Minim Invasive Neurosurg 2006; 49(3): 156-160
DOI: 10.1055/s-2006-944241
Original Article
© Georg Thieme Verlag Stuttgart · New York

The Microsurgical Anatomy of the Ciliary Ganglion and its Clinical Importance in Orbital Traumas: An Anatomic Study

Y.  Izci1 , E.  Gonul1
  • 1Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey
Further Information

Publication History

Publication Date:
18 July 2006 (online)


The ciliary ganglion can easily be injured during surgery for the repair of orbital fractures and laterally situated intraorbital mass lesions. The aim of this study is to elucidate the microsurgical anatomy of the ciliary ganglion and to emphasize its clinical importance in orbital traumas and surgeries. The orbits of 10 adult cadavers were fixed with 10 % formalin and dissected under the microscope with special attention to the presence and location of the ciliary ganglion. The motor (parasympathetic), sympathetic, and sensory roots, and the short ciliary nerves were exposed. Its relationship with other intraorbital neural and vascular structures were investigated. Some anatomic landmarks were determined and the distances between these landmarks were measured. The ciliary ganglion is an intraorbital neural structure approximately 3 mm in size, situated near the orbital apex, posterolateral to the globe in loose areolar tissue between the optic nerve and lateral rectus muscle. The mean distance between the ganglion and the optic nerve was 2.9 mm (range: 2.70 - 3.10 mm) and the mean distance between the lateral rectus muscle and the ganglion was 10.4 mm (range: 9.20 - 11.20 mm). Six to 10 short ciliary nerves arise from the ganglion and run forward in a curving manner with the ciliary arteries above and below the optic nerve. The ciliary ganglion should be taken into the account especially during lateral approaches to the orbit and the patients should be warned before the surgery about possible mydriatic or tonic pupils as a complication.


  • 1 Gray H. Anatomy: Descriptive and Surgical. London: Parragon 1994: p 500-500
  • 2 Sinnreich Z, Nathan H. The ciliary ganglion in man (anatomical observations).  Anat Anz Jena. 1981;  150 287-297
  • 3 Morard M, Tcherekayev V, Tribolet N. The superior orbital fissure: A microanatomical study.  Neurosurgery. 1994;  35 1087-1093
  • 4 Duke-Elder S T. System of Ophthalmology, Vols 2 and 12. London: H. Kimpton 1971: p 662-662
  • 5 Walsh F B, Hoyt W F. Clinical Neuro-Ophthalmology. 3rd edn, Vol. 4. Baltimore: The Williams & Wilkins Company 1969: p 496-496
  • 6 Arai H, Sato K, Katsuta T, Rhoton A L. Lateral approach to intraorbital lesions. Anatomic and surgical considerations.  Neurosurgery. 1996;  39 1157-1163
  • 7 Demiroğlu U, Esen A N, Arvas S. Anatomy of the orbit and clinical importance in traumas.  Turk J Med Biol Res. 1990;  1 170-178
  • 8 Kuchiiwa S, Kuchiiwa T, Suzuki T. Comparative anatomy of the accessory ciliary ganglion in mammals.  Anat Embryol. 1989;  180 99-205
  • 9 Sacks J G. Peripheral innervation of extraocular muscles.  Am J Ophthalmol. 1983;  95 520-527
  • 10 Johnston J A, Parkinson D. Intracranial sympathetic pathways associated with the sixth cranial nerve.  J Neurosurg. 1974;  39 236-243
  • 11 Gonul E, Timurkaynak E. Lateral approach to the orbit: An anatomical study.  Neurosurg Rev. 1998;  21 111-116
  • 12 Gonul E, Timurkaynak E. Inferolateral microsurgical approach to the orbit: An anatomical study.  Minim Invas Neurosurg. 1999;  42 137-141
  • 13 Natori Y, Rhoton A L. Transcranial approach to the orbit: Microsurgical anatomy.  J Neurosurg. 1994;  81 78-86
  • 14 Natori Y, Rhoton A L. Microsurgical anatomy of the superior orbital fissure.  Neurosurgery. 1995;  36 762-775
  • 15 Gurwood A, Lehn L. Tonic pupils.  Optometry today. 1999;  39 37-39
  • 16 Slamovits T L, Glaser J S. The pupils and accommodation. In: Glaser JS (Ed). Neuro-Ophthalmology. Philadelphia: JB Lippincott 1990
  • 17 Slamovits T L, Glaser J S. The pupils and accommodation. In: Tasman W, Jaeger EA (Eds). Duane's Clinical Ophthalmology CD ROM. Philadelphia: JB Lippincott 1998
  • 18 Bodker F S, Cytryn A S, Putterman A M, Marschall M A. Postoperative mydriasis after repair of orbital floor fracture.  Am J Ophthalmol. 1993;  115 372-375
  • 19 Gonul E, Erdogan E, Duz B, Timurkaynak E. Transmaxillary approach to the orbit: An anatomic study.  Neurosurgery. 2003;  53 935-942
  • 20 Hornblass A. Pupillary dilatation in fractures of the floor of the orbit.  Ophthalmic Surg. 1979;  10 44-46
  • 21 Stillwater L B, Levine P A. Anisocoria with orbital floor fractures. Worry and wait.  Otolaryngol Head Neck Surg. 1981;  89 882-888
  • 22 Stromberg B V, Knibbe M. Anisocoria following reduction of bilateral orbital floor fractures.  Ann Plast Surg. 1988;  21 486

Yusuf Izci, M. D. 

Department of Neurosurgery · Gulhane Military Medical Academy

06018 Etlik



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