EYELID_ANATOMY presentation dhir bwn.pptx

1. EYELID ANATOMY
PRESENTER - Dr RUCHIKA DHIR
MODERATOR – DR URMILA
DHIR HOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY

2. UPPER EYELID
LOWER EYELID
LANDMARKS
SUPERIOR PALPEBRAL SULCUS/ UPPER EYELID CREASE
INFERIOR PALPABERAL SULCUS/ LOWER EYELID CREASE

3. MEDIAL CANTHUS
LATERAL CANTHUS
LANDMARKS
SUPERIOR ORBITAL SULCUS
INFERIOR ORBITAL SULCUS

4. Lateral Canthus 2mm
higher than Medial
Canthus
Mongoloid Slant
(DOWN’s Syndrome)
Pseudo A Pattern strabismus
Anti Mongoloid Slant
Treacher collin’s syndrome
Tripod Fracture
Psudo V Pattern strabismus

5. Normal Intercanthal Distance:30-31mm
Telecanthus

6. Palpebral Aperture
• Upper eyelid covers 2mm or
1/6th of the cornea .
• Lower eyelid just touches the
limbus.
28-30mm
8-10mm

7. EYELID MARGIN
• 2MM Thick
• Round Ant. Border
• Sharp Post. Border
• From A-P

8. LAYERS OF THE EYELID
7 LAYERS (A-P)
1. Skin
2. Subcutaneous Connective Tissue
3. Orbicularis Oculi Muscle
4. Submuscular Connective Tissue
5. Tarsus & Orbital Septum (Fibrous Layer)
6. Smooth Muscle Layer
7. Conjunctiva

9. • Thinnest in the body
• Only 0.1mm thick
• Very elastic
• Dermatochalasis – skin
becomes loose and redundant.
Keratinized Stratified Squamous Epithelium
SKIN

10. EYELASHES/CILIA
UPPER LID:- 100-150 Cilia
LOWER LID:- 50-75 Cilia
GLAND OF ZEIS:-
•Modified sebaceous gland
•Pours its secretions in hair follicles
GLAND OF MOLL
•Modified sweat glands
Contributes to lipid layer of Tear Film

11. • Composed of connective tissue – elastic fibes , collagen
• No fat
• During trauma/ inflammation – gets easily distended with blood or
fluids due to presence of areolar tissue
Subcutaneous Connective tissue

12. Orbicularis Oculi Muscle
ORBITAL
PALPEBRAL
PRESEPTAL
PRETARSAL
FUNCTION –
• Orbital part : Squeezing of lids , winking
• Palpebral part : Blinking , drainage of tears
•Striated Muscle
•Concentric fashion
•Protractor

13. ORIGIN & INSERTION
Origin
•Palpebral Part
•Pre-Tarsal
•Superficial
•Deep (Horner Muscle)
•Pre-Septal
•Superficial
•Deep (Jones Muscle)
Insertion
•Lateral Palpebral Raphe
•Orbital part
•Frontal process of maxilla
•Orbital precess of frontal bone
•MCL
•Insertion
•Inf to origin

14. Posterior
Lacrimal
Crest

15. Lacrimal Pump
Horner’s muscle(Pars lacrimalis):-
•Extension of Palpebral part of Orbicularis Muscle
especially pretarsal part
•Contraction of this muscle draws eyelid Medially &
Posteriorly causing Negative pressure in Lacrimal Sac

16. Muscle of Riolan( Pars Ciliaris )
• Most superficial part of the orbicularis
muscle (Not a separate muscle)
• It forms the grey line and helps lid in close
apposition to globe.

17. Nerve Supply: 7th cranial nerve
Facial nerve palsy-
Eyelids do not close and lacrimal pump doesn't works.
Lagopthalmos

18. Tarsus
• Forms skeleton of eyelids
• 10-11mm height in upper eyelid
• 4-5mm height in lower eyelid
• Meibomian glands are embedded in the tarsal plates

19. ORBITAL SEPTUM
• Modification of periosteum .
• Orbital septum separates eyelid from orbit.
• Prevents any infection or blood to enter the
orbit.
• If septum is breached , preseptal cellulitis can
covert into orbital cellulitis .
• Origin : Centrally:-Anterior border of tarsal
plate
• Peripherally :- Arcus marginale
• Laterally :- LCL, Whitnall’s Tubercle
• Medially :- Lacrimal Fascia, ALC
• Insertion:- Sup into Levator Aponeurosis
• Inf into Capsulopalpebral Fascia

20. Levator Palpebrae Superioris Muscle
• Behind septum lies LPS
• Main retractor of upper eyelid
• Nerve supply: Oculomotor nerve
• Origin : Apex of orbit , lesser wing of sphenoid
• Course : Between roof of the orbit and superior rectus . Descends vertically at Whitnall’s
Ligament

21. Medial Canthal Tendon
Lateral Canthal Tendon
Origin :- 4mm
Mid-Orbit :- 8mm
Orbital Rim (Ant) :- 20mm
Whitnall’s :- 24mm
Insertion :- 28-32mm
Total Length :- 36mm
Aponeurosis Length :- 12-18mm
Muscle Length :- 18-24mm
COURSE OF LPS

22. LPS INSERTIONS
1. Upper Fornix
2. Medial Horn – MCT & Post LC
3. Lateral Horn – Lateral Tubercle
4. Skin – Eyelid Crease
5. Tarsus – Upper edge & Ant Surface

23. CHECK LIGAMENT
• Also called as Conjoint Facial Sheath
• Present in Ant 1/3rd of LPS Posterior to
Whitnall’s Ligament
• Joins LPS + Fornix + SR
• Can Injure during Supra-Maximal
LPS Resection

24. WHITNALL’S LIGAMENT
• Superior Transverse Ligament
• Thickened band of orbital fascia
formed by condensation of sheath of
levator muscle
• Prominent White line in 40-50% of
cases
• It is not a part of LPS it just surrounds
LPS
• It acts as fulcrum leading to change
in vector from Horizontal to Vertical
• Whitnall’s Sling Sx

25. •Damage to Whitnall’s during sx will
lead to Undercorrection due to
prolapse of muscular part of LPS

26. Structures Attached At Whitnall’s Tubercle
• Lateral Palpebral Ligament
• Check Ligament of LR
• Lateral Horn of Levator Aponeurosis
• Ligament of Lockwood

27. Muller’s Muscle
• Smooth muscle
• Superior tarsal muscle
• Origin:- Undersurface of LPS ant. Whitnall’s Ligament
• Inserts at superior border of tarsal plate.
• Innervated by sympathetic nervous system .
• Causes 1-2mm of elevation
 In Horner’s Syndrome – Paralysis of muller’s muscle ,
mild lid ptosis of 1-2 mm.
 In Thyroid Opthalmopathy – Increased sympathetic discharge
causing lid retraction

28. Conjunctiva
• Palpebral Conjunctiva
• Firmly attached to the tarsus , it is
impossible to detach conjunctiva from
tarsus by manual dissection .
• Contains goblet cells and accessory
lacrimal glands
• Fasanella Servat ( Tarso – Conjunctival –
Muulerectomy)

29. Meibomian Glands
• Modified Sebaceous Glands .
• Contribute to lipid layer of the tear film.
• Arranged in a single row vertically parallel to
each other .
• 20-30 in lower lid 30-40 upper lid

30. Lower Eyelid Anatomy
Retractor of LL is Capsulopalpebral Fascia & Inf Tarsus Muscle

31. • Inferior Tarsal Muscle :
o Smooth muscle
o Attached to inferior tarsus
o Sympathetic nervous system (can cause reverse ptosis in horner’s syndrome)
o Elongation of IR
• Capsulopalpebral Fascia
Retractors of Lower Eyelid

32. Arterio-venous supply
Supplied by branches of both internal and external carotid artery.
Drained by both internal and external jugular veins.

33. Nerve supply
Motor :
• Orbicularis oculi – 7th cranial nerve
• LPS – 3rd nerve
• Smooth muscles – Sympathetic nervous system
Sensory: Branches of 1st and 2nd division of trigeminal
nerve.

34. • Thank You

35. Submuscular Connective Tissue
Contains nerve fibres and vessels of the lid in this layer . Local anaesthesia should be instilled
in this layer .
Divides eyelid into anterior lamina and posterior lamina through grey line.

36. Fibrous Layer

37. LACRIMAL PAPILLAE&PUNCTA

38. Orbicularis Oculi Muscle
ORBITAL
PALPEBRAL
PRESEPTAL
PRETARSAL
FUNCTION –
• Orbital part-FORCED CLOSURE, WINKING
• Palpebral part : GENTLE CLOSURE DURING
BLINKING

39. Anatomy of Eyelid
• Important surface landmarks
• Layers of eyelid (upper and lower )
• Lid glands
• Eyelid margin
• Important lid anomalies
• Nerve supply
• Blood supply

41. Glands of Eyelid