Eyelids: Different Layer, Nerve Supply, Vascular Supply & Functions of Lids

This is a presentation made for bachelor entrance preparation students.
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1. Eyelids: Different Layers , Nerve Supply , Vascular Supply & Functions of the Lids

2. Presentation Layout Embryology of Eyelids Anatomy of Eyelids Nerve supply Vascular supply Lymphatic drainage Functions of Eyelids Clinical Correlation of Eyelids

3. Embryology of Eyelids Derived from surface ectoderm Reduplication of the surface ectoderm above and below the cornea in 2 nd month of gestation.

4. Embryology of Eyelids contd. Folds enlarge and margins fuse with each other . Mesodermal mesenchyme- during 2nd month which forms the muscles of the lid and tarsal plate.

5. Eyelid adhesions break down during 5-6th month and the lids separate after 7 th months of gestation.

6. Congenital Anomalies Cryptopthalmous Skin is continuous over the eyeball with absence of eyelids . Congenital Coloboma Gap in tissue of eyelids. Microblepharon Eyelid is abnormally small.

7. Gross Anatomy of Eyelids Anatomical definition ;- Mobile , flexible, multilamellar structure that cover the globe anteriorly.

8. Upper Eyelid is divided into Orbital and tarsal part by Superior Palpebral sulcus Superior Palpebral sulcus is created because of the insertion of aponeurotic fibres from LPS. Inferior Palpebral sulcus in lower lid is created by adhesion between the skin and orbicularis occuli . With age, naso jugal sulcus and Malar sulcus are formed

9. Lateral canthus 5-7 mm from lateral orbital margin. Forms angle of 60⁰ with eyes wide-open. Forms angle of 30-40⁰ in normal way. Lateral canthus is about 2 mm above the medial canthus Two eyelids meet each other at inner & outer canthi .

10. Medial canthus Separated from globe by lacus lacrimalis (tear lake ). Forms obtuse angle . Epicanthus D ermal fold across the medial canthus

11. Interpalpebral Fissure - the exposed zone between the upper & lower eyelids 8-11 mm vertically 27-30 mm horizontally Width of the palpebral fissure is determined by the level of tonic activity in the levator palpebrae superioris and the sympathetically innervated Muller’s muscle

12. Anatomy contd.

13. Gross Anatomy Eyelid Margin 2mm wide Grey Line Marks the junction of the skin and conjunctiva Divides the intermarginal strip into Anterior strip bearing lashes & Posterior Stripe bearing the opening of meibomian glands R elatively avascular area Corresponds histologically to muscles of Riolan

14. L acrimal portion : M edial portion of the eyelid margin,extending from the puncta medially to medial canthal angle. R ound & devoid of lashes and glands . Eyelid margin is d ivided into 2 portion by punct a

15. II. C iliary portion : F rom punta to lateral canthal angle C ontains lashes at ant erior strip & meibomian glands at post erior strip R o u nd ant erior border & sharp post erior border

16. Layers of Eyelids Skin Subcutaneous areolar tissues Striated muscle (orbicularis oculi) Submuscularis areolar tissues Fibrous layer ( Tarsal plate & Septum orbitale ) Non-striated muscle Conjunctiva

17. 1. Skin Nasal skin Smoother and more oily Few rudimentary hairs Many unicellular sebaceous glands—Hence xanthelesma develops on the nasal side Lateral skin Numerous sweat gland Palpebral skin is thinnest in body (<1mm) Elastic & folds easily contributing to speed of mobility of upper eyelid .

18. Epithelium consist of 6-7 layers of stratified squamous epithelium. Unicellular sebaceous glands and sweat glands . Dermis Dense connective tissue Rich network of elastic fibers, blood vessels, lymphatics & nerves . 1. Skin contd.

19. 2. Subcutaneous Areolar Tissue L oose areolar connective tissue N o fat A bsent near ciliary margin, at lid folds & at medial and lateral angles where the skin is attached to underlying ligaments Applied Anatomy F luid from oedema or haemorrhage rapidly engorges the loose subcutaneous eyelid tissue & produce dramatic eyelid swelling

20. 3. Layers of Striated muscles Consists of orbicularis oculi ( forms thin oval sheet over eyelid ) U pper lid also contains LPS.

21. Orbicularis Oculi

22. Orbital Orbicularis Overlies the bony orbital rims Origin : M ost peri pheral fibres from anterior part of the med ial palpebral l igaments & adjascent bones ;- U pper orbital margin med ial to supra orbital notch M axi l lary process of frontal bone F rontal process of maxiila L ower orbital margin medial to the infraorbital foramen

23. M uscles fibres sweeps sup erior & inf erior , covering the orbital margin in the form of ellipse & meet at the lateral palpebral raphe Superior fibres called Musculus superciliaris get inserted into the skin of eyebrows Inferior fibres called Musculus malaris attached to skin of cheek Functions of orbital orbicularis;- Helps in forced closure of eye lids & pulls eye brow downward

24. ii. Palpebral Orbicularis Subdivided into 2 parts Preseptal Fibres Pretarsal Fibres

25. Preseptal fibres : arises from Lacrimal fascia Posterior lacrimal crest Anterior part of medial palpebral ligament Fibers pass superior & inferior in front of the orbital septum and unite at the lateral palpebral raphe Pretarsal fibers: arise from Deep head of lacrimal fascia & posterior lacrimal crest Fibers pass laterally above & below overlying the upper & lower tarsus respectively and join at lateral canthal tendon which is inserted over lateral orbital tubercule of whitnall .

26. Functions of Palpebral Orbicularis In gentle closing of eye lid (during blinking,sleep and soft voluntary closure) Horners muscle helps in lacrimal pump mechanism Muscles of Riolan keeps lid in close apposition with globe

27. Horner’s Muscle Prominent bundle of fibers , formed by fusion of the deep heads of the pretarsal orbicularis I nsertion - posterior lacrimal crest Functions - helps to maintain the posterior position of the canthal angle tightens the eyelids against the globe during eyelid closure aids in the lacrimal pump mechanism

28. Muscle Of Riolan S mall bundle of striated muscle fibers at the eyelid margin E xtension of orbicularis oculi fibers Applied Anatomy - spastic entropion after disinsertion of the lower eyelid retractors from the tarsus

29. The Eyelid Retractors Upper lid i . Levator Palpebrae Superioris ii. Muller’s Muscle Lower lid i . Capsulopalpebral fascia

30. Levator Palpebrae Superioris Major eye lid retracor Origin: At the apex of orbit from the under surface of lesser wing of the sphenoid above annulus of zin Course & attachment Passes forward below the roof of the orbit, above the superior rectus At septum Orbitale , it fans out into white tendon called aponeurosis of LPS and forms medial and lateral horns

31. Lateral Horn;- Divides the lacrimal gland into orbital & palpebral parts and inserts into Superior edge of lateral canthal tendon. Medial horn;- Passes over reflected tendon of superior oblique and fuses with medial canthal tendon. Together, the two horns serve to distribute the forces of the levator muscle along the aponeurosis and the tarsal plate.

32. Mullers Muscle S ympathetic accessory retractor of upper eyelid M odulates the position of the upper and lower eyelids when the eye is open Origin - undersurface of the levator muscle, just anterior to Whitnall’s ligament Insertion - anterior edge of the superior tarsal border Applied Anatomy – Horner's Syndrome (triad of ptosis , miosis & anhidrosis )

33. Capsulopalpebral Fascia F ibrous sheet in the lower eyelid, that arises from Lockwood’s ligament Fuses with fibers of the orbital septum, forms a common fascial sheet & inserts onto the lower border of the tarsal plate Fine fibrous slips pass forward from this fascial sheet to the orbicularis intermuscular septae & subcutaneous tissue, so forming the lower eyelid crease

34. 4. Submuscular Areolar Tissue Between the orbicularis & tarsal plate Communicates with the subaponeurotic stratum of the scalp This plane can be entered by incision at the gray line Main nerves to the eyelid also lie in this plane; so it is necessary to inject local anaesthetic agents deep to the orbicularis during local anaesthesia

35. 5. Fibrous layer Frame work of lid Consists of Central thick part Tarsal plate Peripheral thin part the Septum orbitale

36. Tarsal Plates Dense f ibrous tissue. Forms skeleton of eyelids ( gives shape and firmness ) Bears Meibomian Glands. Lateral end of tarsi attached to whitnall’s tubercle by lateral palpebral ligament. Medial end of tarsi attached to anterior lacrimal crest and frontal process of maxilla by medial palpebral ligament.

37. Orbital septum & Muller’s muscle are attached at superior border of upper tarsus. Orbital septum, capsulopalpebral fascia & Inferior palpebral muscle are attached to inferior border of lower tarsus.

38. Septum orbitale Thin floating membrane of connective tissue. Takes part in all movements of eyelids. Thick & strong on lateral side than medial side and in upper eyelid than lower eyelid.

39. A pplied Anatomy: Barrier to orbital fat / extravasation of blood / spread of infection With age, orbitale septum weakens  orbital fat herniates  dermatochalasis

40. 6. Non-striated muscles fibres Consists of smooth muscles fibers of Muller muscles which lie just deep to septum orbitale in the upper & lower lid

41. Origin : From the inferior terminal striated fibres of LPS in Upper Eye Lid & expansion of the inferior rectus in the Lower Eye Lid. Runs vertically & gets inserted in the orbital margin of the tarsal plate. Supplied by sympathetic nerves.

42. 7. Conjunctiva 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 Small accessory lacrimal glands ( Glands of Krause & Wolfring ) are located within the sub mucous connective tissue

43. Plica Semilunaris: Pinkish, c rescentric fold of conjunctiva present in medial canthus Highly vascularized & rich in goblet cells Resemble the nictitating membrane (3 rd eyelid) of lower vertebrates

44. Caruncle : Pinkish mass situated in inner canthus, just medial to Plica semilunaris covered by non-keratinized stratified squamous epithelium Actually a part of margin of lower lid which gets cut off due to development of inferior canaliculi. contains sebaceous glands & sweat glands

45. Glands of eyelids

46. Glands of eyelids contd. Tarsal/ Meibomian Glands Modified sweat gland Present on the posterior part of stroma of tarsal plates 20-30 in each eyelids ( arranged vertically to eachother ) Oily secretion

47. Functions: Forms hydrophobic barrier at the margin of the eyelid, preventing spillage of tears at the lid margin Forms oily layer of tear film over cornea and bulbar conjunctiva Retards evaporation of tears.

48. Gland of zeis Modified sebaceous glands Attached to eyelash follicles (usually 2 glands with each cilium) Sebum secretion Functions;- 1.Prevents eyelashes from being dry & brittle

49. Gland of Moll Modified sweat gland lies between cilia Numerous in lower lid than upper lid

50. Nerve supply Motor Nerve Supply: motor nerves to the orbicularis oculi muscle - facial nerve (temporal & zygomatic branches) motor nerve to the levator palpebrae superioris - superior division of oculomotor nerve motor nerve to the Muller muscle - sympathetic nervous system

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

52. Vascular supply Arterial Supply;- Upper eyelid Marginal Arcade – 2-3 mm from the eyelid margin; either between the tarsal plate & the orbicularis or within the tarsus Peripheral Arcade - along the upper border of tarsal between the levator aponeurosis & Muller’s muscle S upplied by superior medial palpebral vessel (the terminal ophthalmic artery and superior lateral palprebal Vessel from lacrimal artery)

53. Lower eye lid is supplied by medial & lateral inferior palpebral vessels.

54. Venous Drainage System can be divided into two portions: a superficial or pretarsal system & a deep or post tarsal system. mainly into several large vessels of the facial system.

55. Lymphatic drainage Two systems- superficial and deep system. Superficial system- drains skin and orbicularis oculi. Deep system- drain tarsi and conjunctiva. Upper lid, lateral 1/3 of lower lid and lateral canthus-> preauricular Lymph Node and deep parotid nodes- > deep cervical Lymph Node. Medial part of Upper lid, medial 2/3 of Lower Lid and medial canthus-> submandibular Lymph Node- > internal jugular vein .

56. Functions Of eyelids A ct to protect the anterior surface of the globe from local injury. Aid in regulation of light reaching the eye. Tear film maintenance by distributing the protective optically important tear film over the cornea during blinking. Tear flow by their pumping action on the conjunctival sac and lacrimal sac.

57. Clinical Correlation of eyelids Blepharitis Inflammation of eyelid margins. Meibomitis (posterior Blepharitis) Inflammation of Meibomian glands. External Hordeolum (Stye) Inflammation of eye lash follicles & its associated Gland of Zeis and Gland of Moll.

58. Chalazion Lipogranulomatous inflammation of meibomian glands. Internal Hordeolum Inflammation of meibomian gland associated with blockage of the ducts. Entropion Inward rolling and rotation of lid margin toward globe.

59. Ectropion out rolling or outward turning of lid margin. Lagophthalmos Inability to close eyelids voluntarily. Ptosis Abnormal drooping of upper eyelid ( >2mm of the cornea)

60. Eyelashes arranged in 2 to 3 rows. upper lid- 100-150 in number and directed upward, forward and backward. lower lid - 50-75 in number and directed forward, downwards and backwards. taper throughout the length to end in a fine sharp point. life span – 3 to 4 months. (cilia have no erector muscle )

61. Clinical correlations of eyelashes Triachiasis Inward misdirection of cilia. Distichiasis Extra row of cilia occupies the position of Meibomian glands which opens into their follicles.

62. Madarosis Partial or complete loss of eyelashes. Poliosis Whitening of eyelashes.

63. Reference Anatomy and Physiology of eye = A.K Khurana Comprehensive Opthalmology = A.K Khurana Adlers Physiology of Eye = Leonard A Levin Basic sciences for Opthalmology Previous presentation Internet

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