Eyelid Anatomy-2.pptx

Lid antaomy

1. Anatomy of Eyelid Presented By Dr. Suruchi Baluni P.G. Scholar 1 st year Dept - Shalakyatantra

2. Contents Inroduction Embryology Anatomy Layers of Eyelid Muscle of Eyelid Gland of Eyelid Function of Eyelid Nerve supply Vascular supply Venous drainage Lymphatic drainage

3. The eyelids are the mobile tissue in front of the eyeballs. (ocular appendages). Eyelids are thin curtains of skin ,muscle, fibrous tissue and mucous membrane. Two in number: Upper and lower eyelid Introduction

4. Functions: Act as shutters protecting eyes from injuries and excessive light. Spread the tear film over the cornea and conjunctiva. Contribute to the facial feature and information regarding the state of wakefulness and attention. Its is mobile, multilamellar structure that covers eyeball anteriorly.

5. It is formed by reduplication of surface ectoderm above and below the cornea during 2 nd month of gestation. The folds enlarge and their margin meet and fuse with each other by 3 rd month. A closed space, conjunctival sac is formed. The folds thus formed contain some mesoderm which would form the muscles of the lid and the tarsal plate. Lid separate after seventh month of intra uterine life Embryonic development of eyelid

6. 8 Weeks 5-7 month 7 weeks

7. Tarsal glands are formed by ingrowth of a regular row of solid columns of ectodermal cells from the lid margins. Cilliary glands are outgrowth from the ciliary follicles. Cillia develop as epithelial buds from lid margins .

8. Gross Anatomy • Extent • Position of eyelids • Parts of eyelids • Canthi • Eyelids Margin • Eyelashes • Palpebral Aperture

9. Extent : Upper eyelid extends from the eyebrow downward to end in a free margin which forms the superior boundary of palpebral fissure. Lower eyelid merge into the skin of the cheek. Parts Each eyelid is divided by an horizontal furrow into an orbital and tarsal plate. Additional folds in lower lid are Nasojugal fold medially and the malar fold laterally. These folds limit the spread of blood downward from eyelids to cheek .

10. Upper eyelid covers 1/6 th part of the cornea. Lower lid just touchs the limbus. Postion of the eyelids Palpebral aperture It is the elliptical space between the upper and the lower lid. When the eyes are open,it measures about vertically-10-11mm. horizontally 28-30 mm. At Birth horizontal 18-21mm. vertical 8 mm.

11. Eyelids meet at medial and lateral canthi . Medial canthus : it is rounded and is separated from the globe by tear lake ( lacus lacrimalis ). In this area, there is caruncle and plica semilunaris . Canthi Lateral Canthi It is about 5-7 mm from the lateral orbital margin. It forms an acute angle of about 60 degree with eyes wide open and 30-40 degree with eyes open in normal way

12. caruncula lacrimalis : its is a small pink,globular nodule at the inner corner (medial canthus ) of the eye .consist of skin,hair follicle,sweat gland and sebaceous gland. A semilunar fold called plica semilunaris lies on lateral side of caruncle represents the third eye lid of other vertebrae.

13. Each lid margin is divided into two parts by the lacrimal papilla(a small elevation present on the medial side, which contains a hole- the lacrimal punctum in its centre). The medial portion of the eyelid margin, extending from the punctum medially to the medial canthal angle termed as lacrimal portion is rounded and devoid of lashes or glands. The lateral, ciliary portion of the eyelid margin consists of a rounded anterior border, a sharp posterior border (placed against the globe) and an intermarginal strip between the two borders. Eye lid margin

14. Grey line which marks the junction of skin and conjunctiva,divides the intermarginal strip into an anterior strip bearing lashes and a posterior strip which contains opening of meibomian glands arranged in a row and a lipid strip.

15. Arranged in 2-3 row. Upper lid 100-150 directed forward,upward and backward Lower lid 50-75 directed forward downward and backward. Cilia Cillia vary in size ranging from 20-120mm in diameter and from 6-12mm in length Taper throughout their length to end in fine sharp point. Each cilium has a life span of some 3- 4 months. At the termination of this period the old cilium drops away the follicle test for several week and then a new cilium grows out. Each follicle is surrounded by a dense plexus of vessels and nerves, the latter provide the tactile sensibility to each cilium . Eye lashes

16. Trichiasis :Acquired misdirection of eyelashes. Madarosis : Decrease in number of eyelashes. Lash Poliosis : Premature graying of the lashes. Trichomegaly : Excessive eyelash growth. CONGENITAL /DEVELOPMENTAL ANOMALIES Coloboma of lid : Notch in the edge of eyelid Cryptophthalmos : partial or complete loss of brows, palpebral fissure, lashes,conjuctiva and absence of eyelid. Applied Aspect

17. Ectropion : Eversion of eyelid margin Entropion : Eyelid margin inversion

18. Euryblepharon : vertical shortening and horizontal lengthening of eyelids . Epiblepharon : lower lid Pretarsal muscle and skin ride above the lower lid margin to form a horizontal fold of tissue. Ankyloblepharon : partial or complete fusion of eyelids by webs of skin. Symblepharon : adhesion of lid to the gobe .

19. Distichiasis : extra rows of eyelashes. Blepherophimosis : condition in which palpebral fissure appear to be smaller

20. 1. Skin 2. Layer of subcutaneous tissue. 3. Layer of striated muscle. 4. Submuscular areolar tissue 5. fibrous layers 6. Layer of non straited muscle fibres 7. conjunctival layer Layers of the eyelid

21. Skin The skin covering the eyelid is elastic, having a fine texture, is thinnest in the body and folds easily thereby contributing to the ease and speed of mobility of the upper eyelid. Nasal part of the skin is smooth,shining and greasy in comparison to temporal part. Fine hair are seen on the temporal part of skin.

22. Xanthelasma Sharply demarcated yellowish deposits of cholesterol underneath the Skin Mostly on nasal side due to more unicellular sebaceous gland Applied anatomy

23. Beneath the skin is a layer of loose aerolar connective tissue, containing no fat . It is thus readily distended by oedema or blood. This layer is non- existent near the ciliary margin, at the lid folds and at medial and lateral angles where the skin is attached to the underlying ligaments. Subcutaneous aerolar tissue .

24. Layer of striated muscle This layer consists of orbicularis muscle which forms a thin oval sheet across the eyelids. It comprises three portions: the orbital, palpebral and lacrimal. The Orbital part forms the most peripheral fibres of the orbicularis which arise from the anterior part of the medial palpebral ligament and the adjacent bones( upper orbital margin, the maxillary process of frontal bone, frontal process of maxilla and the lower orbital margin medial to the infra-orbital foramen.

25. The Palpebral part of orbicularis are preseptal and pretarsal portions. The fibres of pretarsal portions helps in drainage of tear by lacrimal sac and are called as pars lacrimalis .( H orners muscle) It is supplied by zygomatic branch of facial nerve . Therefore in paralysis of facial nerve there occurs l agophthalmos .

26. Function of orbicularis oculi muscle Closure of eyelids Orbital portions Forced closure of eyelids R eflex blinking Palpebral portion H elps in gentle closure during blinking and sleep.

27. Applied aspects Horner’s syndrome Also known as oculosympathetic paresis Characterised by classical triad Miosis (constricted pupil) Partial ptosis Apparent anhidrosis (decreased sweating)

28. Muscle of riolan (Pars ciliaris ) Small bundle of striated muscle fibers At the eyelid margin Extension of pretarsal portion of orbicularis oculi fibers Function: Keep the lids in close apposition to the globe

29. Levator palpebrae Superioris( major eye lid retractor) Origin- Arises from the apex of the orbit,above annulus of zinn . It is a flat muscle that broadens as it passes forwards.

30. Other sites of insertion Some fibres are attached to:- The skin of upper lid. The superior conjunctival fornix. The upper edge of the superior tarsus( superior tarsal muscle ) Primary insertion- Primary point of insertion is into superior surface of the tarsus.

31. Superior Tarsal Muscle A thin sheet of smooth muscle lies beneath the main tendon of levator palpebrae superiors. This group of smooth muscle fibres help to maintain eyelid elevation. Loss of function of the superior tarsal muscle results in drooping of upper eyelid. Course & attachment o Passes forward below the roof of the orbit, above the superior rectus o At septum orbitale , it fans out into white tendon called aponeurosis of LPS and forms medial and lateral horns

32. Superior division of the oculomotor nerve supplies the muscle. Loss of oculomotor nerve function result in complete ptosis or drooping of the superior eyelid Whereas loss of sympathetic innervation to the superior tarsal muscle result in partial ptosis . Nerve supply of LPS

33. Whitnall ligament- it is located at transition zone- act as a fulcrum for levator transferring its vector from ant-post to sup-inf direction. Its analogue in lower lid is Lockwood Ligament CAPSULOPALPEBRAL FASCIA Fibrous sheet in the lower eyelid ,that arises from the lockwoods ligament

34. This layer splits the eyelid into two- The anterior lamina and posterior lamina- which are easily approachable through the grey line. It’s a layer of loose connective tissue. The nerve and vessels of the eyelids lie in this layers and so to anaesthetise the lid, injection is made in this plane. Submuscular Aerolar (Connective) Tissue

35. It is the framework of the lid which consist of central thick part the tarsal plate and Peripheral thin part the septum orbitale . The fibrous layer also include the medial and palpebral ligaments. Tarsal plate are firm plates that form the skeleton of the eyelids giving them shape and firmness. 29 mm long and 1mm thick Anterior surface -convex Posterior surface-concave - lined by conjunctiva which is firmly adherent to the Tarsal plates. Fibrous layer

36. Septum orbitale is a thin floating membrane of connective tissue which take parts in all movements of the eyelid. Applied aspect With age orbial septum weakens orbital fat herniats the condition manifest as DERMATOCHALASIS

37. Layer of non striated muscle fibres Sympathetics accessory retractor of upper eyelid. Modulates the position of the upper and lower eyelids when the eye is open Origin –under surface of the levator muscle just anterior to whitnall’ligament . Insertion –anterior edge of the superior tarsal border Mullers muscle

38. Transparent vascularized membrane covered by a non keratinized epithelium that lines the posterior surface of the eyelids (palpebral conjunctiva)and the anterior surface of the globe (bulbar conjunctiva) Firmly adherent to the tarsus Conjunctiva

39. Glands Of Eyelids: Tarsal / Meibomian Glands . Gland of Zeis . Gland of Moll . Accessory lacri mal gland.

40. Tarsal / Meibomian Glands Modified sweat gland Present on the posterior part of stroma of tarsal plate 30 - 40 no. in upper eyelid & 20- 30 no. in lower eyelid Oily secretion

41. Gland of Zeis Modified sebaceous glands Attached to eyelash follicles (usually two glands with each cilium) Sebum secretion Gland of Moll Modified sweat gland Lies between cilia Numerous in lower lid than upper lid

42. Acessory lacrimal glands A/k as Ciaccio’s glands or wolfring’s glands Found in lacrimal caruncle of eyelids Located in upper border of superior tarsus and lower border of inferior tarsus Functions: Production of tear which are secreted onto the surface of conjunctiva

43. Another type of accessory lacrimal glands are ”Krause’s glands” which are similar and more numerous than ciaccio’s glands located on superior and inferior fornices of conjunctival sac.

44. Nerve Supply to Eyelids 1.Motor Nerve Supply Orbicularis oculi muscle - Facial nerve(7 th CN) (temporal & zygomatic branches) Levator Palpebrae Superioris (LPS) - superior division of oculomotor nerve(3 rd CN) Müller muscle - sympathetic nervous system

45. Sensory Nerve Supply: Derived from branches of trigeminal nerve. Upper eyelid - supraorbital, supratrochlear & lacrimal nerves (ophthalmic division) extreme medial portion of both upper & lower eyelid - infratrochlear nerve lateral portion of upper eyelid - zygomaticotemporal branch of the maxillary nerve lower eyelid - infraorbital nerve (maxillary division) lateral portion of lower eyelid - zygomaticofacial branch of the maxillary nerve

46. Aeteries of the lid (medial and lateral palpebral)form marginal arterial arcade , 2mm away from lid margin in upper eyelid and 4mm away from lower lid margin. Arterial supply

47. Another arcade ( superior arterial arcade ) is formed in upper eyelid . Branches go forward and backward from these arches to supply various structures.

48. These are arranged in two plexus- 1- A post- tarsal which drain into ophthalmic vein 2- A pretarsal opening into subcutaneous vein. Venous supply

49. Arranged in two sets pretarsal and post tarsal Those from lateral half of the lids drain into pre auricular lymphnodes and those from medial half of the eyelids drain into submandibular lymph nodes. Lymphatics

50. Clinical Co- relations External Hordeolum (Common Stye) Localized suppurative inflammation of gland of Zeis and glands of Moll’s at lid margin at ciliary follicle.

51. Internal Hordeolum( Meibomian stye) Internum Hordeolum is a suppurative inflammation of meibomian gland associated with the blockage of the duct.

52. Chalazion Chronic granulomatous inflammation of meibomian gland or sometimes Zeis glands caused by retained sebaceous secretions Ocurrs secondary to obstruction of the gland duct. More common in upper eyelid appearing as hard, immobile, painless, roundish lump.

53. Blepharitis Blepharitis is chronic inflammation of lid margin occurring as true inflammation. Bilateral and often misdiagnosed as conjunctivitis

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