Superior Orbital Fissure 👁️ Anatomy & Structures Passing Through

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Superior Orbital Fissure 🧠👁️ Anatomy & Structures Passing Through

The superior orbital fissure is one of the most high-yield neuro-orbital gateways tested on USMLE Step 1, and this video explains its anatomy and contents in a clear, cadaveric-correlated and exam-ready manner 🧠👁️📚. Located between the greater and lesser wings of the sphenoid, the superior orbital fissure connects the middle cranial fossa with the orbit and serves as a major conduit for ocular motor nerves and sympathetic fibers. Structures passing through include oculomotor nerve (CN III) supplying most extraocular muscles, trochlear nerve (CN IV) to superior oblique, ophthalmic division of trigeminal nerve (V1) via its branches lacrimal, frontal and nasociliary for corneal and orbital sensation, abducens nerve (CN VI) to lateral rectus, and sympathetic fibers to the dilator pupillae traveling with the cavernous sinus plexus ⚡. The superior ophthalmic vein also traverses the fissure, draining orbital blood into the cavernous sinus, making this region clinically critical in cavernous sinus thrombosis. USMLE-favorite clinical correlations include superior orbital fissure syndrome, presenting with ophthalmoplegia, ptosis, proptosis, and loss of corneal sensation while sparing optic nerve function, which helps differentiate it from optic canal lesions. Understanding the precise anatomy, nerve relationships, and clinical implications of the superior orbital fissure is essential for mastering orbital apex pathology, cranial nerve lesions, and neuro-ophthalmology questions on exam day ❤️🧠.

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