Lagophthalmos

Lagophthalmos
Eyelid Anatomy
Layers & Components of The Eyelid | Sponsors | Bottom of Page

Eyelid Anatomy Eyelid Anatomy

Layers & Components of The Eyelid

  • Skin
    • thinnest in body, no subcutanous fat
    • upper lid crease (fold) = levator . attachment to pretarsal orbicularis and skin; located at level of sup border of tarsus
    • upper puntca is more medial
    • mucocutaneous border is post to meibomian gland level
    • gray line = muscle of Riolan (superficial orbicularis)
    • Zeis, sebaceous glands (holocrine) with cilia
    • Moll glands (only apocrine gland on lid) with skin
    • 100 lashes on upper lid, 50 on lower
  • Blood supply
    • extensive anastamosis between supraorbital, lacrimal branches of ophthalmic a. (from internal carotid) and angular and temporal a. (from ext carotid)
    • venous drainage: pretarsal, poatarsal
    • NO lymphatics for the orbit except in conjunctiva
    • eyelid medial lymphatics drain to submandibular nodes and laterally to preauricular nodes
  • Subcutaneous tissue
    • no fat, loose connective tissue holds fluid in preseptal > pretarsal area b/c less firmly attached
Subcutaneous tissue Subcutaneous tissue
  • Orbicularis Muscle
    • main protractor
    • supplied by Cranial Nerve VII, narrows PF, helps lacrimal pumporbital
    • voluntary sphincter (wink, blepharospasm)
    • origin at medial canthal tendon and corrugator supercilius muscle
    • palpebral (pretarsal & preseptal)
    • reflex blink and involuntary
    • pretarsal origin at post lacrimal crest (most important to keep lid apposed to globe to let punctum lie in tear lake ) & ant limb of med canthal tendon; deep head of pretarsal m. (Horner’s tensor tarsi) encircles canaliculi to facilitate tear drainage
    • upper & lower segments of pretarsal orb m. fuse to become lateral canthal tendon
    • pretarsal muscle firmly adherent
    • pretarsal muscle of Riolan = gray line = superficial orbicularis
  • Septum
    • extension of periosteum
    • in non-Asians, upper lid septum fuses w/levator aponeurosis. 2-5 mm above sup tarsal border; in lower lid it fuses w/capsulopalpebral fascia at or just below inf tarsal border
    • passes medially in front of trochlea
    • barrier to hemorrhage and infection between lid and orbit
    • orb fat can herniate through septum into lids causing bags
    • central orb fat pad lies behind septum, in front of levator aponeurosis.
  • Tarsus
    • dense connective tissue, attach med & lat to periosteum
    • 1 x 29 x 11 mm upper lids, 4 mm vertical height in lower lids
    • meibomian glands are modified holocrine glands
    • in upper lid marginal arcade lies 2 mm sup to lid margin, ant to tarsus
    • peripheral art arcade is sup to tarsus, between levator aponeurosis, Muller’s

    • Tarsus

  • Conjunctiva
    • mucin is produced from goblet cells
    • aqueous is produced from glands of l Krause & Wolfring
  • Eyelid Retractors (muscle)
    • Upper lid
      • Levator Palpebrae Superioris
        • starts just above annulus of Zinn, then 40 mm of muscle, then 14-20 mm of aponeurosis.
        • becomes vertical near Whitnall's (superotransverse) ligament (near transition m. to aponeurosis.) which is a fulcrum for vertical lid retraction (lower lid analog is Lockwood’s ligament)
        • Whitnall's ligament is condensation of tissue around SR and LPS, helps suspend tissue
        • levator aponeurosis: attaches to lower 1/2 of ant tarsus; lat horn of aponeurosis divides lacrimal gland into orb and palpebral lobes, attaches to lat orb tubercle; medial horn attaches to post lacrimal crest
        • lid crease is formed by attachment of ant portion of aponeurosis w/ septum between the pretarsal orbicular m.’s: here the pretarsal tissues are in close apposition to underlying tarsus
      • Superior Tarsal Muscle of Muller
        • posterior to LPS
        • sympathetically innervated; use neo drops to test function in Ptosis w/u: normal = 2 mm lift
        • origin from under LPS, attaches to upper tarsus, firm attachment to conj
    • Lower Eyelids
      • Inferior Tarsal muscle
      • Capsulopalpebral Fascia
        • lower lid analog to levator aponeurosis
        • originates from attachments to Inferior rectus ; therefore do vertical m. surgery before lid surgery
        • inserts onto lower tarsal border
        • inferior tarsal m. is analog to Muller’s, runs post to Capsulopalpebral Fascia

Lower Eyelids

Operation photogallery
 
before operation after operation