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EYELID ANATOMY

FIGURE 2-1

Eyelid anatomy. (Redrawn with permission from Riordan-Eva P, Richter JP: Vaughan & Ashbury's General Ophthalmology, 17th Ed. New York: McGraw-Hill; 2008.)

Eyelids

  • Unique and distinct in their anatomy

  • Five layers superficial to deep: skin, orbital septum, eyelid retractors, tarsal plates, conjunctiva

  • Skin

    • Unique because it is the thinnest in the body, few vellus hair follicles, no subcutaneous fat layer with loose attachments to underlying tissue

  • Orbicularis oculi

    • Main protractor, or closing muscle of the eyelid; motor innervation by cranial nerve VII (facial nerve)

    • Three anatomic parts: pretarsal and preseptal (together comprising the palpebral portion of orbicularis) and orbital parts. The pretarsal and preseptal parts involved with involuntary blink; orbital portion involved with voluntary for forced eye closure

    • Concentric muscle fibers shaped like a horse-shoe, covering entire eyelid; insert at medial and lateral canthal tendons and orbital portion interdigitates with frontalis, corrugator, and procerus muscles in the forehead

  • Orbital septum

    • Dense fibrous sheath of mesodermal origin forming middle lamella of eyelid

    • Extension of periosteum of orbital bones; extends from arcus marginalis at bony rim toward the tarsus; attaches to levator aponeurosis and capsulopalpebral fascia in upper and lower eyelids, respectively

    • Keeps orbital fat in posterior compartment and acts as a barrier between orbit and eyelid, preventing postseptal spread of infection

  • Eyelid retractors

    • Attach to tarsal plates and serve to retract or open eyelids

    • Upper eyelid: levator palpebrae superioris, Müller muscle

    • Lower eyelid: capsulopalpebral fascia, inferior tarsal muscle

  • Tarsal plates

    • Dense connective tissue plates in each eyelid, responsible for structural integrity and contour of eyelids; contain meibomian glands

    • Rigid attachments to orbital rim periosteum by lateral and medial canthal tendons

  • Conjunctiva

    • Divided into palpebral and bulbar conjunctiva

    • Mucosal membrane with numerous mucin-producing goblet cells, blood vessels, nerve endings, and loose underlying stromal tissue (substania propria)

    • Palpebral conjunctiva is the posterior-most lining of the eyelids and is firmly adherent to tarsal plates

    • Palpebral conjunctiva continues to the cul-de-sac or fornices of the eyelids where it is reflected to form the bulbar conjunctiva that covers the globe

    • Bulbar conjunctiva is delicate and freely movable except where it fuses with the globe at the limbus

  • Preaponeurotic fat pads

    • Lie immediately posterior to orbital septum

    • Upper lid: 2 fat pads anterior to levator aponeurosis; nasal smaller and paler than central pad

    • Lower lid: 3 fat pads anterior to capsulopalpebral fascia; lateral pad is small; nasal and middle pads separated by inferior oblique muscle

  • Sensory innervation of the eyelids

    • Cranial nerve V (trigeminal nerve) via terminal branches of ophthalmic (V1) and maxillary (V2) divisions

  • Canthal tendons

    • Medial and lateral tendons attaching to orbital rim periosteum

    • Complex arrangement of fibrous tendon with muscular component from orbicularis muscle, attaching tarsal plates of each eyelid to orbital rim

    • Attachments are important for proper orientation and ...

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