Dr. Mrinmayee Ghatak (DOMS Final Year)Dr. Ankit Punjabi (DOMS Final Year)

Dept of Ophthalmology,KIMS Hospital, Bangalore, Karnataka, INDIA

Email: dr.mrin@gmail.com

1)Extent

2)Lid folds

3)Position of eyelids

4)Canthi

5)Eyelid Margins

6)Eyelashes

7)Palpebral aperture or fissure

Gross Anatomy

Upper eyelid From eyebrow downward to end in a free

margin Superior boundary of palpebral fissure

Lower eyelid Merge into skin of cheek

Superior lid fold Orbital & tarsal portion Formed by fibrous slips, from tendon

of levator Inferior lid fold

On skin of lower eyelids Fibrous slips from fascia of inferior

rectus

In primary position of gaze Upper eyelid covers 1/6th of cornea

Lower eyelid just touches the cornea

2-3 rows

When lids close eyelashes do not interlace

Cilia 20 – 120 microns Taper & end in fine point Lifespan 3-4 months

Glands of Zeis & Moll- empty into infundibulum of each piliary gland

Elliptical space b/w upper & lower lid margins

At Birth Horizontally– 18 to 21 mm Vertically -- 8mm

In Adults 28 to 3o mm (hor) 9 to 11 mm (ver)

Caucasians & the X- axis Mongoloid & antimongoloid slant

From without inwards, each lid has following layers:1) Skin2) Layer of subcutaneous areolar

tissue3) Layer of striated muscles4) Sub muscular areolar tissue5) Fibrous layer6) Layer of non-striated muscle fibres7) Conjunctiva

Elastic , fine texture, thinnest in the body Epidermis

› 6-7 layers , stratified squamous epithhelium› Basal layer- unicellular sebaceous glands,

sweat glands Dermis

› Thin layer , dense connective tissue› Rich network : BV, elastic fibers, lymphatics,

nerve› Variable no. of melanocytes

Beneath the skin No fat Readily distended by blood/ oedema Nonexistent

› Near ciliary margin› At lid folds› Medial & lateral angles

Orbicularis muscle , thin oval sheet across eyelids

Upper eyelid- also has levator muscle

From anterior part of the medial palpebral ligament & adjacent bones

Cover orbital margins , large ellipse , meet at lateral palpebral raphe

Intermingle with frontalis

MUSCULUS SUPERCILIARIS MUSCULUS MALARIS

Preseptal fibres

Pretarsal fibres

› Deep head & superficial head› From lacrimal fascia, posterior

lacrimal crest, MPL› Pass superiorly & inf. In front of

orbital septum› Unite at lateral palpebral raphe

Deep head› From lacrimal fascia & post. Lacrimal crest

Superficial head› From medial palpebral ligament

Overlying upper & lower tarsus Join laterally to form lateral canthal

tendon It is inserted over lateral orbital

tubercle of WHITNALL Pars lacrimalis (Horner’s muscle) Pars ciliaris (muscle of Riolan)

Orbital part› Forced closure of eyelids› Thus pull eyebrows downwards

Palpebral part› Helps in gentle closure during blinking,

sleep, soft voluntary closure Entire muscle supplied by branches of

7th nerve

Origin Course & attachments Superior transverse ligament of

Whitnall Nerve supply & action

At apex of orbit Under surface of lesser wing of

sphenoid Above Annulus of Zinn Short tendon Blended with origin of SR

Ribbon like belly Axis slightly nasal Medial & lateral horns Aponeurosis passes through septum

orbitale LPS inserted – pretarsal skin of lid-

sup.lid fold Thickened posterior part- ant tarsal

surface Few fibrous slips – post.LPS- sup.conj.

Fornix Check lig. Of LPS

Thickened band of orbital fascia From trochlear pulley to the

capsule of orbital lobe of lacrimal gland

How is it formed?? Importance in ptosis surgery…

Branch of superior division of 3rd nerve

Elevator of upper lid

Layer of loose connective tissue

b/w orbicularis muscle & fibrous layer

Nerves & vessels lie in this layer

Splits lid into anterior & posterior lamina

Superiorly communicates with subaponeurotic layer of scalp

Framework of the lids

Central thick part- tarsal plate

Peripheral thin part- septum orbitale/ palpebral fascia

Framework of the lids

Central thick part- tarsal plate

Peripheral thin part- septum orbitale/ palpebral fascia

Dense fibrous tissue, skeleton of lids 29mm long, 1mm thick Dimensions of upper & lower tarsus Borders – septum orbitale, muller’s

muscle Surfaces Extremities Tarsal glands embedded in

substance of tarsal plates

Thin , floating membrane of connective tissue

Takes part in all movements of lids

Thin , floating membrane of connective tissue

Takes part in all movements of lids

Lacrimal vessels & nerves Supraorbital vessels & nerves Supratrochlear artery & nerve Infratrochlear nerve Anastomosing vein b/w angular &

ophthalmic Superior & inferior palpebral arteries Aponeurosis of levator muscle in

upperlid Expansion of inferior rectus in lower

lid

Lacrimal vessels & nerves Supraorbital vessels & nerves Supratrochlear artery & nerve Infratrochlear nerve Anastomosing vein b/w angular &

ophthalmic Superior & inferior palpebral arteries Aponeurosis of levator muscle in

upperlid Expansion of inferior rectus in lower

lid

Triangular band of connective tissue Attached to frontal process of

maxilla From ant. Lacrimal crest To suture line of frontal process with

nasal bone Divided into 2 parts

› Ant. part of MPL› Post. part of MPL

Triangular band of connective tissue Attached to frontal process of

maxilla From ant. Lacrimal crest To suture line of frontal process with

nasal bone Divided into 2 parts

› Ant. part of MPL› Post. part of MPL

Thin band Lateral- whitnall’s tubercle Anterior surface- lat.palpebral raphe Posterior surface- check ligament of LR Upper border- aponeurosis of levator

muscle Lower border- IO ,IR

Modified sebaceous glands Structure Microscopy

epithelium on basement membrane Cuboidal cells actively dividing

Secretion Sebum, prevents lashes becoming dry Oily layer of tear film

Modified sweat gland

Gross structure Unbranched spiral shape Fundus, body, ampullary portion & neck

Microscopic structure Secretory part- cylindrical cell b/w cells & bm – myoepithelial cells Ducts lined by one/two layers of cells

Mainly by medial & lateral palpebral arteries

Marginal Arterial arcades Medial palpebral + lateral palpebral

Superior or peripheral arterial arcade Superior branches of medial palpebral artery

Tarsal arcades Superficial temporal artery Transverse facial artery Infraorbital artery

Pretarsal Venous Plexus Superficial to the tarsus Angular vein– Internal jugular vein , sup.

temporal, lacrimal vein External jugular vein

Post-tarsal venous plexus Structures posterior to tarsal plate Ophthalmic veins

Sympathetic nerves Supply Muller’s muscle Vessels & glands of skin

Arrangement of Nerves Submuscular plane Forward branches for orbicularis & skin Backward to tarsal structures & conjunctiva