This presentation is about the Eyelids & Lacrimal apparatus

1. Eyelids / Palpebrae

2. Features
The space between the two eyelids is the palpebral
fissure.
The two lids are fused with each other to form the medial and
lateral angles or canthi of the eye.
At the inner canthus, there is a small triangular space, the
lacus lacrimalis.
Within it, there is an elevated lacrimal caruncle, made up of
modified skin and skin glands.
Lateral to the caruncle, the bulbar conjunctiva is pinched up
to form a vertical fold called the plica semilunaris.
Each eyelid is attached to the margins of the orbital opening.
Its free edge is broad and has a rounded outer lip and a
sharp inner lip.
The outer lip presents two or more rows of eyelashes or cilia,
except in the boundary of the lacus lacrimalis.
At the point where eyelashes cease, there is a lacrimal
papilla on the summit of which there is the lacrimal punctum.
Near the inner lip of the free edge, there is a row of openings
of the tarsal glands.

3. Structure
Each lid is made up of the following layers from without
inwards:
1. The skin is thin, loose and easily distensible by oedema
fluid or blood.
2. The superficial fascia is without any fat. It contains the
palpebral part of the orbicularis oculi.
3. The palpebral fascia of the two lids forms the orbital
septum.Its thickenings form tarsal plates or tarsi in the lids and
the palpebral ligaments at the angles. Tarsi are thin plates of
condensed fibrous tissue located near the lid margins. They
give stiffness to the lids
The upper tarsus receives two tendinous slips from the levator
palpebrae superioris, or one from voluntary part and another
from involuntary part.
Tarsal glands or meibomian glands are embedded in the
posterior surface of the tarsi; their ducts open in a row behind
the cilia.
4. The conjunctiva lines the posterior surface of the tarsus.
Apart from the usual glands of the skin, and mucous glands in
the conjunctiva, the larger glands found in the lids are:
a. Large sebaceous glands also called as Zeis's glands at the
lid margin associated with cilia.
b. Modified sweat glands or Moll's glands at the lid margin
closely associated with Zeis's glands and cilia.
c. Sebaceous or tarsal glands, these are also known as
meibomian glands.

4. Clinical Anatomy
• The Muller's muscle or involuntary part of
levator palpebrae superioris is supplied by
sympathetic fibres from the superior cervical
ganglion.
• Paralysis of this muscle leads to partial
ptosis. This is part of the Horner's
syndrome.
• The palpebral conjunctiva is examined for
anaemia and for coniunctivitis;
• the bulbar coniunctiva for jaundice.
• Conjunctivitis is one of the commonest
diseases of the eye. It may be caused by
infection or by allergy.
Partial Ptosis

5. Blood Supply
The eyelids are supplied by:
1. The superior and inferior palpebral branches of
the
ophthalmic artery
2 The lateral palpebral branch of the lacrimal artery.
They form an arcade in each lid.
The veins drain into the ophthalmic and facial veins.
Nerve Supply
The upper eyelid is supplied by the lacrimal,
supraorbital, supratrochlear and infratrochlear
nerves
from lateral to medial side.
The lower eyelid is supplied by the infraorbital and
infratrochlear nerves.

6. Lymphatic Drainage
The medial halves of the lids drain into the
submandibular nodes,
and the lateral halves into the preauricular
nodes

7. • Foreign bodies are often lodged in a groove situated 2 mm from the edge of each
eyelid.
• Chalazion is inflammation of a tarsal gland, causing a localized swelling pointing
inwards.
• Ectropion is due to eversion of the lower lacrimal punctum. It usually occurs in old
age due to laxity of skin.
• Trachoma is a contagious granular conjunctivitis caused by the trachoma virus. It is
regarded as the commonest cause of blindness.
• Stye or hordeolum is a suppurative inflammation of one of the glands of Zeis. The
gland is swollen, hard and painful, and the whole of the lid is oedematous. The pus
points near the base of one of the cilia.
• Blepharitis is inflammation of the eyelids, specially of the lid margin.

8. Ectropion
Chalazion
Blepharitis
Stye
Trachoma

9. Lacrimal Apparatus

10. COMPONENTS
The structures concerned with
secretion and drainage of the lacrimal
or tear fluid constitute the lacrimal
apparatus. It is made up of the
following parts:
1. Lacrimal gland and its ducts
2. Conjunctival sac.
3. Lacrimal puncta and lacrimal
canaliculi.
4. Lacrimal sac.
5. Nasolacrimal duct.

11. Lacrimal Gland
It is a serous gland
situated chiefly in the lacrimal fossa on the anterolateral part of the
roof of the bony orbit and partly on the upper eyelid.
Small accessory lacrimal glands are found in the conjunctival
fornices.
The gland is ‘J' shaped, being indented by the tendon of the levator
palpebrae superioris muscle.
It has:
a. An orbital part which is larger and deeper, and
b. A palpebral part smaller and superficial, lying within the eyelid
• About a dozen of its ducts pierce the conjunctiva of the upper lid
and open into the conjunctival sac near the superior fornix.
• Most of the ducts of the orbital part pass through the palpebral
part. Removal of the latter is functionally equivalent to removal of
the entire gland.
• After removal, the conjunctiva and cornea are moistened by
accessory lacrimal glands.
• The gland is supplied by the lacrimal branch of the ophthalmic
artery and by the lacrimal nerve.
• The nerve has both sensory and secretomotor fibres.
• The lacrimal fluid secreted by the lacrimal gland flows into the
conjunctival sac where it lubricates the front of the eye and the
deep surface of the lids.
• Periodic blinking helps to spread the fluid over the eye.
• Most of the fluid evaporates.
• The rest is drained by the lacrimal canaliculi.
• When excessive, it overflows as tears.

12. Conjunctival Sac
The conjunctiva lining the deep surfaces of the
eyelids is called palpebral conjunctiva and
that lining the front of the eyeball is bulbar
conjunctiva.
The potential space between the palpebral and
bulbar parts is the conjunctival sac.
The lines along which the palpebral conjunctiva of
the upper and lower eyelids is reflected on to the
eyeball are called the superior and inferior
conjunctival fornices.
The palpebral conjunctiva is thick, opaque, highly
vascular, and adherent to the tarsal plate.
The bulbar conjunctiva covers the sclera. It is thin,
transparent, and loosely attached to the eyeball.
Over the cornea, it is represented by the anterior
epithelium of the cornea.

13. Lacrimal Puncta and Canaliculi
Each lacrimal canaliculus begins at
the lacrimal punctum,
and is 10 mm long.
It has a vertical part which is 2 mm
long and a horizontal part which is, 8
mm long.
There is a dilated ampulla at the bend.
Both canaliculi open close to each
other in the lateral wall of the lacrimal
sac behind the medial palpebral
ligament.

14. Lacrimal Sac
It is membranous sac 2 mm long and 5 mm
wide,
situated in the lacrimal groove behind the medial
palpebral ligament.
Its upper end is blind.
The lower end is continuous with the
nasolacrimal duct.
The sac is related anteriorly to the medial
palpebral ligament and to the orbicularis oculi.
Medially, the lacrimal groove separates it from
the nose.
Laterally, it is related to the lacrimal fascia and
the lacrimal part of the orbicularis oculi.

15. Nasolacrimal Duct
It is a membranous passage 18
mm long.
It begins at the lower end of the
lacrimal sac, runs downwards,
backwards and laterally, and opens
into the inferior meatus of the nose.
A fold of mucous membrane called
the valve of Hasner forms an
imperfect valve at the lower end of
the duct.

16. Secretomotor pathway for Lacrimal Gland

17. • Inflammation of the lacrimal sac is called dacro cystitis.
• The ducts of lacrimal gland open through its palpebral part into the
conjunctival sac, Because of this arrangement, the removal of palpebral
part necessitates the removal of the orbital part as well
• Excessive secretion of lacrimal fluid, i.e. tears is mostly due to emotional
reasons. The tears not only flow on the cheeks but also flow out through
nasolacrimal duct and the nasal cavity, due to stimulation of
pterygopalatine ganglion.
• Excessive secretion of the lacrimal fluid overflowing on the cheeks is
called epiphora.
• Epiphora may result due to obstruction in the lacrimal fluid pathway,
either at the level of punctum or canaliculi or nasolacrimal duct.

18. DEVELOPMENT OF FACE

19. Five processes of face, one frontonasal, two maxillary
and two mandibular processes form the face.
Frontonasal process forms the forehead, the nasal
septum, philtrum of upper lip and premaxilla bearing upper four incisor
teeth.
Maxillary process forms whole of upper lip except the philtrum and
most of the hard and soft palate except the part formed by the
premaxilla.
Mandibular process forms the whole lower lip.
Cord of ectoderm gets buried at the junction of frontonasal and
maxillary processes. Canalisation of ectodermal cord of cells gives
rise to nasolacrimal duct.