The eyelids are thin folds of skin that protect the eye. They have three main functions - protection, regulation, and maintenance. The eyelids develop from embryonic processes and have several layers including skin, muscle, orbital fat, and conjunctiva. They are supplied by nerves from the oculomotor, trigeminal, and facial cranial nerves as well as the sympathetic nervous system. The eyelids help to spread tears and protect the eyes.

1. THE EYELID
Dr. Samten Dorji
PG Resident Ophthalmology

2. The eyelids are movable folds
which has the thinnest skin of the
whole body.
 Protection
 Regulation
 Maintenance

3. Outline
 Embryology
 Surface anatomy
 Structural layers
 Blood supply
 Innervation

4. Embryology
A-Fertilized ovum
B-Morula
C-Blastula
Forebrain , midbrain and hind
brain

5. Segmentation
• Maxillary process- lower
eyelid(six weeks gestation)
• Frontonasal process- upper
eyelid
(A) Eyelid fusion (8 to 10 weeks'
gestation)
(B) Development of margin
structures (3 to 4 months'
gestation);
(C)Eyelid dysjunction (5 to 6

6. Lid fusion
Lid structures gestation
Lateral canthus 6 weeks
Fusion of eyelids 10 weeks
Riolan muscle 12 weeks
Hair bulbs of eye lashes 12 weeks
Mebomian glands 13 weeks
Apocrine Moll’s gland 13- 16 weeks
Sebaceous glands(Zeis) 13-16 weeks
Levator palpebrae
superioris
10 weeks
Separates from superior
rectus
12-16 weeks
Desmosal adhesions
are formed.

7. Lid dysjunction
 The epithelial adhesions break down
at the end of fifth month of gestation
and completed by sixth month
Causes
 Holocrine production of lipids from the
meibomian glands.
 Keratinization of the lid margin.
 Pull of the developing eyelid
retractors.

8. Cryptophthalmia
(ablepharon)
Micro blepharia
Lid coloboma

9. Surface anatomy
8-
11mm
5mm
3mm
The nasojugal fold
Malar fold
Superior palpebral
sulcus
Inferior palpebral
sulcus

10. 8-11mm
27-30mm Palpebral fissure
Medial canthus
Lateral canthus
2mm
15mm
• The upper eyelid rests at the upper
limbus in the child and about 1 to 2
mm below the upper limbus in the
adult.
• The lower eyelid is generally found at
the level of the lower limbus.

11. Thyroid orbitopathy
Horner’s syndrome

12. Structural layers
 Skin and sub cutaneous tissue
 Muscles of protraction
 Orbital septum
 Orbital fat
 Muscles of retraction
 Tarsus
 Conjunctiva
Anterior lamella
Posterior lamella
Middle lamella

13. Skin
• Thinnest of the body(<1mm)
• Finer hairs and more
sebaceous glands
10
mm
• Reconstructive eyelid
surgery

15. Epidermis
• stratified squamous epidermis
• basal cells, melanocytes,
Langerhans cells, keratinocytes and
stratum corneum
• 0.05mm
Dermis
• is made up of threadlike
proteins including bundles of
elastin and collagen,
fibroblasts, nerves and vessels.

16. Subcutaneous tissue
• Loose connective tissue
• Negligible fat

17. dermatochalasis
blepharochalasis

18. Eye lashes
• The human eyes are protected and lined by
eyelashes
• Each eyelid has a single row of eyelashes.
Upper eyelid Lower eyelid
Longer Shorter
Curve upward Curve downward
100 50
• Each eyelash has a three phases of growth cycle
1. Anagen phase- hair grows actively for a period of
thirty to forty five days.
2. Catagen phase- eyelash stops its growth, and the
follicle starts to shrink.
3. Telogen phase - eyelash rests, and stays in this
phase for about a hundred days till it falls out
naturally.
If the eyelash is pulled out or falls off, it will take as
long as seven to eight weeks to grow back.

19. Orbicularis oculi muscle
 One of superficial muscles of facial
expression
 Protractor of the eye lid
 Superficial musculoaponeurotic
system
 Orbital part and palpebral part
Forced closure Blinking and voluntary winking

20. ORBITAL PART-D
• Wide circular fashion
• Interdigitate with muscles
of expression
• Curved origin
• Horse shoe shaped
MUSCLES OF RIOLAN

21. PRE TARSAL PART-F
• Anterior to tarsus
• Superficial and deep origins
associated with medial palpebral
ligaments
• Inserts into lateral canthal area
HORNER’S MUSCLE
PRE SEPTAL PART-E
• Overlie the orbital septum
• Superficial and deep origins
associated with medial palpebral
ligaments
• Form the lateral palpebral raphe

22. Orbital septum
• Thin multilayered sheet of fibrous
tissue.
• Arises from the periosteum of
orbital rim.(arcus marginalis)
• It is thickest at the arcus marginalis
laterally and is thinnest in the lower
lid medially.

23. Joining of orbital septum and
levator aponeurosis(2-5mm
above superior tarsal border)
Joining of septum and
capsulopalpebral fascia(4 -5 mm
below the inferior tarsus)

24. Clinical application
 The orbital septa provides barrier to
anterior or posterior extravasation of
blood or the spread of inflammation.
 Infectious processes anterior to the
septa are considered to be more
benign than those posterior to the
septa.
 Functionally, the suborbicularis oculi
fibroadipose layer and the
multilayered orbital septum change
with movement, enhancing eyelid and
eyebrow mobility.

25. Thinning of septum in old age(bourrelet senile)

26. Orbital fat
 Fat within the orbit and adnexa serve
as a protective cushion within which
the eyeball moves

27. Central fat pad
Nasal fat pad
Temporal fat
pad
Central fat padNasal fat pad
• Less fibrous tissue
• surrounded by a thin translucent
connective tissue capsule
• Important surgical landmark to the
levator aponeurosis immediately
beneath it.
• More fibrous
• Often herniates
through a weakened
orbital septum.
• Inferior to the lateral
canthus
• Posteriorly is divided by inferior oblique
muscle
• direct communication with the deeper
extraconal fat of the orbit.
Delicate fibrous septal
attachments to the
trochlea
Fibrous extension from the
periorbita and orbital septum.

28. Retractors
Upper eyelid Lower eyelid

29. Levator palpebrae superioris
• Origin- lesser wing of
sphenoid bone.
• Muscular portion is 40mm
long.
• Striated muscle
Whitnall’s ligament
• Represents a transition
zone
• 14-20 mm above the
superior border of the
tarsus.
• Suspensory support for the
upper eyelid

30. • Lateral and medial horn
• Medial horn attaches to medial
canthal ligament
• Lateral horn attaches to the
lateral orbital tubercle.
• At 2 -5mm above the superior
tarsal border it joins with orbital
septum .
• insert primarily on superior
tarsus, with the strongest
attachments 3 mm from the lid
margin.

31. Muller’s muscle
Levator muscle
Superior edge
of tarsus
• Smooth muscle
• Sympathetically innervated
• 2mm elevation
12-
14mm
• Arises from underside of levator
palpebrae superioris
• Inserts on superior tarsal border

32. Horner’s syndrome
Grave’s disease

33. Inferior rectus muscle
Fibrous extension
Capsulopalpebral head
capsulopalpebral head splits to
surround the inferior oblique muscle
Capsulo palpebral
fascia
• insert on the inferior
border of the inferior
tarsus
Inferior tarsal
muscle
• Smooth
muscle
• Sympatheticall
y innervated

34. Tarsus
• thickened fibrous connective
tissue.
• provide structural support to
the eyelids.
• Attached to the orbital margins
by the medial and lateral
palpebral ligaments.

35. Meibomian glands
• Sebacious glands
• Originate from tarsus
• 30 in upper lid and 20 in lower lid
• Eye lash and meibomian glands
differentiate from a common
pilosebacious unit during second
month of gestation
Distichiasis

36. 10-12mm
25-30mm
• 30 to 40 vertically oriented meibomian glands.
• Crescentic in shape

37. 3.5-
5mm
25-30mm
• 20 to 30 vertically oriented meibomian glands
• Rectangular in shape

38. Conjunctiva
 It is the mucous membrane covering
the under surface of the lids and
anterior part of the eyeball upto the
cornea

39. • palpebral
• Forniceal
• Bulbar

40. Palpebral conjunctiva
 Richly vascular.
 Extremely thin.
 Strongly bound to the tarsal plate
marginal tarsal orbital
• Follicle formation
• viral and
chlamydial
• Papilla formation
• allergic
diseases,long term
use of contact lens

41. Conjunctival epithelium
 Non keratinized
 stratified
 cuboidal epithelium- tarsus
 Columnar epithelium-fornices
 Squamous epithelium-globe
 Goblet cell – mucus.

42. Accessory lacrimal glands

43. Suspensory system
1. Whitnall's ligament
2. Lockwood's ligament
3. The lateral canthal ligament,
4. Medial canthal ligament
5. The eyelid margin

44. Whitnall’s ligament
• Main suspensory ligament of the
upper eyelid
• Check ligament for the levator
aponeurosis and levator muscle
• Superior conjunctival fornix
suspension
Structure encountered during
eyelid surgery

45. Lockwood's Ligament
• Suspensory hammock of the
eye globe
• Anchor for inferior conjunctival
fornix
• Tenon's capsule, intramuscular
septa, check ligaments, fibers
from the inferior rectus sheath,
and lower lid retractors.

46. Lateral canthal ligament
• superior crux from the superior
tarsus and an inferior crux from
the inferior tarsus
• lateral canthotomy or cantholysis
to decompress the orbit and to
lower intraorbital pressure
• Attaches to the lateral orbital
tubercle
Punctal
eversion
Horizontal eyelid laxity

47. Medial canthal ligament
• Support to the eyelids
• Aids in function of lacrimal
pump
• Anterior limb
 attaches to frontal process of
maxillary bone and anterior
lacrimal crest
• Posterior limb
 attaches to the posterior lacrimal
crest and lacrimal fascia

48. Eyelid margin
• Confluence

49. Lacrimal puncta
Medial lacrimal
portion
Lateral palpebral
• The medial lacrimal portion is rounded and
without lashes.
• The lateral portion has a sharp border,
which acts like a “windshield wiper” to
assist in moving the tear film toward the
punctum.
• Eyelashes
• Sebacious glands(glands of
zeis)
• Sweat glands(glands of
moll)
• Gray line(muscle of Riolan)
• Mebomian gland orifices

50. Secretion of eyelids
GLANDS METHODS OF
SECRETION
SECRETION
Mebomian glands Holocrine Lipid layer of tear film
Glands of zeis Holocrine Lipid layer of tear film
Glands of moll Apocrine ? Lipid layer of tear
film
Glands of kraus Merocrine Aqueous layer of tear
film
Glands of wolfring Merocrine Aqueous layer of tear
film

51. Accessory eyelid structures
• Small fleshy ovoid structure
• Medial side of plica semilunaris
• Non keratinized stratified
squamous epithelium
• Hair, sebacious and sweat
glands, accessory lacrimal
glands,goblet cells
• Crescent shaped fold of conjunctiva
• 3 to 6 mm laterally from the caruncle
• Lateral border is free
• Rich in goblet cells
• Vestigial structure analagous to the
nictitating membrane in dogs and
other animals

52. Arterial supply

53. Deep arterial system
Lateral palpebral
artery
Medial palpebral
artery

54. Marginal palpebral arcade
• lies on the anterior tarsal surface 2 to
3 mm from the eyelid margin
Peripheral palpebral arcade
• parallels superior to the superior
border of the tarsus, posterior to
the levator aponeurosis, and
anterior to Müller's muscle.
levator
tarsus
arcad
e

55. Superficial artery system
6-8 mm medial to the medial canthus
and 5 mm anterior to the lacrimal sac

56. Venous system
Superficial system
located about 8 mm medial to the
inner canthus and lies lateral to its
artery deep in the skin

57. Deep venous system

58. Lymphatic drainage
superficial deep
skin tarsi
Orbicularis oculi conjunctiva
• Most of the upper eyelid,lateral third of
the lower eyelid, and lateral canthus
• .They eventually empty into the deep
cervical nodes near the internal jugular
vein.
• The medial portion of the upper
eyelids, the medial canthus and the
medial two thirds of the lower lid and
conjunctiva
• Lymph drainage eventually empties

59. Nerve supply
 The oculomotor nerve (CN III)
 The trigeminal (CN V)
 Facial nerve (CN VII)
 Sympathetic innervation.

60. Occulomotor nerve
The superior division
• The superior rectus muscle.
• The levator palpebral superioris
muscle.
The inferior divison
• Medial rectus
• The inferior rectus muscles
• The inferior oblique muscles.

61. The trigeminal nerve
• Ophthalmic
• Maxillary
• Mandibular
-upper lid
-lower
lid

62. Ophthalmic nerve
 Lacrimal nerve-lacrimal
gland,lateral aspects of eyelid
and lateral forehead
 Frontal nerve
 Supraorbital nerve-upper
eyelid,forehead and scalp
 Supratrochlear nerve-the
lacrimal drainage structures,
and the middle of the
forehead.
 Nasociliary nerve
 Long ciliary nerves-iris,ciliary
body and cornea
 Infratrochlear nerve-medial
canthus, conjunctiva, lacrimal
sac, canaliculi, and caruncle
 Posterior ethmoidal nerve-
ethmoid air cells and sphenoid
sinus

63. Maxillary nerve
 Infraorbital nerve-
skin and conjunctiva of
the lower eyelid, the
ala of the nose, the
superior lip, and the
medial and lateral
canthi
 Clinically involved in
orbital floor fractures
 Zygomatic nerve
 Zygomaticotemporal
nerve-communicates
with lacrimal nerve
 Zygomatico facial
nerve-cheek

64. Herpes zoster ophthalmicus

65. Facial nerve
• motor
• parasympathetic
secretomotor

66. SYMPATHETIC SUPPLY TO
THE EYELIDS
 The sympathetic nerves arise from the
carotid plexus
vasoconstriction,
smooth muscle function,
hidrosis,
pupillary dilation,
and pilomotor and sweat gland
function of the skin of the face

67. THANK YOU

68. References
 Fundamentals and principles of
ophthalmology(2012-2013)- American
Academy of Ophthalmology
 Orbits eyelids and lacrimal system(2007-
2008)- American Academy of Ophthalmology
 Chapter 5
Embryology and Anatomy of the Eyelid
EDWARD H. BEDROSSIAN, JR.
 Medscape
 Surgical Anatomy of the Forehead,
Eyelids, and Midface for the Aesthetic
Surgeon Kevin S. Tan, Sang-Rog Oh, Ayelet
Priel, Bobby S. Korn,and Don O. Kikkawa