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.
In this talk , we discuss the assessment and evaluation for patients presenting for cosmetic upper and lower lid blepharoplasty along with surgical technique.
This is a CME article that appears in Plastic and Reconstructive Surgery, the gold standard of publications within the field. Reconstructing the eyelid can be difficult and complicated. This article discusses the various approaches to defects caused by cancer.
Orbital fracture, types, blow in fracture ,blow out fracture ,clinical features ,superior orbital fissure syndrome ,management ,complications ,reconstruction techniques ,Oculocardiac reflex
In this talk , we discuss the assessment and evaluation for patients presenting for cosmetic upper and lower lid blepharoplasty along with surgical technique.
This is a CME article that appears in Plastic and Reconstructive Surgery, the gold standard of publications within the field. Reconstructing the eyelid can be difficult and complicated. This article discusses the various approaches to defects caused by cancer.
Orbital fracture, types, blow in fracture ,blow out fracture ,clinical features ,superior orbital fissure syndrome ,management ,complications ,reconstruction techniques ,Oculocardiac reflex
This lecture includes anatomy, Physiology of eyelids, if u like it kindly share it with colleagues and like it. I will share more lectures related to eye anatomy and optometry.
Thank You.
3. Eyelid
• Thin skin, areolar tissue,
orbicularis occuli ms., tarsus,
levator palpabrae superioris,
Muller’s ms., septum orbitale,
fat and conjunctiva
• Skin – thin, elastic, moderately
adherent to orbicularis over
the tarsus, becomes more
loose and mobile in the
preseptal and orbital regions
• Becomes thicker at the
junction of the skin of the
cheek and eyebrow at the bony
orbital margin
4. Embryology
• 2 ectodermal folds containing a core of
mesenchyme
• Ectoderm: eyelashes and lacrimal glands
• Mesoderm: muscles & tarsal plate
5. Blood Supply
• Via marginal & peripheral arcades
– Upper marginal arcade - via ophthalmic artery
– Lower marginal arcade - via facial artery branches
– Medial peripheral network - via anastomosis from
ICA & ECA systems
– Lateral peripheral network - via branches of STA &
lacrimal artery
13. Orbicularis oculi
• Surrounds the palpaberal fissure
• Responsible for lid closure
• Divided into palpebral & orbital regions
• Palpebral region subdivided into pretarsal &
preseptal parts
15. Orbital Septum
• Facial membrane which separates the eyelid
structures from the deep orbital structures
• Barrier that helps prevent the spread of
hemorrhages, infection, inflammation
• Attaches to the orbital margin at a thickening of the
periosteum called the arcus marginalis
• Arcus is also the point of confluence of the facial
bones periosteum and the periorbita
16. Orbital Septum
• Upper lid: OS inserts
onto the levator
aponeurosis 2-5mm
above the superior
portion of the tarsus
• Lower lid: OS inserts
into the lower edge of
the tarsus
17. Orbital Septum
• Laterally: OS anterior to the lateral canthal ligament
• Medially: OS posterior to Orbicularis oculi & anterior to
Superior oblique/Trochlear pulley & inserts into the posterior
lacrimal crest
• Superomedially: AM forms the inferior part of the
supraorbital groove
• Inferomedially: OS attaches to the anterior lacrimal crest &
inferior orbital rim
• Recess of Eisler: potential space along the lateral half of the
orbital rim where OS originates just inferior to the orbital
margin
19. Medial Canthus
• Tripartite apparatus:
– Vertical component -
suspension & fixation
of the medial canthus
– Horizontal
components
contribute little to
stability
20. Lateral Canthus
• Attaches to: upper &
lower tarsal plates,
orbicularis oculi,
fibrous portion of OS
• Inserts to: lateral
orbital tubercle of
Whitnall (5mm behind
the rim)
21. Tarsal plates
• Thin elongated plates of
connective tissue
• Contribute to form and support
the eyelids
• Closely related to the LPS,
medial, lateral canthal structures
• Superior tarsus 10-12mm
tapering to the sides. Inferior
tarsus 3.8-4.5 mm
• The meibomian glands are
approx 20 in each lid within the
substance opening in a row of
tiny dots corresponding to the
Grey line – mucocutaneous
junction
24. Levator palpebrae superioris
• Striated muscle (CN III)
• Origin: lesser wing of sphenoid
anterior to the optic foramen
• Length: 40-45mm (including
10-15mm aponeurotic
extension)
• Aponeurosis attaches to the
lower 7-8mm of the anterior
tarsus & sends fibres through
the orbicularis to the skin -
upper lid crease
• Total excursion 10-15mm
27. Conjunctiva
• Marginal: lid margin
to anterior skin
• Tarsal: adherent to
the tarsus
• Orbital: posterior to
Muller’s muscle
• Bulbar: extends
posterior to the fornix
28. Lacrimal system
• Controls the tear secretion
• Basic and Reflex secretors
• Basic secretors – three sets of glands
Limbal: mucus secreting goblet cells – produce a
mucoprotein layer covering the cornea
Conjunctival: Accessory lacrimal glands of Krause
and Wolfring located in the s/c tissue
Tarsal: Oil producing Meibomian glands and the
palpaberal glands of Zeis and Moll. Outermost
precorneal lipid layer helps stabilize the tear film and
retards evaporation
• Reflex Secretors - main lacrimal gland (orbital & palpebral
lobes)
30. Lacrimal drainage system
• Upper and Lower puncta open 5-7
mm from the canthal angle at the
apex of the papilla
• Ampulla – vertical portion of the
canaliculus – dilated portion just
prior to the transition to a
horizontal direction
• Horizontal portion measures
approximately 8mm and converge
to form the common canaliculus to
enter the sac, may enter
separately
• Lacrimal sac is located in the
lacrimal fossa just posterior to the
medial canthal tendon
• Nasolacrimal duct passes
downward inferiorly to open into
the inferior meatus
32. Eyelid Reconstruction
• Aims:
– To reestablish functional eyelids
– Adequate protection of the eyeball
– Reasonable cosmesis
33. Eyelid Reconstruction
• Requirements:
– Smooth mucous membrane internal lining to maintain lubrication of
the ocular surface and avoid corneal irritation
– Skeletal support to provide adequate lid rigidity and shape but also
allow molding to the globe
– Stable eyelid margin to keep eyelashes & skin away from cornea
– Proper fixation of the medial & lateral canthal attachments of the lids
for eyelid stability & orientation
– Adequate muscle to provide tone & power for closure
– Supple, thin skin to allow eyelid excursion
– Adequate levator action to lift the upper lid above the visual axis
37. Eyelid Reconstruction
• In the reconstruction of both anterior & posterior
lamellae, at least one must have its own blood
supply
• Techniques would depend on the size, location,
configuration, & depth of the defect
• Superficial defect: only anterior lamella needs to be
repaired
• Full thickness defect: needs reconstruction of both
layers
50. Can close defects up to 25-50% directly +/-
Canthol release.
Approximate Margin first, if tight then
proceed to:
Lateral
Canthotomy
Inferior
Cantholysis
51. Tenzel Slide
-Up to 70% defects of
lower eyelid
-best if tarsal plate
remnant at each end
-good in elderly with
poor other eye
-McGregor Flap is
similar but
incorporates a Z-Plasty
55. Tripier Flap
-Shallow defects up to
100% of lower lid
-Can be lined or unlined
-But, Tendency to sag
and for margin to retract
-Medially, Laterally or
Bipedicle
-?Treacher Collins
Coloboma
56. Reverse Hughes
-No support but ?good results
-Note: Another type of flap good for up to 70% of margin is the upper lid horizontal
advancement tarsoconjunctival flap with a skin graft.
57. Cutler-Beard 1955
-up to 100% of eyelid margin, divide at 8 weeks
-Incision 4 to 6mm below lid margin
-Lacks support, modify with ear cartilage deep to orbicularis
58. Mustarde Lid Switch
-Laterally based is unreliable
-Medially based is a 2 stage procedure