The document summarizes the anatomy of the eyelids. It describes the development of the eyelids from early cell division through eyelid fusion and development of structures. It then discusses the muscles that make up the orbicularis oculi and their roles in eyelid movement. The document also summarizes the anatomy of the tarsal plates, orbital septum, orbital fat pads, levator palpebrae superioris muscle and other structures that make up the eyelid suspensory system.
1. The conjunctiva is a thin mucous membrane that covers the sclera and lines the eyelids. It contains goblet cells that secrete mucus and accessory lacrimal glands that secrete the aqueous layer of tears.
2. The conjunctiva has distinct regions including the palpebral, bulbar, and forniceal conjunctiva. It is loosely attached except at the limbus, allowing eye movement.
3. Histologically, the conjunctiva has an epithelial layer with goblet cells and a subepithelial layer containing lymphoid tissue, blood vessels, and nerves. Follicles and papillae may form in response to inflammation.
The document summarizes the anatomy of the orbit. It is formed by 7 bones and has a quadrangular pyramid shape. The orbit contains 4 walls - medial, inferior, lateral, and roof. Each wall has specific bone formations and relationships to structures like muscles and nerves. The orbit also contains openings like the optic canal and superior orbital fissure that connect to other areas. The periorbita lining and fascia bulbi surrounding the eyeball are described. Finally, the document outlines the 3 surgical spaces within the orbit.
Anatomy of Eyelids & Its Clinical CorrelationsSarmila Acharya
This document provides an overview of the anatomy of the eyelids. It discusses the layers of the eyelids from front to back including skin, muscles like the orbicularis oculi and levator palpebrae superioris, the fibrous tarsal plates, and conjunctiva. It also covers the nerve and blood supply, functions of eyelid structures like blinking and tear distribution, and some clinical correlations like entropion and dermatochalasis.
Entropion is the in-turning of the eyelid margin. It can be congenital or acquired, with the most common type being involutional/senile entropion caused by laxity of the eyelid tissues and weakness of the retractors. Examination involves assessing lid laxity, snap back test, and tendon laxity. Treatment depends on severity and includes sutures, transverse lid splits with everting sutures, horizontal lid shortening procedures, and lower lid retractor procedures. Ectropion is eyelid eversion away from the globe and can also be congenital or acquired, with involutional being most common. Examination tests for laxity and muscle weakness.
Anatomy of extraocular muscles and ocular motilityvanya kodali
The document summarizes key anatomical and physiological details of the extraocular muscles and eye movements:
1. It describes the bony orbit anatomy, six extraocular muscles and their actions, innervation and blood supply. The four rectus muscles control horizontal and vertical eye movements, while the two oblique muscles enable torsional movements.
2. The document outlines uniocular and binocular eye movements including versions, vergences, and diagnostic positions of gaze. Hering's and Sherrington's laws govern coordinated eye movements between the eyes.
3. Supranuclear control systems like saccadic, smooth pursuit, vergence and vestibulo-ocular pathways mediate voluntary and reflexive eye movements
The document discusses the anatomy of the orbit, including:
1. The orbit develops from mesenchyme between the 6th and 7th week, with bones forming around the optic vesicle.
2. The bones that make up the orbit include the frontal, ethmoid, sphenoid, lacrimal, palatine, maxillary, and zygomatic bones.
3. The orbit contains the eyeball, orbital fat, connective tissue system, blood vessels, and nerves including the extraocular muscles.
This document provides an overview of approaches to orbital surgery. It discusses the different surgical spaces in the orbit and various instrumentation used. It describes techniques for superior, inferior, medial, lateral, and transcranial approaches. Key steps are outlined for each approach. The document also discusses orbital decompression procedure and postoperative care. Potential complications of orbital surgery are noted. References for further reading are provided.
1. The conjunctiva is a thin mucous membrane that covers the sclera and lines the eyelids. It contains goblet cells that secrete mucus and accessory lacrimal glands that secrete the aqueous layer of tears.
2. The conjunctiva has distinct regions including the palpebral, bulbar, and forniceal conjunctiva. It is loosely attached except at the limbus, allowing eye movement.
3. Histologically, the conjunctiva has an epithelial layer with goblet cells and a subepithelial layer containing lymphoid tissue, blood vessels, and nerves. Follicles and papillae may form in response to inflammation.
The document summarizes the anatomy of the orbit. It is formed by 7 bones and has a quadrangular pyramid shape. The orbit contains 4 walls - medial, inferior, lateral, and roof. Each wall has specific bone formations and relationships to structures like muscles and nerves. The orbit also contains openings like the optic canal and superior orbital fissure that connect to other areas. The periorbita lining and fascia bulbi surrounding the eyeball are described. Finally, the document outlines the 3 surgical spaces within the orbit.
Anatomy of Eyelids & Its Clinical CorrelationsSarmila Acharya
This document provides an overview of the anatomy of the eyelids. It discusses the layers of the eyelids from front to back including skin, muscles like the orbicularis oculi and levator palpebrae superioris, the fibrous tarsal plates, and conjunctiva. It also covers the nerve and blood supply, functions of eyelid structures like blinking and tear distribution, and some clinical correlations like entropion and dermatochalasis.
Entropion is the in-turning of the eyelid margin. It can be congenital or acquired, with the most common type being involutional/senile entropion caused by laxity of the eyelid tissues and weakness of the retractors. Examination involves assessing lid laxity, snap back test, and tendon laxity. Treatment depends on severity and includes sutures, transverse lid splits with everting sutures, horizontal lid shortening procedures, and lower lid retractor procedures. Ectropion is eyelid eversion away from the globe and can also be congenital or acquired, with involutional being most common. Examination tests for laxity and muscle weakness.
Anatomy of extraocular muscles and ocular motilityvanya kodali
The document summarizes key anatomical and physiological details of the extraocular muscles and eye movements:
1. It describes the bony orbit anatomy, six extraocular muscles and their actions, innervation and blood supply. The four rectus muscles control horizontal and vertical eye movements, while the two oblique muscles enable torsional movements.
2. The document outlines uniocular and binocular eye movements including versions, vergences, and diagnostic positions of gaze. Hering's and Sherrington's laws govern coordinated eye movements between the eyes.
3. Supranuclear control systems like saccadic, smooth pursuit, vergence and vestibulo-ocular pathways mediate voluntary and reflexive eye movements
The document discusses the anatomy of the orbit, including:
1. The orbit develops from mesenchyme between the 6th and 7th week, with bones forming around the optic vesicle.
2. The bones that make up the orbit include the frontal, ethmoid, sphenoid, lacrimal, palatine, maxillary, and zygomatic bones.
3. The orbit contains the eyeball, orbital fat, connective tissue system, blood vessels, and nerves including the extraocular muscles.
This document provides an overview of approaches to orbital surgery. It discusses the different surgical spaces in the orbit and various instrumentation used. It describes techniques for superior, inferior, medial, lateral, and transcranial approaches. Key steps are outlined for each approach. The document also discusses orbital decompression procedure and postoperative care. Potential complications of orbital surgery are noted. References for further reading are provided.
The document discusses recent advances in the management of obstruction of the lacrimal drainage system. It describes the history and evolution of various surgical techniques for treating this obstruction, including external dacryocystorhinostomy (DCR), endoscopic endonasal DCR, ultrasonic endoscopic DCR, non-laser endonasal DCR, endocanalicular laser DCR, and balloon-assisted DCR. It then provides details on the surgical procedure for external DCR, including patient preparation, instrumentation, osteotomy creation, flap formation, flap anastomosis, wound closure, and post-operative management. Potential complications are also briefly mentioned.
The document provides detailed anatomical information about the orbit, including its boundaries, contents, measurements, and relationships. Key points include:
- The orbit is a quadrangular pyramid situated between the anterior cranial fossa and maxillary sinus.
- Structures passing through openings in the orbital walls include cranial nerves, vessels, and the optic nerve.
- The orbit contains extraocular muscles, fat, and other connective tissues divided into anatomical spaces.
- Measurements like the orbital index and volume are provided for racial variation and comparisons.
- Landmarks, foramina, and fossae of the orbital bones are described.
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
The eyelids have several layers including skin, muscle, and glands. The orbicularis oculi muscle closes the eyelids. The tarsal plates provide structure and the septum orbitale divides tissue planes. Glands include meibomian, Zeis, and Moll glands which lubricate the eyelids. Blood vessels and nerves pierce the septum orbitale. Lymphatics drain via superficial and deep plexuses.
The eyelid is a thin fold of skin that covers and protects the eye. It assists in distributing tears and draining them from the eye. The upper eyelid extends from the eyebrow down and forms the upper boundary of the palpebral fissure, while the lower eyelid merges with the cheek. Each eyelid has skin, muscle, and glandular layers. When closed, the upper eyelid covers about 2mm of the cornea while the lower lid just touches the cornea.
The document discusses the embryology, anatomy, physiology and applied anatomy of the lens. It begins by describing the early embryonic development of the lens, including the formation of the lens vesicle from surface ectoderm. It then details the anatomy of the adult lens, including its layers of capsule, epithelium and fibers which make up the nucleus and cortex. The physiology section covers lens transparency, metabolism and accommodation. Finally, it briefly mentions some anatomical anomalies of accommodation such as presbyopia and paralysis.
1) Trabeculectomy is a glaucoma surgery that creates an opening in the eye to drain fluid from the anterior chamber and reduce intraocular pressure.
2) It involves making a partial thickness scleral flap, removing a block of tissue underneath, and suturing the flap loosely to allow fluid drainage.
3) Antifibrotic agents like mitomycin C or 5-fluorouracil are often applied to reduce scarring and improve surgical success rates.
This document provides an overview of eyelid anatomy and ptosis. It describes the gross anatomy, layers, muscles, glands, blood supply, nerves and functions of the eyelid. It then discusses ptosis in detail including types (congenital, acquired), evaluation methods and treatment options depending on levator function and ptosis severity. Surgical procedures for ptosis include levator resection, frontalis sling, tarsoconjunctival resection. Common eyelid conditions like blepharitis, stye, chalazion are also briefly mentioned.
Physiology of lens and CataractogenesisSristiThakur
This document discusses the physiology of the lens and the process of cataractogenesis. It begins by describing the biochemical composition and metabolism of the lens, which is important for maintaining transparency. It then discusses how cataracts form, including congenital and acquired cataracts. The key factors involved in cataractogenesis are any disturbances that disrupt the critical intracellular and extracellular balance in the lens, deranging the colloid system and resulting in opacification.
This document discusses various surgical techniques for treating ptosis including modified Fasanella-Servat procedure, levator resection, and tarsofrontalis sling. It provides details on patient evaluation, surgical steps, guidelines for amount of levator resection, and potential complications. The modified Fasanella-Servat procedure involves tarso-conjunctival mullerectomy and is best for mild congenital ptosis. Levator resection is performed through skin or transcutaneous approaches. A tarsofrontalis sling uses silicone or fascia and is ideal for bilateral or severe ptosis. Potential complications include under or overcorrection, contour abnormalities, crease issues, and conjunctival prolapse.
The document provides an anatomy overview of the eyelids in 3 paragraphs:
1) The eyelids are mobile tissue curtains placed in front of the eyeballs. They regulate light entry and spread tears over the cornea. Embryologically, the upper eyelid develops from the frontonasal process and the lower eyelid from the maxillary process.
2) Gross anatomy details include the extent of the upper and lower eyelids, lid folds, palpebral aperture, eyelid margins containing lashes and puncta, and canthal positions. The orbicularis oculi muscle encircles the eyelids for closure.
3) Structurally, the eyelids have skin, subcutaneous tissue
The eyelids develop from the frontonasal and maxillary processes during embryogenesis. They contain skin, muscle, fibrous tissue and glands that work together to protect the eye. The orbicularis oculi muscle helps with blinking while the levator palpebrae superioris muscle elevates the upper eyelid. The tarsal plates provide structure and the meibomian glands secrete oils to form the tear film. Blood vessels from the internal and external carotid arteries provide a rich blood supply to support the eyelids' functions.
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.
This document provides information about the extraocular muscles:
- There are 6 extraocular muscles that control eye movement: the superior, inferior, medial, and lateral rectus muscles, and the superior and inferior oblique muscles.
- The muscles originate from the annulus of Zinn and insert into different parts of the eyeball. They are innervated by different cranial nerves.
- The muscles work together or antagonistically to enable movements like elevation, depression, adduction, and abduction. Fundamental laws like Listing's law and Hering's law govern their coordinated function.
- Common anomalies include nystagmus and strabismus. Surgical procedures like resection and recession can correct muscle
This document provides an overview of oculoplastics, focusing on the anatomy and pathologies of the orbit, eyelid, and lacrimal system. Key points include a detailed review of orbital anatomy and the bones that make up its walls. Common orbital pathologies are discussed such as inflammation from cellulitis or Graves' disease. Pediatric and adult orbital tumors are also summarized. Eyelid anatomy is reviewed including the layers, muscles, fat pads, and vascular supply. Common eyelid conditions like ectropion and its causes are defined.
The document summarizes eyelid anatomy and physiology of the lacrimal pump. It describes the embryology, gross anatomy, structures, muscles, glands, blood supply and lymphatic drainage of the eyelids. The key structures discussed include the tarsal plates, septum orbitale, orbicularis oculi muscle, levator palpebrae superioris muscle, and meibomian glands. The document also briefly outlines the functions of the meibomian glands and arterial blood supply to the eyelids.
The orbit develops around the eyeball from cranial neural crest cells. The bones that make up the orbital walls differentiate during the third month in utero and undergo ossification through both endochondral and membranous processes. The shape and size of the orbit changes with age. In adults, the orbit is quadrangular in shape and bounded superiorly, medially, inferiorly and laterally by bones. It contains the eyeball and extraocular muscles, nerves, vessels and fat. The walls are thin and prone to fractures or invasion by adjacent structures like sinuses.
This document summarizes the case of a 6-year-old male child with blepharophimosis-ptosis epicanthus inversus syndrome. On examination, the patient had small eyes, drooping eyelids, reduced vertical palpebral aperture, absent lid creases, and inward-folded skin at the inner corner of the eyes. Based on these findings, the patient was diagnosed with moderate bilateral blepharophimosis-ptosis epicanthus inversus syndrome type 2. To correct the eyelid abnormalities, the patient underwent a single-stage procedure involving bilateral Mustarde's double Z plasty with fascial sling surgery. The document discusses the features, genetics, associations, and surgical
The document provides an anatomy overview of the eyelids. It discusses the key structures of the eyelids including the orbicularis oculi muscle, levator palpebrae superioris muscle, tarsal plates, septum orbitale, canthi, caruncle, plica semilunaris, and eyelid margins. The document also describes the layers of the eyelid from skin to conjunctiva and the position and function of the eyelids.
The document discusses recent advances in the management of obstruction of the lacrimal drainage system. It describes the history and evolution of various surgical techniques for treating this obstruction, including external dacryocystorhinostomy (DCR), endoscopic endonasal DCR, ultrasonic endoscopic DCR, non-laser endonasal DCR, endocanalicular laser DCR, and balloon-assisted DCR. It then provides details on the surgical procedure for external DCR, including patient preparation, instrumentation, osteotomy creation, flap formation, flap anastomosis, wound closure, and post-operative management. Potential complications are also briefly mentioned.
The document provides detailed anatomical information about the orbit, including its boundaries, contents, measurements, and relationships. Key points include:
- The orbit is a quadrangular pyramid situated between the anterior cranial fossa and maxillary sinus.
- Structures passing through openings in the orbital walls include cranial nerves, vessels, and the optic nerve.
- The orbit contains extraocular muscles, fat, and other connective tissues divided into anatomical spaces.
- Measurements like the orbital index and volume are provided for racial variation and comparisons.
- Landmarks, foramina, and fossae of the orbital bones are described.
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
The eyelids have several layers including skin, muscle, and glands. The orbicularis oculi muscle closes the eyelids. The tarsal plates provide structure and the septum orbitale divides tissue planes. Glands include meibomian, Zeis, and Moll glands which lubricate the eyelids. Blood vessels and nerves pierce the septum orbitale. Lymphatics drain via superficial and deep plexuses.
The eyelid is a thin fold of skin that covers and protects the eye. It assists in distributing tears and draining them from the eye. The upper eyelid extends from the eyebrow down and forms the upper boundary of the palpebral fissure, while the lower eyelid merges with the cheek. Each eyelid has skin, muscle, and glandular layers. When closed, the upper eyelid covers about 2mm of the cornea while the lower lid just touches the cornea.
The document discusses the embryology, anatomy, physiology and applied anatomy of the lens. It begins by describing the early embryonic development of the lens, including the formation of the lens vesicle from surface ectoderm. It then details the anatomy of the adult lens, including its layers of capsule, epithelium and fibers which make up the nucleus and cortex. The physiology section covers lens transparency, metabolism and accommodation. Finally, it briefly mentions some anatomical anomalies of accommodation such as presbyopia and paralysis.
1) Trabeculectomy is a glaucoma surgery that creates an opening in the eye to drain fluid from the anterior chamber and reduce intraocular pressure.
2) It involves making a partial thickness scleral flap, removing a block of tissue underneath, and suturing the flap loosely to allow fluid drainage.
3) Antifibrotic agents like mitomycin C or 5-fluorouracil are often applied to reduce scarring and improve surgical success rates.
This document provides an overview of eyelid anatomy and ptosis. It describes the gross anatomy, layers, muscles, glands, blood supply, nerves and functions of the eyelid. It then discusses ptosis in detail including types (congenital, acquired), evaluation methods and treatment options depending on levator function and ptosis severity. Surgical procedures for ptosis include levator resection, frontalis sling, tarsoconjunctival resection. Common eyelid conditions like blepharitis, stye, chalazion are also briefly mentioned.
Physiology of lens and CataractogenesisSristiThakur
This document discusses the physiology of the lens and the process of cataractogenesis. It begins by describing the biochemical composition and metabolism of the lens, which is important for maintaining transparency. It then discusses how cataracts form, including congenital and acquired cataracts. The key factors involved in cataractogenesis are any disturbances that disrupt the critical intracellular and extracellular balance in the lens, deranging the colloid system and resulting in opacification.
This document discusses various surgical techniques for treating ptosis including modified Fasanella-Servat procedure, levator resection, and tarsofrontalis sling. It provides details on patient evaluation, surgical steps, guidelines for amount of levator resection, and potential complications. The modified Fasanella-Servat procedure involves tarso-conjunctival mullerectomy and is best for mild congenital ptosis. Levator resection is performed through skin or transcutaneous approaches. A tarsofrontalis sling uses silicone or fascia and is ideal for bilateral or severe ptosis. Potential complications include under or overcorrection, contour abnormalities, crease issues, and conjunctival prolapse.
The document provides an anatomy overview of the eyelids in 3 paragraphs:
1) The eyelids are mobile tissue curtains placed in front of the eyeballs. They regulate light entry and spread tears over the cornea. Embryologically, the upper eyelid develops from the frontonasal process and the lower eyelid from the maxillary process.
2) Gross anatomy details include the extent of the upper and lower eyelids, lid folds, palpebral aperture, eyelid margins containing lashes and puncta, and canthal positions. The orbicularis oculi muscle encircles the eyelids for closure.
3) Structurally, the eyelids have skin, subcutaneous tissue
The eyelids develop from the frontonasal and maxillary processes during embryogenesis. They contain skin, muscle, fibrous tissue and glands that work together to protect the eye. The orbicularis oculi muscle helps with blinking while the levator palpebrae superioris muscle elevates the upper eyelid. The tarsal plates provide structure and the meibomian glands secrete oils to form the tear film. Blood vessels from the internal and external carotid arteries provide a rich blood supply to support the eyelids' functions.
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.
This document provides information about the extraocular muscles:
- There are 6 extraocular muscles that control eye movement: the superior, inferior, medial, and lateral rectus muscles, and the superior and inferior oblique muscles.
- The muscles originate from the annulus of Zinn and insert into different parts of the eyeball. They are innervated by different cranial nerves.
- The muscles work together or antagonistically to enable movements like elevation, depression, adduction, and abduction. Fundamental laws like Listing's law and Hering's law govern their coordinated function.
- Common anomalies include nystagmus and strabismus. Surgical procedures like resection and recession can correct muscle
This document provides an overview of oculoplastics, focusing on the anatomy and pathologies of the orbit, eyelid, and lacrimal system. Key points include a detailed review of orbital anatomy and the bones that make up its walls. Common orbital pathologies are discussed such as inflammation from cellulitis or Graves' disease. Pediatric and adult orbital tumors are also summarized. Eyelid anatomy is reviewed including the layers, muscles, fat pads, and vascular supply. Common eyelid conditions like ectropion and its causes are defined.
The document summarizes eyelid anatomy and physiology of the lacrimal pump. It describes the embryology, gross anatomy, structures, muscles, glands, blood supply and lymphatic drainage of the eyelids. The key structures discussed include the tarsal plates, septum orbitale, orbicularis oculi muscle, levator palpebrae superioris muscle, and meibomian glands. The document also briefly outlines the functions of the meibomian glands and arterial blood supply to the eyelids.
The orbit develops around the eyeball from cranial neural crest cells. The bones that make up the orbital walls differentiate during the third month in utero and undergo ossification through both endochondral and membranous processes. The shape and size of the orbit changes with age. In adults, the orbit is quadrangular in shape and bounded superiorly, medially, inferiorly and laterally by bones. It contains the eyeball and extraocular muscles, nerves, vessels and fat. The walls are thin and prone to fractures or invasion by adjacent structures like sinuses.
This document summarizes the case of a 6-year-old male child with blepharophimosis-ptosis epicanthus inversus syndrome. On examination, the patient had small eyes, drooping eyelids, reduced vertical palpebral aperture, absent lid creases, and inward-folded skin at the inner corner of the eyes. Based on these findings, the patient was diagnosed with moderate bilateral blepharophimosis-ptosis epicanthus inversus syndrome type 2. To correct the eyelid abnormalities, the patient underwent a single-stage procedure involving bilateral Mustarde's double Z plasty with fascial sling surgery. The document discusses the features, genetics, associations, and surgical
The document provides an anatomy overview of the eyelids. It discusses the key structures of the eyelids including the orbicularis oculi muscle, levator palpebrae superioris muscle, tarsal plates, septum orbitale, canthi, caruncle, plica semilunaris, and eyelid margins. The document also describes the layers of the eyelid from skin to conjunctiva and the position and function of the eyelids.
The three sentences are:
The eyelids are multilamellar structures that cover and protect the eyeball. They assist in distributing tears and providing protection from excessive light, dryness, and particles. The anatomy of the eyelid includes skin, muscles like the orbicularis oculi and levator palpebrae superioris, glands, blood vessels, and nerves that allow it to perform functions like blinking and maintaining the tear film.
The eyelids are composed of several layers including skin, muscle, orbital septum, fat and conjunctiva. The upper eyelid is raised by the levator palpebrae superioris muscle and Muller's muscle. The lower eyelid is retracted by the capsulopalpebral fascia. Several glands including the meibomian glands and glands of Zeis and Moll are located within the eyelids and help form the tear film. The orbicularis oculi muscle allows for eyelid closure and blinking. Together, the eyelid structures protect the eye and help spread tears across the surface of the eye.
The document provides an overview of ocular anatomy, beginning with the anatomy of the orbit. It describes the bones that make up the orbit, including the medial, lateral, roof and floor. It also discusses openings into the orbit like the superior and inferior orbital fissures. Next, it covers the anatomy of the eyelids, lacrimal apparatus, conjunctiva and their structures. This includes the layers of the eyelid like skin, muscle and connective tissue. Blood supply and drainage of the eyelids is also summarized. The document concludes with a brief section on the anterior chamber anatomy.
This document describes the anatomy and reconstruction of the eyelids. It discusses:
1. The layers and structures of the eyelid including the skin, orbicularis oculi muscle, tarsal plates, levator palpebrae superioris muscle, and conjunctiva.
2. Embryology, blood supply, innervation, and cross section of the eyelid.
3. Specific structures like the orbital septum, tarsal plates, pre-aponeurotic fat, and lacrimal system.
4. Goals and requirements of eyelid reconstruction including reestablishing function, protection, cosmesis as well as anterior and posterior lamellae reconstruction techniques.
This document describes the anatomy and reconstruction of the eyelids. It discusses:
1. The layers and structures of the eyelid including the skin, orbicularis oculi muscle, tarsal plates, levator palpebrae superioris muscle, and conjunctiva.
2. Embryology, blood supply, innervation, and cross section of the eyelid.
3. Specific structures like the orbital septum, tarsal plates, pre-aponeurotic fat, and lacrimal system.
4. Goals and requirements of eyelid reconstruction including reestablishing function, protection, cosmesis as well as anterior and posterior lamellae reconstruction techniques.
This document describes the anatomy and reconstruction of the eyelids. It discusses:
1. The layers and structures of the eyelid including the skin, orbicularis oculi muscle, tarsal plates, levator palpebrae superioris muscle, and conjunctiva.
2. Embryology, blood supply, innervation, and cross section of the eyelid.
3. Specific structures like the orbital septum, tarsal plates, pre-aponeurotic fat, and lacrimal system.
4. Goals and requirements of eyelid reconstruction including reestablishing function, protection, cosmesis as well as anterior and posterior lamellae reconstruction techniques.
Tenon capsule ,Sclera and limbus : subashsubash kc
The fascia bulbi is a thin fibrous sheath that envelops the globe from the cornea to the optic nerve. It has two surfaces - an inner surface firmly attached to the sclera, and an outer surface in contact with the orbital fat. Its main functions are to position and support the globe within the orbital cavity and allow movements of the extrinsic eye muscles. It is important during eye surgery and enucleation to preserve the fascia bulbi to serve as a socket for a prosthesis.
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on Anatomy of orbit which helps for a quick refresh.
Applied aspects described well and slides contains images for easy understanding of the subject.
Surgical anatomy of orbit 1 /certified fixed orthodontic courses by Indian de...Indian dental academy
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The document discusses different surgical techniques for blepharoplasty, including upper and lower blepharoplasty, focusing on approaches for removing excess skin and fat to improve the appearance of the eyes while maintaining natural shape. Key steps for upper and lower blepharoplasty techniques are outlined, including incision placement and closure, as well as potential complications.
The orbital cavity contains the eyeball and associated structures. It is formed by 7 bones and has dimensions of approximately 50mm deep, 40mm wide, and 35mm high. There are several openings including the superior and inferior orbital fissures, optic canal, and ethmoidal foramina. The walls are lined with periosteum and consist of a roof, floor, medial and lateral walls. Knowledge of the orbital anatomy is important for understanding orbital pathology and surgical planning.
The orbit is a pyramidal cavity containing the eyeball and associated structures. It is formed by 7 bones and has 4 walls. The eyeball has 3 layers - fibrous, vascular and inner retinal layer. The orbit contains the eyeball, extraocular muscles, nerves and vessels, lacrimal apparatus and orbital fat. The lacrimal apparatus produces and drains tears to lubricate the eye.
The three main structures of the eyelid are the skin, orbicularis oculi muscle, and tarsal plate. The orbicularis oculi muscle is responsible for eyelid closure and blinking. Below the muscle sits the tarsal plate, a dense fibrous structure that provides structure to the eyelid. In the upper eyelid, the levator palpebrae superioris and Müller muscle act as retractors to open the eyelid. The document describes the anatomy and structures of the eyelid in detail.
The document summarizes the main muscles of the face, dividing them into four groups - epicranial, circumorbital and palpebral, nasal, and buccolabial. It describes the origin, insertion, innervation, blood supply, and actions of each muscle. Key muscles discussed include the occipitofrontalis, orbicularis oculi, corrugator supercilii, levator labii superioris, zygomaticus major, mentalis, and orbicularis oris.
The eyeball is located in the front of the orbital cavity, with one third exposed. It is approximately 24mm long and has important structures like the cornea, lens, vitreous humor, and retina. The eyeball is covered by two layers - the fascial sheath and conjunctiva. The conjunctiva lines the exposed front of the eyeball and the inner eyelid, forming the conjunctival sac. It has important functions like providing nourishment, immunity, and secretions to keep the eye smooth and lubricated.
The document provides an overview of the anatomy of the eyelid. It describes the eyelid's gross anatomy including its extent, folds, margins, lashes and palpebral aperture. It details the layers that make up the eyelid including skin, muscles such as the orbicularis oculi and levator palpebrae superioris, and glands like the meibomian and moll glands. The arterial blood supply and lymphatic and nerve drainage of the eyelid are also summarized.
ocular anatomy of eye for optometry and optalomolgydevaramgehlot
The document summarizes the key anatomical structures of the eye, including the outer protective layers like the sclera and cornea, middle uveal layer containing the iris and choroid, inner retinal layer containing photoreceptors, and associated structures like the lacrimal system and extraocular muscles. The summary provides a high-level overview of the essential anatomical components and their functions in 3 sentences.
The document summarizes the key anatomical structures of the eye, including the outer protective layers like the eyelids, sclera, and cornea. It describes the inner layers like the iris, ciliary body, choroid, retina, and optic nerve. It explains the functions of various parts like tear production, intraocular fluid circulation, and the conversion of light to neural signals in the retina.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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3. The facial processes.
• The frontalis muscle arises from the temporal lamina, whereas the orbicularis oculi,
cor- rugator supercilii, and procerus muscles arise from the infraorbital lamina.
• Conjunctival mucous membrane is formed by a surface epithelium resting on a
mesodermal substantia propria.
4. Eyelid development. (A) Eyelid fusion (8 to 10 weeks'
gestation); (B) development of margin structures (3 to 4
months' gestation); eyelid dysjunction (5 to 6 months'
gestation).
6. Topography of eye lid
A. Sagittal section of Asian eyelid anatomy.B. Sagittal section of
Caucasian eyelid anatomy.
7. Concavity of superior orbital
sulcus after enucleation of right
eye.
Convexity of superior sulcus from
herniated orbital fat.
8. Langer lines (A) as they appear in a diagram and (B)
clinically. These static skin lines are formed by
collagenous, reticular, & elastic fibers in reticular
dermis.
10. Dynamic lines. Overaction of the procerus & corrugator
superciliaris muscle create these frowns line in this
patient with ocular phemigoid.
11. Structure of eye lid
12
1. Skin & Subcutaneous tissue
2. Muscles of protraction
3. Orbital septum & tarsal plates
4. Orbital fat
5. Muscle of retraction
6. Conjunctiva
12. Skin of eye lid
• Skin of eyelid is thin.
• Fat is absent in pretarsal skin
• In preorbital & preseptal skin subcutaneous fat is sparse
• Pretarsal skin is firmly adherent to the underlying tarsus because of attachments of
levator aponeurosis.
• Clinically, edema collects under loose preorbital & preseptal skin, leaving an
identifiable border at pretarsal skin where there are denser subcutaneous
fibroadipose attachments.
13. Eyelashes
14
• The human eyes are protected and lined by eyelashes
• They are in 2-3 rows
• In upper eyelid(100-150)
• In lower lid(50-75)
• life span of 100-150 days.
• If the eyelash is pulled out or falls off, it will take as
long as seven to eight weeks to grow back.
14. Glands of eye lid
Meibomian glands:
• Present in stroma of tarsal plate
arranged vertically. About 30-40 in
upper & 20-30 in lower lid. They are
modified sebaceous glands & their
ducts opens at lid margin
Glands of zeis:
• Sebaceous glands opens into
eyelashe follicles
Accessory lacrimal glands of Wolfring:
• Present near upper border of tarsal
plate
Glands of Moll:
• Modified sweat gland situated near
hair follicles or into duct’s of Zeis
glands. They do not open directly
into skin surface
16. Protractors
Orbicularis oculi muscle
• Firmly attached to underlying lateral palpebral raphe, medial canthal region,
insertions of upper & lower eyelid retractors, supraorbital ridge, naso-orbital
valley & malar crease
Orbital portion
• Superiorly- to eyebrow, where it interdigitates with frontalis & corrugator
superciliaris
• Medially- extends from supraorbital notch in a curvilinear fashion over side of
nose
• Laterally- extends to temporalis muscle
• Inferiorly- to infraorbital foramen. It continues along infraorbital margin
These thick course fibers play an important role in voluntary lid
closure (winking) & forced eyelid closure.
17. Preseptal Orbicularis Oculi
• It overlies orbital septum & in between is a fibroadipose layer
• If this post orbicularis layer contains a significant amount of fat, ptosis
surgeon may misinterpret it as being preaponeurotic fat.
• Laterally- Whitnall’sl tubercle. Because of fibrous component of this
lateral attachment, Jones misleadingly termed this lateral canthal
tendon rather than lateral canthal ligament.
• Medially- lacrimal sac, its fascia, & lacrimal crests.
• Medial origin
– Deep head or Jones muscle is adherent to lacrimal sac & fascia
– Superficial head arises from anterior rim of medial canthal ligament.
Functionally, the preseptal fibers contribute to voluntary lid
closure (winking) & involuntary lid closure (blinking).
18. Pretarsal Orbicularis Oculi
• It is firmly adherent to underlying tarsus & to superficial insertion of levator
aponeurosis at superior tarsal border.
• The superficial head inserts on anterior lacrimal crest & anterior limb of medial
canthal ligament. Superficial fibers also surround canaliculi.
Contraction shortens canaliculi, forcing lacrimal fluid into lacrimal sac.
Functionally, involuntary lid closure (blinking) is primarily responsibility
of smaller pretarsal orbicularis fibers.
19. Pretarsal Orbicularis Oculi
Medial origin
Deep head, Horner's tensor tarsi muscle arises from 4 mm behind posterior
lacrimal crest & from lacrimal fascia to insert medially on tarsi of upper & lower
eyelids.
It’s contraction pulls eyelid medially & posteriorly, allowing eyelids to follow &
cover, convex globe. In addition, it’s lateral contraction on lacrimal diaphragm
creates a negative pressure in lacrimal sac that draws tears from canaliculi.
20. Orbicularis Oculi
• Horner's & Jones muscles are essential for proper
functioning of lacrimal pump
• Deep fibers medially & posteriorly are responsible for
proper eyelid-to-globe apposition.
• Laterally orbital & preseptal fibers fuse over zygoma to form
lateral palpebral raphe.
• Deep fibers of pretarsal orbicularis joins inferior & superior
crux of lateral canthal ligament, which inserts on Whitnall's
tubercle
23. Orbicularis Oculi
24
• Nerve supply
Temporal and zygomatic branches of facial nerve
• Antagonist muscles
Orbital part frontal belly of occipitofrontalis muscle
Palpebral part levator palpebrae superioris
24. Orbital Septum
• Discreet, well-defined structure arising from arcus
marginalis
• Deep fascia of overlying orbicularis oculi muscle
• Multilayered structure
• Fibrous septa within submuscular fibroadipose tissue
become contiguous with more compact lamellae of orbital
septum, imparting a multilayered quality to orbital septum.
• Fat within fibroadipose layer anterior to orbital septum may
be mistaken for preaponeurotic fat pad during eyelid
surgery
• Orbital septum & levator aponeurosis joins 2 to 5 mm
above superior tarsal border.
• The orbital septum directly adjoins posterior epimysium of
orbicularis for about 1 to 5 mm before joining levator
aponeurosis.
25. Orbital Septum
• The cross-sectional thickness of orbital septum through its parallel
lamella varies but is less than 1 mm.
• It is thickest at the arcus marginalis laterally and is thinnest in lower
lid medially.
• Medially, posterior orbital septal lamella are carried posteriorly by
pretarsal orbicularis muscle, which inserts on posterior lacrimal crest.
• Superficial orbital septal fibers, as described by whitnall appear to
cross & adhere to lacrimal fascia before reaching anterior lacrimal
crest.
• At lateral canthus, orbital septum is also split; deep fibers insert at
Whitnall's tubercle, whereas superficial fibers join at lateral canthal
raphe, just deep to orbicularis muscle.
26. Orbital Septum
• Variation in septal strength is seen between individuals & varies with
age.
• Clinically, weakness of septum explains medial upper lid bulge
(bourrelet senile) seen in older patients & due to herniation of medial
fat pad through an attenuated septum.
• It also may explain high incidence of orbital invasion of basal cell
carcinoma in medial canthal region.
27. Lower lid Orbital Septa
• Arises from inferior orbital rim as a condensation of periosteum & periorbita.
• Anteriorly & superiorly to a point 4 to 5 mm below inferior tarsus, where it joins with lower
eyelid retractors & as a single structure inserts on lower border of inferior tarsus.
• Medially orbital septum splits & is carried posteriorly by pretarsal orbicularis muscle (Horner's
muscle) & attaches to posterior lacrimal crest.
• Laterally, orbital septum also splits & is carried deep by insertion of orbicularis.
The orbital septa of upper & lower eyelids form an anatomic barrier between preseptal &
orbital structures. Infectious processes anterior to septa are considered to be more
benign than posterior to septa.
• Functionally, suborbicularis oculi fibroadipose layer & multilayered orbital septum change with
movement, enhancing eyelid & eyebrow mobility.
29. Orbital fat pad
• Serve as a protective cushion within which eyeball
moves
• Fat within muscle cone is termed central or conal
• Fat outside muscle cone is termed peripheral or
extraconal
• The whitish medial fat pad is more fibrous, whereas
larger central fat pad is more yellow because of a
decreased amount of fibrous tissue
• Larger central fat pad is termed preaponeurotic fat pad.
• Trochlea separates two fat pads.
• Clinically, preaponeurotic fat pad lies directly on the
surface of muscular portion of levator & serves as an
important surgical landmark to levator aponeurosis
immediately beneath it
30. Orbital fat pad
• Preaponeurotic fat pad is less vascular than other fat pads.
• Medial fat pad is more vascular because of location of palpebral arterial arcade,
which serpiginously courses through this pad
• Lateral to preaponeurotic fat pad lies lacrimal gland, which is typically pinker in
appearance, firmer in texture, & distinctly more vascular than preaponeurotic fat
pad
• During removal of orbital fat, eyelid surgeon is careful to avoid injury to laterally
located lacrimal gland.
• In lower eyelid, there exists a smaller temporal fat pad & a larger medial fat pad .
Temporal fat pad lies inferior to lateral canthus. It is separated from larger medial fat
pad by a fibrous extension from periorbita & orbital septum infralaterally, joining with
capsulopalpebral fascia & Lockwood's ligament
31.
32. Orbital fat pad
• The lower eyelid fat pads are in direct communication with deeper
extraconal fat of orbit.
• Clinically, this is important during lower eyelid surgery because
excessive traction may be transmitted deeper into orbit, resulting in
intraoperative or postoperative orbital hemorrhage.
• During transconjunctival lower eyelid blepharoplasty, lateral eyelid fat
pad tends to be more fibrotic & prolapses less easily. Care is also taken
to avoid inferior oblique muscle, which originates just lateral to ostium of
nasolacrimal canal.
33. LPS Origin-
• At the orbital apex from lesser wing of sphenoid bone, superolateral to optic foramen
• At the level of superior tarsal border, fused lamellae of orbital septum & levator aponeurosis
sends connective tissue attachments to secondarily insert onto overlying orbicularis oculi
muscle & subcutaneous tissue.
These attachments result in a sharp upper eyelid crease. Variations in these attachments
result in variations in the location of the upper eyelid crease.
• The levator aponeurosis then sends connective tissue attachments, which insert primarily on
the anterior inferior third of the superior tarsus, with the strongest attachments 3 mm from the
lid margin
It is these tarsal attachments that are more important for proper upper eyelid function.
34. Retractors upper lid
LPS
• Triangular shaped striated muscle. Muscular portion -36 mm. Aponeurosis- 18 mm
• At the level of globe, levator muscle fans out & thins as whitish gray superior
transverse ligament of Whitnall.
• Anteriorly, aponeurosis expands horizontally to insert onto medial & lateral
retinacula as “horns”
• Medial horn of levator attaches to medial canthal ligament.
• lateral horn of levators splits lacrimal gland into larger orbital lobe & smaller
palpebral lobe. It then attaches to lateral orbital tubercle by lateral canthal tendon &
may provide suspensory support for gland.
• Aponeurosis continues anteriorly to a point 2 to 5 mm above the superior tarsal
border, where it joins with fibers orbital septum
• Motor innervation of the levator muscle is the superior division of the oculomotor
nerve (cranial nerve III).
35.
36. Retractors upper lid
Mullers (superior tarsal muscle)
• Müller's muscle takes its origin from underside of levator muscle
22 mm above superior tarsal border where it inserts.
• It is loosely adherent to the conjunctiva & more adherent near tarsus
• Innervated by sympathetic nerve, pierced by peripheral arterial arcade & other
small arteries
Clinically, increased sympathetic stimulation (as seen in Graves' disease) is
thought to be a factor in thyroid eyelid retraction
37. Retractors lower lid
Capsulopalpebral fascia
• Posterior to globe, a fibrous extension arises from inferior rectus muscle
• Collectively termed capsulopalpebral head of inferior rectus muscle that splits to surround
the inferior oblique muscle
It has no inherent innervation but its action mirrors action of inferior rectus muscle, which is
innervated by inferior division of oculomotor nerve.
External portion is termed
capsulopalpebral fascia
Inner counterpart that
contains smooth muscle
is termed inferior tarsal
muscle
The two layers fuse anterior to
inferior oblique muscle to form a
dense fibrous structure termed
Lockwood's suspensory ligament.
38. Retractors lower lid
Inferior tarsal muscle
• It consists of numerous discontinuous smooth muscle bundles &
becomes totally fibrous as the inferior tarsus is approached
• It is sympathetically innervated. Clinically, in Horners' syndrome, the
atonic muscle may allow lower eyelid to elevate as much as 1 mm.
• Conversely, in thyroid eye disease, the lower eyelid may retract from
increased sympathetic tone.
Thyroid lid retraction. Sympathetic stimulation of Müller's muscle & inferior tarsal
muscle is a factor in this patient with Graves' disease.
39. The upper & lower tarsal plates.
• Thickened fibrous connective tissue that provide structural support to
the eyelids.
• Medially and laterally, the tarsal plates are connected to bony orbital
margins by ligamentous fibrous tissue
• Superior tarsal plate is 10 mm in vertical height and 25 to 30 mm in
horizontal dimension. 30 to 40 vertically meibomian glands are
present
• Inferior tarsal plate is 3 to 5 mm in vertical height and measures 25 to
30 mm horizontally. 20 to 30 vertically oriented meibomian glands are
present
40. Suspensory system of the eyelids
• Whitnall's ligament
• Lockwood's ligament
• Lateral canthal ligament
• Medial canthal ligament
• Eyelid margin
41. Suspensory System Of The Eyelids
Superior transverse ligament of Whitnall
• Main suspensory ligament of upper eyelid & as a check ligament for levator
aponeurosis & muscle
• Superior conjunctival fornix suspension assisted by curvature of globe,
• It is suspended from periorbita of orbital roof, extending medially from
trochlea across horizontal dimension of orbit to frontozygomatic suture, 10
mm superior to Whitnall's orbital tubercle
• Laterally, it sends weaker attachments to Whitnall's tubercle
.
42. .
The most significant lateral attachment site of Whitnall's ligament
is at frontozygomatic suture
• Whitnall's ligament is found 15 to 20 mm superior to the superior
border of the tarsus as a white, shiny, glistening structure where the
levator muscle becomes an aponeurosis
43. Suspensory System Of Eyelid
Lockwood's Ligament
• It acts as a suspensory hammock for globe even if all bone inferior to its
attachments at medial & lateral orbital walls are removed.
• Outer fibers of capsulopalpebral fascia fuse with inner fibers of inferior
orbital septum 4 to 5 mm below inferior tarsus & together advance as a
single layer to insert on inferior border of inferior tarsus
• Serves as an anchor for inferior conjunctival fornix
• It is composed of thickened Tenon's capsule, intramuscular septa, check
ligaments, fibers from inferior rectus sheath, lower lid retractors.
• Medially it iattaches to medial canthal ligament and laterally to lateral
canthal ligament.
44. Suspensory System Of Eyelid
Medial Canthal Ligament/tendon-
• Aids in function of lacrimal pump.
• Anterior limb is a broad fibrous structure that attaches eyelids to frontal process of
the maxillary bone & to anterior lacrimal crest. It gives origin to superficial head of
pretarsal orbicularis oculi muscle.
• Posterior limb of medial canthal ligament inserts on posterior lacrimal crest and
lacrimal fascia.
Lateral Canthal Ligament/ tendon-
• Superior crux from superior tarsus & an inferior crux from inferior tarsus they fuse
at the lateral border of tarsal plates to join lateral retinaculum, a condensation of
several anatomic structures that inserts onto lateral orbital tubercle of Whitnall.
45.
46. Anterior limb of medial canthal ligament. In this cadaver
dissection, the anterior limb of the medial canthal ligament
(arrow) is seen originating from the frontal process of the
maxillary bone (pointer). Forceps reflect the medial aspect of the
eyelid.
47. Conjunctiva
• Conjunctiva represents differentiated inner portion of skin fold that forms eyelid. It is
composed of nonkeratinized stratified squamous epithelium with goblet cells.
• Palpebral conjunctiva is loosely adherent, except at tarsus & at superior tarsal
muscle where it is tightly adherent. In lower eyelid, conjunctiva is adherent to lower
tarsus but can be elevated from lower eyelid retractors without difficulty.
49. Arterial Supply
Superficial / Facial System• Facial artery continewes as angular artery it lies within
orbicularis oculi muscle 6 to 8 mm medial to medial canthus
& 5 mm anterior to lacrimal sac. Anastomose with dorsal
nasal branch of ophthalmic artery.
• Superficial temporal artery (ECA) gives off 3 branches to
supply eye lid.
– Frontal branch- frontalis muscle of forehead & orbicularis
oculi anastomosing with lacrimal & supraorbital arteries
– Zygomatico-orbital- upper eyelid, anterior orbit
– Transverse facial- supply malar region & lateral aspect of
lower eyelid to anastomoses with lacrimal & infraorbital
arteries
• Infraorbital arteries- rich contribution to lower eyelid
(internal maxillary artery)
50. Forehead, eyebrow & upper eyelid
frontal vein
supraorbital vein
deep to orbicularis oculi into
(angular & supraorbital veins) superior ophthalmic v
Leaves orbit near annulus of Zinn by SOF
Inferior ophthalmic vein
begins as a plexus near anterior aspect of orbital floor
receives blood from
lower eyelid, lacrimal sac, IR muscle, IO muscle,
2 inferior vortex veins
Deep venous system
Other branches of deep orbital system…. central retinal vein, anterior ciliary veins, & cavernous
sinuses.
receives venous
drainage from
superior vortex veins
cavernous sinus
pterygoid plexus
by IOF
51. Superficial venous system
superior ophthalmic vein
superficial frontal vein from the forehead
Posterior facial v
common facial vIJV
Superiorly & laterally, venous blood from forehead, eyebrow & eyelid drain from supraorbital
vein into superficial temporal vein, into EJV
EJV
55. Sympathetic supply
• Causes vasoconstriction, smooth muscle function, hidrosis, pupillary dilation,
pilomotor and sweat gland function of skin of face.
• Arise from carotid plexus & enter cavernous sinus sheathing intracavernous carotid
artery.
• Within cavernous sinus, sympathetic fibers join nerve branches & arteries entering
the orbit.
• Sympathetic innervation may reach tarsal muscles through a combination of roots:
with (1) levator muscle, (2) marginal vascular arcades, (3) perivascular plexus of
arterioles of muscles, (4) motor nerves of the ocular motor muscles, or (5) sensory
nerves.
• Clinically, interruption of sympathetic nerve fibers may result in Horner's syndrome,
with vascular dilation, ptosis, anhidrosis, miosis, & heterochromia.
56. Forehead
• Transverse elevation of superciliary ridge of frontal bone
• layer consists- skin, subcutaneous connective tissue, muscular layer,
submuscular areolar layer & pericranium
• Skin is thick & mobile contains sebaceous glands
• Subcutaneous tissue layer has more fibrous tissue than fat
• Muscular layer
– Vertical fibers of frontalis
– Horizontal fibers of orbicularis oculi
– Oblique fibers of corrugator supercilii
58. Forehead….
• Corrugator supercilii muscle
– Origin - frontal bone near superomedial orbital margin
– Insertsion- at muscle, skin behind & immediately superior to middle third of
eyebrow
• Procerus muscle
– Origin- from nasal bone & upper nasal cartilage
– Insertion- on medial forehead skin
• Depressor supercilii muscle
– Origin- frontal potion of maxillary bone
– Insertion- on skin superior to medial canthal tendon
• Frontalis muscle & orbicularis interdigitate in eyebrow, a unique feature in
superficial muscle plane of face
Brow muscle force vectors. Open arrows depict
upward muscular force vectors and solid arrows
depict downward muscular force and gravity.
59. Age related changes
• (1) photo-induced aging or ultraviolet (UV) damage, (2) mechanical influences such
as gravity and muscle contraction, and (3) chronologic or intrinsic aging changes.
• Skin changes are characterized clinically by elastosis, irregular pigmentation,
roughness or dryness, teleangiectasia, atrophy, deep wrinkling, and a variety of
neoplasms.
• Mechanical influences from gravity and contraction of the muscles of facial
expression cause a decrease in skin elasticity resulting from constant stretch and
tension.
• Chronologic skin aging is the histologic and physiologic changes seen in sun-
protected skin of most older individuals. Clinical changes seen in the skin are laxity,
dryness, and fine wrinkling.
60. Age related changes
• Eyebrow ptosis
• Synophrys- hypertrophy of eyebrows result in fusion at midline glabellar area
• levator aponeurosis may become infiltrated with fat & disinsert from tarsus
compensatory brow arching
• Involutional lid ptosis
• Horizontal lid laxity- ectropion or entropion
• Telangiectasias, lid thickening, hyperkeratinization & meibomian gland orifice
changes
• Decrease in amplitude & peak velocity of closure phase of both spontaneous &
voluntary blinks. Narrowing of palpebral fissure with age. However, it may also be
partially because of a reduction in dopamine levels with age.
61.
62. References…
• Embryology & Anatomy of the Eyelid. Edward H. Bedrossian, JR.
• Eyebrows, Eyelids, & Face: Structure & Function. Michael s.
Mccracken, Jonathan d. Del Prado, & Don O. Kikkawa.
• Oculoplastic Surgery. Second Edition. Brian Leatherbarrow.
• Smith & Nesi’s Ophthalmic Plastic & Reconstructive Surgery.