HN [5: Eyelid]

Eyelid

Plays a big role in facial rejuvenation and visual function

Eyelid

Thinnest skin in the body to allow for uninterrupted and quick blinking

Anterior, Posterior Lamellae

The eyelid is divided into___

Skin, Orbicularis oculi

Anterior Lamellae is composed of___

Tarsus, Conjunctiva

Posterior Lamellae is composed of ___

Crow’s feet

Horizontal forehead furrows

Glabellar furrows

Orbital ocularis

A

Preseptal obicularis

B

Pretarsal obicularis

C

Corrugator supercilli

D

Depressor supercilli

E

Procerus

F

Frontalis

G

Orbicularis oculi, Corrugator supercilli, Procerus

Protractor of the eyelid muscle for closure

Pretarsal, Preseptal, Orbital

Orbicularis oculi muscle Divisions

Orbicularis oculi

Responsible for what can be seen as crow’s feet around one’s eyes

Corrugator supercillli

Attaches from the brow to the nasal bone

Procerus

Attaches from the frontal bone to the glabella, causing the glabellar furrows

Levator, Muller’s

Opening of the upper eyelid muscle

Levator

Primary elevator (retractor) of the upper lid

CN III/ Oculomotor

Nerve Supply of Levator

Levator

Extends beyond the rim as Whitnall’s ligament

Levator

Its fibrous aponeurosis gives out attachment extending to the skin, creating the lid crease

Eyelid Skin Crease

Separates the upper skin fold from the flat pre-tarsal component

Eyelid Skin Crease

Formed by attachments of the levator aponeurosis to the orbicularis and skin

Eyelid Skin Crease

Great surgical significance since it is a good incision site and hides and possible scar

Muller’s

Involuntary muscle of elevation

Muller’s

Subserved by the Sympathetic Nervous System

Muller’s

Accounts for about 1-2 mm of lid elevation

Muller’s

Located between conjunctiva and the levator, inserting to the superior border of the tarsus

Capsulopalpebral Fascia

Levator is analogous to ___ but for Lower Eyelid Retraction

Inferior Tarsal

Muller’s is analogous to ___ but for Lower Eyelid Retraction

Capsulopalpebral Fascia

Fibrous tissue extending from inferior rectur to inferior border of tarsus

Inferior Tarsal

Runs posterior to capsulopalpebral fascia

Inferior Tarsal

Extending from Lockwood’s ligament to inferior tarsal border

Tarsus or Tarsal Plates

Firm, dense plates of connective tissue that serve as structural support of the eyelids

Tarsus or Tarsal Plates

Have rigid attachments to the periosteum via the medial and lateral canthal tendons

Orbital Septum

Thin multi-layered sheet of fibrous tissue that arises from the periosteum over the superior and inferior orbital rims at the arcus marginalis

Orbital Septum

Attenuation or thinning of this structure tends to contribute to fat herniation in the aging eyeli

Preaponeurotic/Orbital Fat

Can be found anterior to the levator and posterior to the septum

Central, Medial

2 main fat pads of the Upper Lid

Nasal/ Medial, Central, and Temporal/ Lateral

3 fat pads of the Lower Lid

Suborbicularis Oculi Fat

Deep subcutaneous fat beneath the orbicularis running from the lower lid to the midface

Suborbicularis Oculi Fat

These fats are what we see as eye bags or dermatochalasis

Eyelid Coloboma

Eyelid Disorder: Embryologic cleft that is usually an isolated anomaly when occurs in medial upper eyelid

Eyelid Coloboma

Eyelid Disorder: When found in lower eyelid, it is frequently associated with other congenital conditions such as facial clefts of Goldenhar syndrome and lacrimal deformities

Eyelid Coloboma

Eyelid Disorder: A true one includes a defect in the eyelid margin

Blepharitis

Eyelid Disorder: Inflammation of the lid margin causing redness, itchiness and formation of dandruff-like scales called collarettes around base of lashes

Blepharitis

Eyelid Disorder: Due to bacteria or clogged oil glands

Blepharitis

Eyelid Disorder: Remedy is Lid hygiene with shampoo (mild) or antibiotic lid scrub

Eyelid Coloboma

Eyelid Disorder

Blepharitis

Eyelid Disorder

Hordeolum or Stye

Eyelid Disorder

Hordeolum or Stye

Eyelid Disorder: Acute, localized swelling of the eyelid due to bacterial infection

Hordeolum or Stye

Eyelid Disorder: May be internal (inflammation/infection in the Meibomian gland) or external (infection of Zeiss or Moll gland)

Hordeolum or Stye

Eyelid Disorder: External (infection of Zeiss or Moll gland) commonly involves eyelashes

Hordeolum or Stye

Eyelid Disorder: Remedy is Oral or topical antibiotics with warm compress

Chalazion

Eyelid Disorder

Chalazion

Eyelid Disorder: Is a non tender cyst noted along the eyelids

Chalazion

Eyelid Disorder: Usually develops when a Meibomian gland is clogged and develops inflammation

Chalazion

Eyelid Disorder: Sometimes it is an undertreated stye

Chalazion

Eyelid Disorder: Remedy is warm compress and proper drainage

Ectropion

Eyelid Disorder

Ectropion

Eyelid Disorder: Eversion (outward turning) of lid margin

Ectropion, Entropion

Eyelid Disorder: Caused by natural aging process like lid laxity of medial & lateral canthal tendon

Ectropion

Eyelid Disorder: Also caused by mechanical* causes like a lid tumor and other conditions like facial paralysis

Entropion

Eyelid Disorder

Entropion

Eyelid Disorder: Inversion (inward turning) of lid margin that irritates the eye

Entropion

Eyelid Disorder: Also caused by overriding of the preseptal over pretarsal orbicularis and disinsertion of lower lid retractors

Trichiasis

Eyelid Disorder

Trichiasis

Eyelid Disorder: Inward growth of the lashes due to inflammation & trauma

Trichiasis

Eyelid Disorder: Only the lashes are turned in. Lid margins are in correct position

Trichiasis

Eyelid Disorder: To correct, epilation, electrocautery of follicles, or sometimes surgery is required

Ptosis

Eyelid Disorder

Ptosis

Eyelid Disorder: Drooping of the upper lid

Ptosis

Eyelid Disorder: Usually due to congenitally weak and fat infiltrated levator

Ptosis

Eyelid Disorder: In elderly, it is due to the lengthening of the levator aponeurosis