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ModeratorDr. Sanjeev BhattaraiPresented by:Sarmila AcharyaSantosh Pandit 2nd year

EYELIDS: Layers, Nerve Supply, Vascular Supply,Functions & Clinical Correlation

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Presentation LayoutIntroductionEmbryology AnatomyLayers of EyelidsGlands of EyelidsFunctions Nerve SupplyVascular SupplyDrainage SystemClinical Correlations

IntroductionAn eyelid is a mobile, flexible, multilamellar structure that covers globe anteriorly.

Assist in distribution of tears over the anterior surface of the eyeball.

Provide protection from excessive light, desiccation and air borne foreign matter.

EmbryologyDerived from surface ectoderm

Starts as a proliferation in the region future outer canthus at 4-5 weeks gestation

Mesodermal mesencyhme infiltration during 2nd month

Fusion at 10 weeks gestation

Orbicularis condensation at 12 weeks gestation

Eyelid adhesions break down during 5-6th month

Clinical SigCryptophthalmos coloboma

Microblepharon

The Anatomy Of The Eyelids:Extention:eyebrow superiorlycheek inferiorlyEyelid folds/sulcus:Upper eyelid: orbital part , tarsal partFormed by the insertion of the aponeurotic fibers of LPS into the skinLower eyelid - less obvious Formed by few connections between the skin and the orbicularis oculi muscle.(with age, Nasojugal sulcus & Malar sulcus are formed)

CanthiEyelids meet at medial and lateral canthiMedial canthus: Rounded, -separated from globe by Lacus lacrimalis (tear lake)Lateral canthus:- 5-7mm from lateral orbital margin,-60 deg with eyes wide open,-30-40 deg with eyes open in a normal way-About 2 mm above the medial canthus

Epicanthus dermal fold across the medial canthus

Eyelid Margins- 2mm wide, round anterior border & sharp posterior border

contdEyelid margin is divided into 2 portion by lacrimal papilla.Lacrimal portion: -medial portion of the eyelid margin -extending from the punctum medially to medial canthal angle. -Round & devoid of lashes and glandsCiliary portion: -From punctum to lateral canthal angle -Contains lashes at anterior border & sharp posterior border

contd Gray line-Correspond histologicaly to the muscle of Riolan- relatively avascular areaGrayEyelashes emerge anteriorlyPosteriorly opening of meibomian gland (just anterior to mucocutaneous junction)

contInterpalpebral Fissure: - the exposed zone between the upper and lower eyelid- 8 to 11 mm vertically- 27 to 30 mm horizontallyWidth of the palpebral fissure is determined by the level of tonic activity in the levator palpebrae superioris and the sympathetically innervated Mullers Muscle

Position:In primary positionUpper eyelid margin is at 1.5-2mm below the superior corneal limbusLower eyelid margin is at inferior corneal limbus

EyelashesArranged in 2 to 3 rows.Upper lid: 100-150 in number and directed upward, forward and backwardLower lid : 50-75 in number and directed forward, downwards and backwardTaper throughout the length to end in a fine sharp pointLife span : 3 to 4 months(cilia have no erector muscle)

Layers Of The Eyelids: (From front to back)SkinSubcutaneous Areolar TissueLayers of Striated MusclesSubmuscular Areolar TissueFibrous LayerNon Striated Muscles FibresConjunctiva

Skin:Palpebral skin is thinnest in body ( preauricular Lymph Node and deep parotid nodes-> deep cervical Lymph Node.

Medial part of Upper lid, medial 2/3 of Lower Lid and medial canthus-> submandibular Lymph Node-> internal jugular vein.

Clinical corelations of eyelids Hordeolum Externum (Stye) Localized suppurative inflammation of gland of zeis at lid margin at ciliary follicle.

Hordeolum Internum Hordeolum Internum is a suppurative inflammation of meibomian gland associated with the blockage of the duct.

ChalazionChalazion is chronic inflammatory granuloma of meibomian gland

Blepharitis Blepharitis is chronic inflammation of lid margin occurring as true inflammation.

Meibomitis (posteriorBlepharitis)

inflammation and obstruction of meibomian glands. Characterized by diffuse thickening of posterior border of lid margin which becomes rounded.

Entropion Inward rolling and rotation of lid margin toward globe.

Ectropion

out rolling or outward turning of lid margin.

Lagophthalmos Incomplete closure of the palpabral aperture when attempt is made to close the eyes.

Ptosis Drooping of upper lid usually due to paralysis or defective development of the levator palpebrae superioris (LPS)

BlepharospasmIt is the involuntary, sustained and forceful closure of the eyelids.

SymblepharonIt is a partial or complete adhesion of the palpebral conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball.

AnkyloblepharonIt is an adhesion of the ciliary edges of the eyelid to each other.

Clinical correlations of eyelashesTriachiasis Inward misdirection of cilia.Distichiasis Extra row of cilia occupies the position of Meibomian glands which opens into their follicles.

Madarosis Partial or complete loss of eyelashes.

Poliosis Whitening of eyelashes.

ReferenceAnatomy and Physiology of eye = A.K KhuranaComprehensive Opthalmology = A.K KhuranaSection 7 - Orbit_ Eyelids_ and Lacrimal System ( American Academy of Ophthalmology ) Previous presentation Internet

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