1. ANATOMY OF THE EYELIDS
--Dr. Samir kumar lal
1st year PG.
2. Presentation layout
1. Introduction
2. Embryology
3. Gross anatomy
Extent
Lid folds / Crease
Position of eyelids
Canthi
Eyelid margin
Eyelashes
Palpebral aperture
Structure
Glands of eyelids
Vessels & Nerve supply
Lymphatic drainage
4. Congenital anomalies of eyelids.
3. (1) INTRODUCTION
• THE EYELIDS are mobile tissue curtains placed in
front of eyeballs.
• It covered anteriorly by skin and posteriorly by
mucous membrane-the tarsal conjuctiva.
• It contain muscle,glands,blood vessels and nerves.
• Acts as shutters{regulate the amount of light
reaching thr retina}
• Spread tear film over cornea.
• Relay information regarding the state of
wakefulness/asleep.
• Contribution to facial features.
4. (2) EMBRYOLOGY
• Development of the five
pharyngeal arches occurs in the
first few weeks of gestation.
• Mesenchymal proliferation
occurs in the first brachial arch
to form the facial processes:
frontonasal, medial nasal,
lateral nasal, maxillary and
mandibular.
• The UPPER eyelids are formed
from-frontonasal process.
• The LOWER eyelids are formed
from-maxillary process.
• Eyelid adhesions breakdown
during 5th -6th months.
5. (3) GROSS ANATOMY
EXTENT
Upper eyelid extends from eyebrows to
superior boundary of palpebral fissure.
Lower eyelid –inferior boundary of palpebral
fissure to merge into cheeks.
6. Lid folds/Creases
• Upper eyelid divided by the superior lid fold
into
• ----orbital portion{above}
----tarsal portion{below}
The superior lid fold lies 4mm above the edge
of the eyelid which is formed by fibrous slips
arising from the tendon of levator and insert
into the skin.
The inferior lid fold is less distinct.It is formed
by the fibrous slips that arises from the
capsulopalpebral fascia surrounding the
inferior rectus muscle and are inserted into
the skin.
7. Other fairly constant folds on the lower eyelids-
1. Nasojugal fold or sulcus{medially}
2. Malar fold or sulcus{laterally}
NOTE-These mark the line of junction between the skin and denser
tissue of the cheeks,Hence limiting oedema and demarcating
adipose herniation.
8. POSITION OF EYELIDS
• In primary position of gaze,
• Upper eyelid covers about 1/6th of the
cornea.
• Lower eyelid just touches the cornea.
9. Canthi
• The two eyelids meet each other at medial[inner] &
lateral angles[outer].
Lateral canthus =
• 5-7mm from lateral orbital margin
• 1cm from frontozygomatic suture.
• 60 deg. with eyes wide open.
• Lies in contact with the eyeball.
Medial canthus =
• Rounded
• Has a horizontal lower rim,
• Separated from the globe by tear lake
[LACUS LACRIMALIS] in this area,there are Caruncle and
Plica semilunaris.
10. EYELID MARGINS
• Each lidmargins are 2mm in width.
• Lacrimal papilla which has the lacrimal puncta in its centre is divided into 2
parts- i.e. Lacrimal part and Ciliary part.
* Lacrimal portion{medial} is rounded and devoid of lashes and glands.It extends
from the punctum medially to the medial canthel angle.
* Ciliary portion{lateral} consists of a rounded anteriorly and has a sharp posterior
border.
* Intermarginal strip= b/w the two borders.
* Grey line(junction of the skin and conjuctiva) divides the intermarginal strip into an
anterior strip bears the lashes and a posterior strip which contains opening of
the meibomian glands.
11. Palpebral aperture of fissure
• An eliptical space b/w the upper and lower
eyelid margin.
Horizontal Vertical
At birth 18-21mm 8mm
At adult 27-30mm 8-11mm
12. •Greater elevation of the lateral canthus.
=Mongoloid slant eg=Down synd,Noonan’s synd
•A lateral canthus placed lower than the medial
=Antimongoloid slant. eg=Treacher-collins
synd,Franceschetti{oculomandibular fascial}synd
13. Eyelashes
• Arranged in 2-3 rows.
• In Upper eyelids(100-150)
direction= forward,upward,backward.
• In lower eyelid(50-70)
direction=foreward,downward,backward.
• Cilia
1. 20-120 microns
2. Taper and end in fine points.
3. Life span= 3-4months.
4. Replacement is fully grown in 10 wks.
[ Glands of Zeis and Moll empty into
infundibulum of each ciliary canal.]
14. Structure
• (Layers of palpebral tissue
from the front to back are)
1. Skin
2. Subcutaneous areolar
tissue
3. Straited muscle(orbicularis
oculi)
4. Submuscular areolar tissue
5. Tarsal plates and fibrous
tissue
6. Septum orbitale
7. Non striated muscle
8. Conjuctiva
15. 1.SKIN= The palpebral skin is thin ( <1 mm thick) and almost transparent, folding and
wrinkling easily.
=The skin of medial part of eyelid is smoother and more oily with few
rudimentary hairs b/w sebaceous gland than temporal part.
16. Microscopic Structure = [EPIDERMIS and DERMIS]
EPIDERMIS= although it is thin ,it is composed of 6-7 layers of
STATIFIED SQUAMOUS EPITHELIUM.
KERATIN layer ( stratum corneum or horny layer)-consists of flat cells devoid of nuclei.
Granular cell layer(stratum granulosum) -1 or 2 layer consists of flattened cells with
keratohyaline granules.
Prickel cell layer(stratum spinosum) –polygonal cells with abundant eosinophilic cytoplasm.
Basal cell layer(stratum basale)- single layer of columnar shaped proliferating cells.
DERMIS- thin layer of dense connective tissue with rich network
elastic fibres, blood vessels, lymphatics and nerves.
* Melanocytes are also present which increase their pigment production in
response to chronis oedema or inflammation.
17. 2.SUBCUTANEOUS AEOLAR TISSUE
• Loose connective tissue beneath the skin.
• No fat.
• Readily distended during oedema or blood.
• Non existent-
Near ciliary margin
At lid folds
medial and lateral angles.
18. *This layer consists of orbicularis oculi muscle
(orbicularis palpebrarum).
*The muscle fibres encircle the palpebral opening are obliquely interrelated and
overlaps each other.
3.Striated muscles
19. Divided into 2 parts-
1) Orbital part= forms the most peripheral fibres .
ORIGIN= arises from the anterior part of the medial palpebral ligament and adjacent bones(frontal bone and
lacrimal bone)
INSERTION =At the lateral angles of the eyelid fibers interlace at the lateral palpebral raphe .
Superiorly the upper medial fibers of the orbital part which pass to skin of the medial part of eyebrow is
termed=MUSCULUS SUPERCILIORIS.
Inferiorly =the medial and lateral perifheral fibres of the orbital part which attached to skin of the cheek are called
MUSCULUS MALARIS.
Function=forced closure of the eyelids.
20. 2) Palpebral part subdivided into preseptal and pretarsal portions.
a) Preseptal fibres.
ORIGIN=
• lacrimal fascia
• Posterior lacrimal crest(deep head)
• Anterior part of medial palpebral ligament(superficial head)
These fibres pass superiorly and inferiorly in front of orbital septum.
INSERTION=unite at the lateral palpebral raphe.
b) Pretarsal fibres.
ORIGIN=
• Deep head [ from lacrimal fascia and posterior lacrimal crest ]
• superficial head [ from medial palpebral ligament ]
INSERTION=lateral orbital tubercle of WHITNALL.
21. PRETARSAL PORTION
Some fibres which arises from the
lacrimal fascia and upper part of
posterior lacrimal crest help in the
drainage of tears by lacrimal sac are
called as PARS LACRIMALIS
[HORNER’S MUSCLE]
Some fibres run along the lid margin
behind the ciliary follicles form the
PARS CILIARIS
[MUSCLE OF RIOLAN]
22. NERVE supply= temporal and zygomatic branches of facial
nerve.
Antagonist muscle=
•Orbital part ---frontal belly of occipitofrontalis muscle.
•Palpebral part--levator palpebrae suprioris.
23. Levator palpebrae superioris
• ORIGIN= At the apex of the orbit from the under surface of lesser wing of
the sphenoid bone above the annulus of zinn by a short tendon which is blended
with origin of Superior rectus muscle.
• COURSE and ATTACHMENT=
Flat ribbon like belly
Axis slightly nasal
Aponeurosis passes through septum orbitale
Forms Medial & lateral horns.
1)MEDIAL HORN =Passes over the
reflected tendon of the superior oblique
and fuses with upper border of MEDIAL
CANTHAL TENDON.
2)LATERAL HORN=Thicker, and divides the
lacrimal gland into orbital & palpebral
parts and inserts into the superior edge
of the LATERAL CANTHAL TENDON.
24.
25. INSERTION = The aponeurosis of LPS passes through the septum orbitale
and continues forward and Downward to a level just above the superior border of
the tarsus where it widens into two attachment.
•The Anterior collagen fibres attach to septa b/w orbicularis muscle fibres at the
level of upper tarsal border.
•A few fibrous slips from LPS are also inserted into the pretarsal skin of eyelids.
(forming superior lid folds)
•The thickened posterior part of the muscle inserts onto anterior surface of the
tarsus.
•Some fibrous slips also attached to the superior conjuctival fornix.
26. LPS
Fleshy part = (40 mm long) runs horizontally.
Tendinous aponeurosis =(15 mm long ,30
mm wide) runs vertically.
This change of direction occurs at the level of ------------
SUPERIOR TRANSVERSE LIGAMENT OF WHITNALL.
NERVE SUPPLY =Branch of superior division of the
Occulomotor nerve.
FUNCTION= Elevation of upper eyelids.
27. SUPERIOR TRANSVERSE LIGAMENT of
WHITNALL.
• Thickened band of orbital fascia
• Extends from the trochlear
pulley to the capsule of the
orbital lobe of lacrimal gland.
• Formed by condensation of the
superior sheath of levator
muscle joined medially by the
sheath of the reflected tendon
of superior oblique muscle.
• Recognition of its is important in
PTOSIS SURGERY.
• SEVERING of whitnall’s ligament
=failure of LPS function.
28.
29. 4.Submuscular areolar tissue
• It is a layer of loose connective tissue present b/w the orbicularis
muscle and the fibrous layer.
• It split the eyelid into-anterior lamina and posterior lamina.
• In the lower lid,the submuscular tissue lie in a single spacebehind the
orbicularis.
• In upper eyelid it is traversed by LPS which divide into two spaces---
a) pretarsal space.
b) preseptal space.
Clinical importance:
1. The nerves and vessels of the lids lie in the this layer,so anaesthesia for
lids given in this plane.
2. In upper eyelid,it is connected superiorly with Subaponeurotic stratum
of the scalp—Dangerous area of scalp.
30. Pre tarsal space:
1. It is a small space which appears fusiform in a vertical section.
2. Bounded by –LPS(anteriorly) and TARSAL PLATE(POSTERIORLY)
3. The peripheral arterial arcade is present here.
Preseptal space:
1. It appears triangular in vertical section.
2. Bounded by –ORBICULARIS OCULI (anteriorly) and
ORBITAL SEPTUM(posteriorly).
Preseptal cushion of fat:
1. It is crescent shaped pad of fat.
2. Bounded by- ORBICULARIS
OCULI(anteriorly) to which it is firmly
adherent and ORBITAL
SEPTUM(posteriorly)
31. 5.Tarsal plate and fibrous tissue.
• It is the framework of the lids.
• It consists –Tarsal plate(central thick part)and Septum
orbitale(peripheral thin part:palpebral fascia.
• It also includes the medial and lateral palpebral ligaments.
32. TARSAL PLATES:
Tarsi are firm plates of dense fibrous tissue that form the skeleton of
the eyelids giving them shape and firmness.
Size: 29mm long and 1 mm thick.
Upper tarsus is 10-11mm in
height,
lower tarsus is 4-5 mm in
height.
Borde
r:
free borders are straight while
the attached borders are convex.
Superior border of upper tarsus
gives attachment to –
Septum orbitale and
Muller’s muscle.
Inferior border of lower tarsus
gives attachment to –
Orbital
septum,Capsulopalpebral fascia
and Inferior palpebral muscle.
33. Surface: Anteior surface of each tarsus is convex and
seperated from orbicularis muscle by areolar
tissue,so that muscle moves freely on the
tarsus.
Posterior surface is concave coinciding with the
globe of the eye,and is lined by conjuctiva
which is firmly adherent to the taral plates.
Extremities
(ends)
Lateral ends are attached to Whitnall’s tubercle
by the lateral palpebral ligament.
Medial ends are attached by the medial
palpebral ligament to the anterior lacrimal crest
and frontal process of maxilla.
34. 6.Septum orbitale(palpebral fascia)
• It is a thin, floating membrane of connective tissue which takes part in the
movements of the eyeball.
• Attachment:
Centrally= it becomes continuous with the convex borders of the tarsi.
Peripherally= it is attached to the orbital margins at a thickening called
Arcus marginale.
35. Clinical importance of septum orbitale:
The septum orbitale forms a barrier against spread of infection
to the deeper structure of the eyes.
An infection ,which is in front of the septum ,preseptal cellulitis,
has better prognosis than a deeper infection and is associated
with less number of complications.
36. Structures piercing through septum orbitale—
1.Lacrimal vessels and nerves.
2.Supraorbital vessels and nerves.
3.Supratrochlear artery and nerves.
4.Infratrochlear nerves.
5.Anastomosing vein b/w the angular and ophthalmic veins.
6.Superior anf inferior palpebral arteries.
7.Aponeurosis of levator muscle in the upperlid.
8.Expansion of the inferior rectus in the lower lid.
37. Medial palpebral ligament.
It is a triangular band of connective tissue,attached to the frontal process of the maxilla
from anterior lacrimal crest to suture line of frontal process with the nasal bone.
Divided into 2 parts—
1) Anterior part of MPL= from its attachment at the anterior lacrimal crest fans out
laterraly.
This part gives origin to the superficial portion of orbicularis muscle.
The anterior part continue laterally and at the medial canthus splits into upper and lower
bands which are attached to the medial ends of the upper and lower tarsal plates
,respectvely
Anterior part resembles the letter Y placed on its side with two open limbs facing laterally.
2)Posterior part of MPL=passes behind the lacrimal sac from the anterior lacrimal
crest to the posterior lacrimal crest.
38. Lateral palpebral ligament
EXTENT 7 mm horizontally and
2.5 mm in height.
LATERALLY ATTACHED TO THE WHITNALL’S TUBERCLE ON LATERAL ORBITAL MARGIN.
MEDIALLY ATTACHED TO THE LATERAL ENDS OF THE UPPER AND LOWER TARSAL
PLATES.
ANTERIOR
SURFACE
RELATED TO LATERAL PALPEBRAL RAPHE.
POSTERIOR
SURFACE
RELATED TO CHECK LIGAMENT TO THE LATERAL RECTUS MUSCLE.
UPPER
BORDER
MERGES WITH LATERAL EXPANSION OF THE LEVATOR APONEUROSIS.
LOWER
BORDER
LATERAL EXPANSIONS OF INFERIOR OBLIQUE AND INFERIOR RECTUS
MUSCLE.
39.
40. 7.NON STRIATED MUSCLE
This layer consists of smooth muscle fibres
of Muller (the superior and inferior
palpebral muscles) which lie deep to the
septum orbitale in the upper and lower
eyelids,respectively.
ORIGIN: Inferior terminal striated fibres of
the LPS in the upper eyelid.
INSERTION: orbital margin of tarsal plate.
NERVE SUPPLY: Sympathetic nerve fibres.
41.
42. 8.CONJUNCTIVA
• The posterior most layer of the eyelid is
formed by the palpebral conjunctiva.
• It extends from the mucocutaneous junction
at the lid margin to the conjunctival fornix.
• It is firmly adherent to posterior surface of the
Tarsal plate and Muller’s muscle.
43. Glands Location Opening Secretion
Meibomian gland
(modified sweat
gland)=20-30 in
each lid.
Posterior part of stroma
of tarsal plates.
Single row on the lid
margin b/w the grey
line and posterior
border of lid.
Oily in
nature.(sebum)
Gland of Zeis
(modified sweat
gland)=usually 2
glands with each
cilium.
Follicles of cilia,eyelid
and caruncle.
Open directly into the
eyelash follicle.
Oily in nature(sebum)
Gland of Moll
(modified sweat
gland)
Between the cilia Terminate seperately
b/w 2 lashes or into
the ducts of Zeis
gland.
sweat
Glands of Wolfring
(accessory lacrimal
gland)=2-5 in upper
Upper border of
superior tarsus
Lower border of inferior
Into inner surface of
eyelid
Aqueous
(contribute to tear
film).
Glands of the eyelid.
46. ARTERIAL supply—
•Mainly supplied by the Medial and Lateral palpebral arteries which are
branches of the dorsal,nasal,and lacrimal arteries.
•The superior and inferior arteries pierce through the above septum
orbitale and below medial palpebral ligament and enter the upper and
lower eyelids respectively.
•Marginal arterial arcades- anastomosis b/w Medial palpebral
artery and corresponding Lateral palpebral artery (branch of lacrimal
artery) which lie in the submuscular plane in front of tarsal plate ,2-3
mm away from lid margin.
•In upper eyelid another arcade is formed from superior branches of
Medial palpebral artery which lies near upper border of the tarsal plate.
•Branches from the arterial arcade go forward to supply orbicularis and
skin and backward to supply tarsal glands and conjunctiva.
47.
48.
49. VENOUS DRAINAGE—arranged in 2 sets of venous plexus.
PRE TARSAL VENOUS
PLEXUS
It drains structure superficial to the tarsus.
It drains mainly into subcutaneous veins –
Angular vein>> Internal jugular vein( medially)
Superficial temporal vein & Lacrimal vein>>External jugular
vein(laterally)
POST TARSAL VENOUS
PLEXUS
It drains structures posterior to the tarsal plate.
It drains mainly into the Ophthalmic vein.
50.
51. Lymphatic drainage
• Lymphatic plexuses are 2 in each lid—
Superficial or pre-tarsal
plexus
Skin and orbicularis
Deep or post tarsal plexus Tarsal plate and conjunctiva.
52. Medial group=
superficial:
1) medial ½ of lower lid,
2) medial ¼ of upper lid,
3)medial commissure.
Deep:
1)medial 2/3rd of conjunctiva of lower lid
2) caruncle.
Lateral group=
Superficial:
1) lateral ½ of lower lid ,
2) lateral ¾ of upper lid.
Deep :
1)lateral 1/3rd of conjunctiva of lower lid
2)entire conjunctiva of upper lid.
53. NERVE SUPPLY:
Motor supply–zygomatic branch of facial nerve (orbicularis muscle),
Oculomotor nerve(levator palpebrae superioris)
Sensory— trigeminal nerve (1st and 2nd division )
Upper lid = supraorbital ,supratrochlear,infratrochlear & lacrimal.
Lower lid = infraorbital,infratrochlear & lacrimal.
Sympathetic supply to Muller’s muscle,skin & glands.
Arrangement – the nerves are arranged in the submuscular plane.
(b/w orbicularis and the tarsal plates).
This is the plane of anaesthesia of eyelids.
54.
55. Congenital anomalies of eyelids.
• 1) Eyelid coloboma =
--Eyelid defect due to either due to failure of
migration of lid ectoderm to fuse the lid folds
or mechanical
forces such as amniotic band.
a) Upper lid coloboma {middle &inner 1/3}
eg- facial anamolies &goldenhar synd( oculo
auriculo vertebral syndrome.
b) Lower lid coloboma {at junct of outer
&middle 1/3}
eg-treacher collins synd(mandibulofacial dystosis)
57. 4) Microphthalmos =
• small eyelids, sometimes a/w anophthalmos.
5) Ablepharon =
• deficiency of anterior lamellae of eyelids.
58. 6) Ankyloblepharon =
• Upper and lower eyelids joined.
7) Epicanthic folds =
• Bilateral vertical folds of skin that
extend from upper & lower lids towards.
• Pseudoexotropia.
59. 8) Telecanthus =
• Increased distance b/w the medial canthi due to abnormally
long medial canthal tendon.
• In contrast Hypertelorism is wide bony separation of orbits.
