Anatomy

of Eyelid
PRESENTER:-DR. VIJAYALAXMI
MODERATOR:-DR. SANJANA
 INTRODUCTION
 EMBRYOLOGY
 EXTENT
 STRUCTURES
 VESSELS
 NERVE SUPPLY
 Introduction:
 Two eye lids are mobile tissue curtains placed in front of
the eyeballs.
 The upper eye lid is more mobile
 The lower eye lid more or less stable
f
Functions of Eyelid:

 1. Cover the globe for protection from injuries and excessive

light.
 2.Move the tears toward drainage at the medial canthus on
closure.
 3.Spread the tear film over cornea and conjunctiva.
 4.Contain Structures that produce the tear film.
EMBRYOLOGY:
 The lid folds starts at 7th week of gestation
 The upper eye lid formed from the lateral and medial
aspect of frontonasal process
 The lower lid is formed by the maxillary process
 The two lids unite with flimsy tissue at 9th week of
gestation
 The two lids separate at five months of gestation

Eyelid development. (A) Eyelid fusion (8 to

10 weeks' gestation); (B) development of
margin structures (3 to 4 months'
gestation); eyelid dysjunction (5 to 6
months' gestation).
 The upper eyelid extends superiorly to
the eyebrow, which separates it from
the forehead.
 The lower eye lids below merge with
the cheek
 Lid Folds :-
Upper lid :- Superior palpebral crease
Lower lid :- Inferior Palpebral crease
Nasojugal fold
Malar fold
Surface Anatomy
Surface Anatomy:
 Superior Palpebral Crease :-
 A Prominent Horizontal Crease .
 formed by the attachment of the superficial insertion of
levator aponeurotic fibers.
 Marks the upper border of the Tarsus
 Located approximately 8-11 mm superior to the eyelid
margin
Surface Anatomy
 Inferior palpebral crease :-
 Less noticeable than the superior palpebral crease
 Marks the lower tarsus
 5mm below the lid margin medially & 7mm laterally

 Nasojugal crease:-
 Below the inferior palpebral crease on medial aspect &
extends inferiorly 45 degrees

 Malar crease:-
 runs inferiorly and medially from the outer canthus toward the
inferior aspect of the nasojugal fold.
Surface Anatomy:
 Palpebral fissure
 An Almond shaped opening bounded by two lids
 Average
Height :-10 mm Width :- 25 – 30mm
• In normal straight gaze upper lid covers about 2mm of
upper part of cornea cuts at 11’O clock & 1’O clock
position
• The lower eyelid is generally found at the level of the lower
limbus.
Canthi:
 Two canthi viz., Lateral & Medial
 The lateral canthi is acute about 30-40 degrees or 60
degrees when eye is wide opened
 The lateral canthus is in contact with the globe
 The medial canthus more obtuse
 Has horizontal inferior rim & superior rim sloping
inferomedially
 The medial canthus is separated from globe by a small
tear lake
The structure of the eyelid:
 Skin
 Sub subcutaneous areolar tissue
 Striated muscles
 Sub muscular areolar tissue
 Fibrous layer
 Non – Striated muscle
 Conjunctiva.
Skin and Subcutaneous Tissue:
 Skin of the eye lids is thin and elastic
 The nasal portion of the eyelid skin has finer hairs and more
sebaceous glands than the temporal aspect.
 Subcutaneous fat is sparse in preorbital & preseptal skin
 Fat is absent in pre tarsal skin
 The subcutaneous areolar tissue is loose & contains no fat.
 Skin is mobile on the subjacent muscle
Muscles of the Eyelid
MUSCLES OF PROTRACTION:
The orbicularis oculi muscle
 The orbicularis oculi muscle is a thin sheet of concentrically
arranged muscle fibers covering the eyelids and
periorbital region
 It is oval, with the long axis being horizontal, corresponding
to the palpebral opening.
 The orbital ocularis muscle:
 Extends superiorly to the eye brow where it inter digitates
with the frontalis & corrugator superciliaris muscle
 Medially extends from supra orbital notch in a curvilinear
fashion over the nose
 Inferiorly extends to infra orbital foramen
 Laterally extends to temporalis muscle
 The Preseptal Orbicularis muscle – over lies the
orbital septum
 Superiorly – continuous with eyebrow pad of fat
 Laterally - muscle inserts directly in to Whitnall’s tubercle 3-
4 mm deep to lateral raphe
 Medially - arises from two heads i.e., Deep & superficial
head
 The deep head arises from Lacrimal sac& lacrimal facia
 The superficial head arises from anterior rim of medial
canthal ligament
 Pretarsal orbicularis :- Is firmly adherent to the
underlying tarsus
 Medially the muscle arises from two heads i.e., The deep &
superficial heads
 The deep head or the Horners tensor tarsi muscle arises
from 4 mm behind the posterior lacrimal crest& from
lacrimal facia
 inserts medially to the tarsi of upper & lower lid
 The superficial head inserts on the anterior lacrimal crest &
anterior limb of medial canthal ligament
 ORBITAL SEPTUM:
 Upper Eyelid
 The orbital septum is a discreet, well-defined structure arising from
the arcus marginalis.
 The orbital septum & levator aponeurosis join 2-5 mm above the
tarsal border.
 The thickness of the septum is 1mm
 It is thick at arcus marginalis & thinnest in lower lid medially
 Medially the septum inserts into posterior lacrimal crest
 At lateral canthus the orbital septum splits into two the superficial
fibers join at lateral canthal raphe & deep fibers in to whitnall’s
tubercle
 LOWER LID
 The orbital septum arise from inferior orbital rim
 It extends anteriorly & superiorly 4-5 mm below inferior tarsus
to join lower eye lid retractors
 Medially the septum splits & carried post by pretarsal
orbicularis muscle & attaches to posterior lacrimal crest
 Laterally also septum splits & carried deep by the insertion of
orbicularis muscle
 FAT PADS:
 Fat within the orbit and adnexa serve as a protective cushion
within which the eyeball moves.
 Fat within the muscle cone is termed central or conal. Fat
outside the muscle cone is termed peripheral or extraconal.
 Upper Eyelid:
 Upper eyelid, there are two fat pads: the medial fat pad and
the central fat pad
 The medial fat pad usually is pale yellow or white and lies
anterior to the levator aponeurosis extending superomedial to
the medial horn of the levator.
 The central fat pad is yellow and broad.
 Lower Eyelid
 Three retroseptal fat pads are associated with the lower eyelid.
 The medial and central fat pads are separated by the inferior
oblique.
 The medial and lateral fat pads are separated by the arcuate
expansion, a fascial band extending from the capsulopalpebral
fascia to the inferolateral orbital rim.
 RETRACTORS:
 Each eyelid contains two retractors, which open the
palpebral fissures.
 Upper lid:-
 Levator palpebrae superioris muscle
 Muscle of Müller.
 Lower lid:-
 Capsulopalpebral fascia
 Inferior tarsal muscle.
 Upper Eyelid Retractors:
 The major retractor is levator palpebrae superioris
 It arises from the superior mesenchyme as superior rectus
and are connected by fibrous attachments.
 The LPS proceeds anteriorly for 40 mm and ends in an
aponeurosis approximately 10 mm behind the orbital septum.
 The levator aponeurosis spreads laterally and medially to form
lateral and medial horns
 The medial horn attaches to the posterior lacrimal crest.
 The lateral horn divides the lacrimal gland into orbital and
palpebral lobes before attaching to the lateral retinaculum at
the lateral orbital tubercle.

 The aponeurosis fuses with the orbital septum prior to reaching
the level of the superior tarsal plate border..
 Inferiorly attaches to the septum, tarsal plate, and skin, the
levator aponeurosis attaches medially to the medial canthal
tendon, and laterally to the lateral canthal tendon
 Müller’s muscle is smooth muscle innervated by the
sympathetic nervous system
 Fibers originate from the under surface of the levator in the
region of the aponeurotic muscle junction.
 Müller's muscle is adherent to the levator aponeurosis anteriorly
and is loosely adherent to the conjunctiva on its posterior
surface.
 Lower Eyelid Retractors:
 The capsulopalpebral fascia and inferior tarsal muscle
comprise the lower eyelid retractors.
 The capsulopalpebral fascia originates from the fascia of the
inferior rectus muscle and inserts on the inferior tarsal border.
 This fascia does not move independently,
 Mimics the movement of the inferior rectus muscle from which
it originates.
 The inferior tarsal muscle arises from the under surface of
the capsulopalpebral fascia
 Two are tightly adherent to each other and to the lower lid
conjunctiva.
 The inferior tarsal muscle is sympathetically innervated
 The capsulopalpebral fascia and the inferior tarsal muscle
are often grouped together and termed the lower lid
retractors.
 TARSAL PLATES:
 The tarsal plates are thickened fibrous connective tissue that
provide structural support to the eyelids.
 Medially and laterally, the tarsal plates are connected to the
bony orbital margins by ligamentous fibrous tissue

The upper and lower tarsal plates

 Upper Eyelid:
 The superior tarsal plate is 10 mm in vertical height and 25 to
30 mm in horizontal dimension.
 The border nearest the eyelid margin is flat, whereas the
antimarginal border is curved with its largest vertical
dimension centrally.
 Within each superior tarsus lies 30 to 40 vertically oriented
sebaceous secreting glands, the meibomian glands, which
produce the outer lipid portion of the tear film.
 Lower Eyelid:
 The inferior tarsal plate is 3 to 5 mm in vertical height and
measures 25 to 30 mm horizontally.
 The lower tarsus also tapers medially and laterally.
 Within each lower tarsus, there are 20 to 30 vertically
oriented meibomian glands whose orifices are located
anterior to the mucocutaneous junction of the lower eyelid.
 SUSPENSORY SYSTEM OF THE EYELIDS:
 Five anatomic structures provide support and mechanical
function to the eyelid and eyeball:
Whitnall's ligament,
Lockwood's ligament,
The lateral canthal ligament,
The medial canthal ligament,
and the eyelid margin.
 Whitnall's Ligament:
 The superior transverse ligament of Whitnall provides the dual
function of acting as the main suspensory ligament of the
upper eyelid and as a check ligament for the levator
aponeurosis and levator muscle.
 It gives superior conjunctival fornix suspension.
 Whitnall's ligament is found 15 to 20 mm superior to the
superior border of the tarsus as a white, shiny, glistening
structure where the levator muscle becomes an aponeurosis
 Lockwood's Ligament:
 Lockwood's ligament in the lower eyelid is more rudimentary
than Whitnall's ligament in the upper eyelid but it acts as a
suspensory hammock for the globe
 Lockwood's ligament is a condensation of the
capsulopalpebral fascia anterior to the inferior oblique
muscle.
 Medially, it attaches to the medial canthal ligament and
laterally to the lateral canthal ligament.
 Lateral Canthal Ligament:
 Often called the lateral canthal tendon,
 The lateral canthal ligament is comprised of a superior crux
from the superior tarsus and an inferior crux from the inferior
tarsus.
 The superior and inferior crux of the lateral canthal tendons
fuse at the lateral border of the tarsal plates to join the lateral
retinaculum, that inserts onto the lateral orbital tubercle of
Whitnall.
 Medial Canthal Ligament
 The medial canthal ligament, or the medial canthal tendon,
provides support to the eyelids and aids in the function of the
lacrimal pump.
 The medial canthal ligament has two components—an
anterior limb and a posterior limb.
 The anterior limb is a broad fibrous structure that attaches the
eyelids to the frontal process of the maxillary bone and to the
anterior lacrimal crest. It gives origin to the superficial head of
the pretarsal orbicularis oculi muscle.
 The posterior limb of the medial canthal ligament inserts on the
posterior lacrimal crest and the lacrimal fascia.
 Eyelid Margin:
 The eyelid margins are divided by the lacrimal puncta into a
medial lacrimal portion and a lateral palpebral portion.
 At the lid margin near the medial edge of the tarsus, the lacrimal
papilla is seen as the fibrous ring surrounding the lacrimal
punctum.
 The medial lacrimal portion is rounded and without lashes. It
carries the horizontal portion of the canaliculi 1 to 2 mm from the
marginal surface.
 The lateral portion of the lid margin has a more distinct or sharp
border, which acts like a “squeegee” or “windshield wiper” to
assist in moving the tear film toward the punctum.
 Glands in the Eyelids:
 Tear glands are relatively large glands located within the bony
eye sockets, there are several sets of smaller glands all situated
within the structure of the eyelids. These glands are:
 Meibomian glands – in the tarsal plate. secretion forms the oily
part of the tear film.
 Glands of Zeis – sebaceous glands that open into the follicles of
the eyelashes.
 Glands of Moll – modified sweat glands that also open into the
eyelash follicles.
 Glands of Wolfring – these are accessory lacrimal or tear
glands.
 The Tarsal Glands (Meibomian glands):
 The tarsal glands are situated upon the inner surfaces of the
eyelids, between the tarsi and conjunctiva,
 Distinctly seen through the conjunctiva on everting the eyelids,
presenting an appearance like parallel strings of pearls.
 There are about thirty in the upper eyelid, and fewer in the
lower.
 The ducts open on the free margins of the lids by minute
foramina
 Glands of Zeis :
 Holocrine; sebaceous; secrete sebum to keep eyelashes
flexible and lubricate skin
 Number of glands of zeis per follicle 2; glands emplty into
eyelash follicle
 Glands of Zeis size much smaller than Meibomian glands; not
involved with tear film

 Glands of Moll/ciliary glands :

 unknown function; large, distended, apocrine secretion
 Location of Glands of moll located in eyelid margin; develop
from lash follicles; not every lash has one; end on zeis gland
duct or surface of skin
Conjunctiva
 The conjunctiva is a smooth, translucent mucous
membrane.
 Palpebral conjunctiva lines the posterior surface of the
lids as tarsal conjunctiva and continues as orbital
palpebral conjunctiva into the fornix.
 Arteries :
 1. Medial palpebral from the ophthalmic artery
 2. Lateral palpebral from the lacrimal artery
 3. branches from the facial vessels
 In the upper lid, the vessels anastamose
freely to form two arches; one along
the upper border of the tarsus
(peripheral arcade) and the second
near the lid margin (marginal
arcades).
o The lower lid has only
one arcade as it is short in height
compared to the upper
 VENOUS SYSTEM:
 The venous system has both a superficial and a deep
distribution.
 The superficial system consists of the angular vein, the
anterior facial vein, and the superficial temporal vein.
 Branches of the deep venous system
involving the eyelids consist of the
superior ophthalmic vein and the
inferior ophthalmic vein
 LYMPHATIC SYSTEM TO THE EYELIDS:
 The lymphatic system of the eyelids has two divisions: a
superficial system and a deep system.
 The superficial system drains the skin and orbicularis oculi
muscle, whereas the deep system drains the tarsi and the
conjunctiva.
 Most of the upper eyelid,lateral third of
the lower eyelid, and lateral canthus
drain into the preauricular and
deep parotid nodes
 The medial portion of the upper eyelids,
the medial canthus and the medial two
thirds of the lower lid and conjunctiva
drain into the submandibular nodes
 Nerve supply:
 Sensory :
 Upper lid :
 • palpebral branch of lacrimal nerve
 • supra orbital nerve
 • supra trochlear nerve
 • infra trochlear nerve
 Lower lid : infra orbital nerve
 Motor supply to muscles of the lids:
 - orbicularis : 7th cranial nerve
 - levator : 3rd cranial nerve
 - Muller's : sympathatic innervation
 SYMPATHETIC SUPPLY TO THE EYELIDS:
 The sympathetic nerves arise from the carotid plexus and enter
the cavernous sinus sheathing the intracavernous carotid
artery.
 Within the cavernous sinus, sympathetic fibers join the nerve
branches and arteries entering the orbit.
 Sympathetic nerves to the orbit provide vasoconstriction,
smooth muscle function, hidrosis, pupillary dilation, and
pilomotor and sweat gland function of the skin of the face.
 References:

 WOLFF’S ANATOMY
 DUANE’S Clinical ophthalmology
 Anatomy and physiology by A.K.Khurana
THANK YOU