Orbit: superior orbital fissure syndrome: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Orbit: superior orbital fissure syndrome

Sample item

A 40-year-old man after a midface fracture has ptosis, a fixed dilated pupil, complete ophthalmoplegia and loss of sensation over the forehead and upper eyelid. Visual acuity is normal and cheek sensation is intact. Which statement best localises the lesion?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Superior orbital fissure, since the optic nerve runs in the optic canal and the maxillary nerve in the foramen rotundum

The superior orbital fissure transmits the oculomotor, trochlear and abducens nerves, the ophthalmic division of the trigeminal nerve and the superior ophthalmic vein. A lesion there paralyses all eye movements and the sensation of the forehead, while vision is preserved because the optic nerve travels in the optic canal. Involvement of the optic nerve as well indicates an orbital apex syndrome.

Option by option

  • A. Orbital apex, since the optic nerve is spared in apex lesions

    Apex lesions involve the optic nerve and would reduce visual acuity.

  • B. Foramen rotundum, since it transmits the oculomotor, trochlear and abducens nerves

    The foramen rotundum transmits only the maxillary nerve.

  • C. Superior orbital fissure, since the optic nerve runs in the optic canal and the maxillary nerve in the foramen rotundum (correct)

    Correct. The pattern matches the contents of the fissure, with the optic and maxillary nerves passing through other openings.

  • D. Inferior orbital fissure, since it transmits the ophthalmic division of the trigeminal nerve

    The inferior orbital fissure transmits the infraorbital nerve and vessels, not the ophthalmic division.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is C, Superior orbital fissure, since the optic nerve runs in the optic canal and the maxillary nerve in the foramen rotundum. The superior orbital fissure transmits the oculomotor, trochlear and abducens nerves, the ophthalmic division of the trigeminal nerve and the superior ophthalmic vein.

Why is "Orbital apex, since the optic nerve is spared in apex lesions" not the answer?

Apex lesions involve the optic nerve and would reduce visual acuity.

Why is "Foramen rotundum, since it transmits the oculomotor, trochlear and ab…" not the answer?

The foramen rotundum transmits only the maxillary nerve.

Why is "Inferior orbital fissure, since it transmits the ophthalmic division…" not the answer?

The inferior orbital fissure transmits the infraorbital nerve and vessels, not the ophthalmic division.

What concept does this question test?

It tests Orbit: superior orbital fissure syndrome in Anatomy. A lesion there paralyses all eye movements and the sensation of the forehead, while vision is preserved because the optic nerve travels in the optic canal. Involvement of the optic nerve as well indicates an orbital apex syndrome.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Orbit: superior orbital fissure syndrome?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.