Eyelid Anatomy

ANATOMY OF EYELID AND
LACRIMAL SYSTEM
GROSS ANATOMY
EYELID MARGINS
about 2 mm in width.
Lid margin divided into two parts
by Lacrimal papillae(small elevation on
the medial side which has punctum in the
centre)
Lacrimal portion
Ciliary portion
GRAY LINE
EYE LASHES
Arranged
IN 2-3 rows
Those in upper lid(100-150 in
number)directed forward and and
upward.
Those in lower eyelid(50-70)directed
forward and downward.
Each cilium has lifespan of about 34months.
1. SKIN
Thinnest
in the body.
2. SUBCUTANEOUS
AREOLAR TISSUE
Beneath
the skin is a layer of loose areolar

connective tissue, containing no fat.
Applied anatomy: it is this layer which gets

readily distended by oedema or blood.
This layer is non existent near the ciliary
margin , at the lid folds and at the medial and
lateral angles where the skin is directly attached
to the underlying ligaments.
3. LAYER OF STRIATED
MUSCLES
Orbicularis
oculi muscle.
Levator palpebrae superioris.
A.Orbicularis oculi muscle.
Nerve supply and function

Palpebral
part-gentle closing of eyelid

Orbital part -forced closure of eyelid
Nerve
supply-facial nerve.
B. Levator palpebrae
superioris muscle.
course
Insertion of LPS
As
the levator muscle approaches ,the

septum orbitale it fans out into a wide
sheet like glistening white
tendon(aponeurosis of LPS)
It
forms medial horns and lateral horns

Medial horn-fuses with upper border of
medial canthal tendon
Lateral horn-thicker and divides the
lacrimal gland into orbital and palpebral
part. It inserts into superior edge of
lateral canthal tendon.
Attenuation of the levator muscle and dehiscence of its attachments may

demonstrate aging changes of the upper eyelid. This can result in elevation of the
eyelid crease as seen in involutional blepharoptosis. 3Congenital and acquired ptosis
is a drooping of the upper eyelid usually caused by poor elevating power of the upper
eyelid. Congenital ptosis is typically characterized by lagophthalmos and an absence
of an eyelid crease resulting from fibrofatty degeneration and poor function of the
LPS. There are several classifications of ptosis. (See Volume 5, Chapter 78.)
Muller's muscle, also known as the superior tarsal muscle, is the other retractor
muscle of the upper eyelid (Fig. 17). It is a smooth, sympathetically innervated
muscle that acts in concert with the levator muscle to elevate the upper lid.
Sympathetic innervation is derived from nerve fibers, which travel along the
peripheral arterial arcade and other small arteries.29Muller's muscle is highly
vascularized and is often a source of bleeding in surgery. It originates from the
underside of the levator muscle approximately 20 to 22 mm above the superior
tarsal border at the origin of the aponeurosis.24High in the eyelid, Muller's muscle is
loosely attached to the aponeurosis anteriorly and to the conjunctiva posteriorly. It is
more adherent posteriorly to the conjunctiva as is nears the upper boarder of the
tarsus. The superior tarsal muscle inserts into the upper border of the tarsal plate.
Clinically, increased sympathetic stimulation as seen in fright or Grave's
ophthalmopathy can retract the upper lid 2 to 3 mm above the normal resting
position. Diminished tone as seen in fatigue, paralysis, or Horner's syndrome may
cause the lid to drop as much as 2 mm. Topical administration of a short-term
sympathomimetic agent (i.e., phenylephrine) can be used to determine
preoperatively the effect of tarsal muscle surgery on ptosis. 36,37A positive result
following topical administration of phenylephrine is elevation the upper eyelid 2 to 3
mm, which suggests that Muller's muscle resection may be beneficial. (See Volume 5,
Chapter 78.)
Nerve supply and action.

Oculomotor nerve(voluntary part)
Sympathetic nerve(involuntary part)
ACTION
Elevation of upper eyelid
damage to the oculomotor nerve leads to
paralysis of this muscle and causes ptosis.
Damage to the sympathetic fibres in horners
syndrome leads to partial ptosis due to paralysis
of mullers muscle.
Superior transverse ligament

of whitnall
Mullers muscle
4.Submuscular areolar tissue

It is a layer of loose connective tissue present between
orbicularis muscle and the fibrous layer.
Nerves and vessels of the lid are in this layer,
So to anasthetise the lid, injection is made in this
plane.
In the upper eye lid this layer communicates with the
sub aponeurotic stratum of scalp .
Hence, pus or blood can
make its way into
the upper eyelid from
dangerous area of the scalp.
In the upperlid this space is traversed by

the levator muscle which divides it into
Preseptal space
Pretarsal space
Preseptal and pretarsal space
5.Fibrous layer
Frame
work of the lids is formed by this
layer.
Central thick part- Tarsal plate
Peripheral thin part-septum
orbitale(palpebral fascia)
It also includes the medial and the lateral
palpebral ligaments
Tarsal plates
The
upper tarsus contains approximately 30

meibomian glands, and the lower tarsus
contains approximately 20.
The oil-secreting glands are aligned vertically,
and their orifices are seen at the eyelid margin
Anterior surface of tarsus
Posterior surface of tarsal

plate
Concave
Coinciding
with globe of the eye.

It is lined by the conjunctiva which is
firmly adherent to the tarsal plate.
Extremities (ends)
Septum orbitale
Attachments
LATERALLY
septum is superficial and is attached to
the orbital margin in front of the lateral
palpebral ligament which goes to the
whitnalls tubercle.
Potential space is formed between the
two
Which contains
Lobule of fat.
SUPERIORLY-It
follows posterior lip of orbital
margin.
It bridges supra-orbital notch
and converts it into foramina.
It passes in front of pulley of superior oblique
muscle. Comes forward and is attached to
posterior lacrimal crest
Inferiorly-
The attachment of septum orbitale

follows the lower orbital margin.
At one point- near zygomatic bone it leaves
orbital margin and lies few mms away from it.
So here the septum forms osteo-fibrous pocket
called pre-marginal recess of Eisler.
It contains fat .
It re-joins the orbital margin just below the
whitnalls tubercle.
STRUCTURES PASSING
THROUGH SEPTUM ORBITALE
medial palpebral ligament

Extent
anterior lacrimal crest to suture

line in front of frontal process with the
nasal bone
Anterior
part of the MPL
Gives origin to superficial portion of

orbicularis oculi .
The angular artery and vein pass over the
anterior surface of the ligament ,artery is
medial to the vein.
Posterior part of MPL

It
passes behind behind the lacrimal sac

to reach the posterior lacrimal crest.
Lateral palpebral ligament

thin band of fibrous tissue
7mm horizontal extent
2.5mm vertical extent.
Medially-lateral ends of upper and lower tarsel
plates.
Laterally to whitnals tubercle.
Anterior surface-lateral palpebral raphe.(fusion
of septum orbitale and insertion of preseptal
portion of palpebral part of orbicularis oculi
muscle).
7. palpebral conjunctiva
Marginal
conjunctiva
Tarsal conjunctiva
Orbital part
GLANDS OF EYELID
Meibomian
glands
modified sweat glands present in

posterior part of stroma of tarsal plate.
They are arranged in a single row
vertically parallel to each other
20-30 in each lid.
structure of the gland

Each
gland consists of a central duct

which runs straight perpendicular to the
lid margin
Into the central canal open 10-15 acini
from sides.
The acini of the gland are lined by
glandular epithelium.
Opening of the gland

They
are arranged in a single row.

On the lid margin between the grey line
and the posterior border of the lid.
Secretions of meibomian
glands.
Oily
in nature(sebum)
Functions
Prevents over flow of tears across lid

margin.
Smooth movements of eyelid over the
globe
Ensure air tight closure of the eyelids
2.Glands of zeis
Modified
sabaceous glands
Attached to the eyelash follicle
Usually two glands with each cilium
Microscopy
Gland has epithelium placed on basement

membrane
Cuboidal cells lining the acini are actively
dividing
Glands of moll
vessels of eyelid
Venous drainage
Pretarsal
plexus.
Post-tarsal venous plexus.
Nerve supply of eyelid

Motor
nerve-facial nerve
Sensory nerve-first and second division
of trigeminal nerve.
Sympathetic nerve supply-mullers
muscle.
Lymphatic drainage of eyelid

LYMPHATIC
PLEXUS-two in each eyelid
Superficial or pre-tarsal plexus-skin and

orbicularis muscle.
Deep or post tarsal plexus tarsal plate
region and conjunctiva.
LYMPHATIC VESSELS.
LACRIMAL APPARATUS
LACRIMAL GLAND
Parts of lacrimal gland

The
gland is divided by the lateral horn

of aponeurosis of levator muscle into
two parts.
Structure of lacrimal gland
Nerve supply of lacrimal gland
Blood
supply-lacrimal artery ,a branch of

ophthalmic artery.
sometimes , a branch of transverse
facial
artery.
lymphatic drainage along the
conjunctival drainage into pre-auricular
lymph nodes.
Accessory lacrimal glands.
Lacrimal passages
Lacrimal sac
Relations of lacrimal sac.
Nasolacrimal duct

Eyelid Anatomy

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ANATOMY OF EYELID AND

the skin is a layer of loose areolar

Applied anatomy: it is this layer which gets

A.Orbicularis oculi muscle.

Nerve supply and function

part-gentle closing of eyelid

the levator muscle approaches ,the

forms medial horns and lateral horns

Attenuation of the levator muscle and dehiscence of its attachments may

Nerve supply and action.

Superior transverse ligament

4.Submuscular areolar tissue

In the upperlid this space is traversed by

Preseptal and pretarsal space

work of the lids is formed by this

upper tarsus contains approximately 30

Anterior surface of tarsus

Posterior surface of tarsal

with globe of the eye.

follows posterior lip of orbital

The attachment of septum orbitale

medial palpebral ligament

anterior lacrimal crest to suture

part of the MPL

Gives origin to superficial portion of

Posterior part of MPL

passes behind behind the lacrimal sac

Lateral palpebral ligament

modified sweat glands present in

structure of the gland

gland consists of a central duct

Opening of the gland

are arranged in a single row.

Prevents over flow of tears across lid

Gland has epithelium placed on basement

Nerve supply of eyelid

Lymphatic drainage of eyelid

PLEXUS-two in each eyelid

Superficial or pre-tarsal plexus-skin and

Parts of lacrimal gland

gland is divided by the lateral horn

Structure of lacrimal gland

Nerve supply of lacrimal gland

supply-lacrimal artery ,a branch of

Accessory lacrimal glands.

Relations of lacrimal sac.

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