerve lesion at or above the geniculate ganglion interrupts this pathway and causes an ipsilateral dry eye. After facial nerve injury, regenerating salivary fibres may be misdirected into the lacrimal pathway, producing tearing while eating (crocodile tears). The nerve is at risk in lateral orbital wall approaches for orbital decompression in thyroid eye disease.
Injury to the lacrimal nerve or its secretomotor connections during lateral orbital surgery reduces tear secretion, producing dry eye that needs lubrication and occasionally punctal occlusion.
After Bell's palsy or other facial nerve injury, aberrant regeneration sends salivary fibres to the lacrimal gland so the eye waters during meals; severe cases respond to botulinum toxin injected into the lacrimal gland.
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