This slide includes very basic idea about eye lids which is very important.

1. Eye Lids
-6th semester mbbs
Nischal Shrestha
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2. • Eyelids act as shutters protecting eyes from injuries and excessive
light.
• Spread tear film over the cornea and conjunctiva . They keep the eyes
from drying out when asleep.
• also help in drainage of tears by lacrimal pump system.
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4. Orbital portion
Upper palpebral
furrow
Tarsal part
Lower palpebral
furrow
Outer canthus
or lateral angle
Medial angle or
inner canthus
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5. • When eye is open, the upper eyelid covers about 1/6th of the cornea and
lower lid just touches the limbus. This has importance during
iridectomy. It is done in upper part not lower to prevent diplopia.
• The two lids meet each other at medial and lateral angles or canthi. In
Caucasians with eyelids open , the lateral canthus is about 2mm higher
than medial canthus.
• Palpebral aperture: it is elliptical space between the upper and lower lid.
When the eyes are open it measures about 10-11, vertically in the center
and about 28-30 mm horizontally.
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6. • Lid Margin:
- It is about 2 mm broad
- It is divided into 2 parts by the punctum
- The grey line (which marks the junction of skin and conjunctiva) divides the
intermarginal strip into anterior strip bearing 2-3 rows of lashes and a
posterior strip on which openings of Meibomian glands are arranged in a row.
- The splitting of eyelids when required in operations is done at the level of
grey line.
Medial/ lacrimal
portion, which is
rounded and devoid
of lashes or glands
Lateral /ciliary portion consisting of a
rounded anterior border, sharp posterior
border (placed against globe) and
intermarginal strip (between 2 borders)
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11. Lacrimal pump. A, In the relaxed
state, the puncta lie in the tear lake.
B, With eyelid closure, the orbicularis
oculi muscle contracts. The pretarsal
orbicularis squeezes and closes the
puncta and canaliculi. The preseptal
orbicularis, which inserts into the
lacrimal sac, pulls the lacrimal sac
open, creating a negative pressure
that draws the tears into the sac. C,
With eyelid opening, the orbicularis
relaxes, the puncta open, and the
lacrimal sac collapses, propelling tears
down the duct. Simultaneously, with
the puncta opened, the canaliculi
refill, completing the cycle.
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12. STRUCTURE
• From anterior to posterior, consists of following layers:
1. Skin: thinnest in the body
2. Subcutaneous areolar tissue: very loose and contains no fat. It is thus readily
distended by edema or blood.
3. Layer of striated muscle : It consists of orbicularis muscle which forms an
oval sheet across the eyelids.
Orbicularis muscle comprises of 3 parts: the orbital , palpebral (pretarsal and
preseptal parts) and lacrimal.
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13. • Palpebra :One of two movable folds that cover the front of the eyeball
when closed; formed of a fibrous core (tarsal plate) and the palpebral
portions of the orbicularis oculi muscle covered with skin on the
superficial, anterior surface and lined with conjunctiva on the deep,
posterior surface
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14. • The orbicularis oculi muscle lies directly underneath the surface the skin, around the eyes.
Its function is to close the eyelid, and to help in the passing and draining of tears through the
punctum, canaliculi, and lacrimal sac, all parts of the tear drainage system.
• The orbicularis oculi muscle is composed of three parts: the orbital portion, the palpebral
portion, and the lacrimal portion. The orbital portion closes the eyelids firmly and is
controlled by voluntary action. The palpebral portion closes the eyelids gently in involuntary or
reflex blinking. The palpebral portion is divided into three parts; the pretarsal portion, the
preseptal portion, and the ciliary portion. The lacrimal portion compresses the lacrimal sac,
which receives tears from the lacrimal ducts and conveys them into the nasolacrimal duct.
• Facial paralysis often affects the orbicularis oculi muscle. Inability to close the eye
(lagophthalmos) causes it to dry out (exposure keratitis), resulting in pain or even blindness in
extreme cases.
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15. • In addition, the upper lid also contains levator palpebrae superioris
muscle (LPS).
• It arises from the apex of orbit and is inserted by 3 parts on skin of
lid, anterior surface of tarsal plate and conjunctiva of superior fornix.
• It raises the upper lid .
• It is supplied by a branch of oculomotor nerve.
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Muller’s muscle?
But its smooth
muscle. How
possible?

17. 4. Submuscular areolar tissue : it is a layer of loose connective tissue. The
nerve and blood vessels lie in this layer. Therefore, to anesthetize lids,
injection is given in this plane.
5. Fibrous layer: it is the framework of lids and consists of 2 parts: the
central tarsal plate and peripheral septum orbitale.
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18. i. Tarsal plate
• There are 2 plates of dense connective tissue , one for each lid, which
give shape and firmness to lids.
• The upper and lower tarsal plates join with each other at medial and
lateral canthi; and are attached to orbital margins through medial and
lateral palpebral ligaments.
• Meibomian glands lie in parallel rows in tarsal plates.
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22. ii. Septum orbitale (palpebral fascia)
• It is a thin membrane of connective tissue attached centrally to tarsal
plates and peripherally to periosteum of orbital margin.
• It is perforated by nerves, vessels and LPS , which enters lids from
orbit.
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24. 6. Layer of non-striated (smooth) muscle fibres
• It consists of the palpebral muscle of Muller which lies deep to the
septum orbitale in both the lids.
• In the upper lid it arises from fibres of LPS ( & is k/a superior tarsal
muscle) and in the lower lid from prolongation of inferior rectus
muscle (k/a lower tarsal muscle); and is inserted on the peripheral
margins of tarsal plate.
• It is supplied from sympathetic fibres.
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25. • The superior tarsal muscle works to keep the upper eyelid raised after
the levator palpebrae superioris has raised the upper eyelid.
• Damage to some elements of the sympathetic nervous system can
inhibit this muscle, causing a drooping eyelid (partial ptosis). This is
seen in Horner's syndrome. The ptosis seen in Horner's syndrome is of
a lesser degree than is seen with an oculomotor nerve palsy.
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28. Directly beneath
and attached to the
levator is Muller’s
muscle. It arises
from the
undersurface of the
levator, inserts onto
the superior tarsal
border, and
accounts for
approximately 2 mm
of lid elevation.
Posterior to Muller’s
muscle is
conjunctiva and
adnexal structures
for tear and mucous
production.
plate
Meibomian gland
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30. 7. Conjunctiva
• The part which lines the lids is called palpebral conjunctiva.
• It consists of 3 parts: marginal, tarsal and orbital.
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32. Glands of eyelids
1. Meibomian glands: aka tarsal glands since present in the stroma of
tarsal plate (arranged vertically).
- They are about 30-40 in upper lid and 20-30 in lower lid.
- They are modified sebaceous glands.
- Their ducts open at lid margin.
- Their secretion (meibum) constitutes the oily layer of tear film
(prevents evaporation). Meibum prevents tear spillage onto the cheek,
trapping tears between the oiled edge and the eyeball, and makes the
closed lids airtight.
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36. 2. Gland of Zeis : also sebaceous glands which open into follicles of
eyelashes.
3. Glands of Moll: modified sweat glands situated near the hair follicle.
They open into the hair follicles or into the ducts of Zeis glands. They do
not open directly onto the skin surface as elsewhere.
4. Accessory lacrimal glands of Wolfring or Ciaccio's glands : are small
tubular accessory lacrimal glands found in the lacrimal caruncle of the
eyelid. These are present near the upper border of the tarsal plate. There
are usually 2 to 5 of these glands in the upper eyelid. Present near lower
border of tarsal plate in lower eyelid.
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37. Blood supply
•
Ophthalmic artery
Medial palpebral
artery
Lacrimal artery
Lateral palpebral
artery
Internal carotid artery
1st
branch
Marginal arterial arcades(
2 mm away from lid
margin in upper lid
whereas 4mm away in
lower lid)
anastomosis
In the upper lid another
arcade (superior arterial
arcade) is formed which lies
near upper border of tarsal
plate
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40. • Veins : arranged in two plexuses
• Lymphatics : also arranged in 2 sets; pre-tarsal and post-tarsal. Those
from lateral half drain into pre-auricular lymph node and those from
medial half of eyelids drain into submandibular lymph nodes.
Posterior tarsal
Ophthalmic vein
Drains
into
Pre-tarsal
Subcutaneous veins
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43. Nerve supply
• [ 1,2,8 CN are sensory ; 5,7,9,10 are mixed and rest are motor, 3,7,9,10 are
parasympathetics]
motor
facial occulomotor
Orbicularis
muscle
LPS muscle
Sympathetic
fibres Muller’s muscle
sensory
trigeminal
Supraorbital,
supratrochlear,
lacrimal nerves
for upper lid
Infraorbital,
infratrochlear
for lower lid
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