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Tanat Tabtieang, profile picture
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Anatomy of Eyelid

The three main structures of the eyelid are the skin, orbicularis oculi muscle, and tarsal plate. The orbicularis oculi muscle is responsible for eyelid closure and blinking. Below the muscle sits the tarsal plate, a dense fibrous structure that provides structure to the eyelid. In the upper eyelid, the levator palpebrae superioris and Müller muscle act as retractors to open the eyelid. The document describes the anatomy and structures of the eyelid in detail.

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Gross Anatomy• Plastic Surgery• Medical Education•
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Anatomy of Eyelid Tanat Tabtieang, MD Fellowship of Royal College of Radiologists ofThailand Diploma of theThai Board of Diagnostic Radiology Lecturer, Department of Anatomy Faculty of Medicine, Chulalongkorn University
Contents • Surface anatomy • Skin and subcutaneous tissue • Orbicularis oculi muscle • Submuscular areolar tissue • Tarsi and orbital septum • Retractors and post septal fat pads • Fat pads • Conjunctiva • Nerves, vessles and lymphatics
Eyelids • Movable folds covering the eyeball anteriorly • Protecting injury and excessive light, keeping cornea moist
Surface anatomy • Superior eye lid crease (superior palpebral sulcus) – Attachment of superficial insertion of levator aponeurotic fibers • Inferior eye lid crease (inferior palpebral sulcus) • Nasojugal fold – From medial canthal region along depression of separation of orbicularis oculi and levator labii superioris • Malar fold – Groove in the skin that extends downward and medially from the lateral canthus. • Lateral canthus • Madial canthus
Skin and subcutaneous tissue • Thinnest of the body – Very elastic and recovers rapidly after being distended by fluids • Nasal part: finer hairs, more sebaceous gland • Sparse fat in preseptal and preorbital skin, Absent fat in pretarsal skin – Easily be lifted by effusion with blood • Absent subcutaneous tissue over medial and lateral palpebral ligaments
Eyelashes • Anterior border of margin of the eyelid • Found in the lateral part of the lid margin • Punctum: at the junction of the ciliary and nonciliary parts of the lid margin
Glands of eyelid Glands of Moll • 1–2 mm long • Simple spiral, modified sweat glands • Obliquely in contact with and parallel to the bulbs of the cilia. • Duct passes through the dermis and epidermis • Terminate separately between two lashes or may open into the duct of a sebaceous gland of Zeis. Sebaceous glands of Zeis • Modified sebaceous glands • Attached directly to the follicles of the eyelashes • Stye: suppurative inflammation of the Zeis gland
Orbicularis oculi muscle • Muscle of facial expression • Superficial musculoaponeurotic system • Orbital part: forced eye closure • Palpebral part: blinking and voluntary winking superficial to the tarsi, deep to the skin – Preseptal portion – Pretarsal portion
Orbicularis oculi muscle Orbital portion • Around the orbit • Origin: medial orbital margin • Insertion: – Superomedial orbital margin – Maxillary process of frontal bone – Medial palpebral ligament – Frontal process of maxilla – Inferomedial orbital margin • Extending and intermixing with other facial muscles
Orbicularis oculi muscle Preseptal portion • Overlie orbital septum • Origin: superficial and deep head at medial palpebral ligament • Insertion: joining laterally forming lateral palpebral raphe
Orbicularis oculi muscle Pretarsal portion • Anterior to tarsus • Origin: superficial and deep heads at medial palpebral ligament • Insertion: deep to lateral palpebral raphe, insert into lateral orbital tubercle through lateral canthal tendon
Submuscular areolar tissue • Loose connective tissue between the orbicularis oculi and the tarsal plate • Splitting anterior and posterior portion • Main nerves lies in this tissue • Upper lid: traversed by fibers of levator aponeurosis – Attach to skin forming lid crease • Superior continuing at retro- orbicularis oculi fat (ROOF) • Lower lid: traversed by fibers of orbitomalar ligament
Tarsal plate • Dense fibrous tissue: “skeleton” of the eyelid – Crescentic superior tarsus – Rectangular inferior tarsus • Posterior surface adhering conjunctiva • About 25 Meibomian glands: lipid secretion – Run from attached margin of tarsal to their free margins – Vertically, parallel with each other, at a right angle to the lid margin – Open at just anterior to posterior lid margin, posterior to gray line, anterior to mucocutaneous junction • Medial and lateral ends attaching to orbital rim by medial and lateral palpebral ligaments
Medial canthal tendon • Triangular band • Connecting tarsi to medial margin of orbit, stabilizing medial tarsi • Attached to the frontal process of the maxilla from the anterior lacrimal crest to near its suture with the nasal bone • Upper border: adherent to and continuous with the periosteum • Anterior portion – Continued at the medial canthus and divided into two bands, passing across the lacrimal fossa • Posterior portion – Continuous with the lacrimal fascia – Helps to place a roof over the upper part of lacrimal sac.
Medial canthal ligament • Superficial head of pretarsal orbicularis oculi lies anterior to canaliculi, forming anterior limb of MCT • Deep head of pretarsal orbicularis oculi inserts into posterior lacrimal crest and fascia of lacrimal sac • Superficial head of preseptal orbicularis oculi inserting into and augmenting MCT • Deep head of preseptal orbicularis oculi inserting into lacrimal sac fascia
Lateral canthal tendon • Attach tarsi to lateral margin of orbit – Not provide direct muscle attachment • Dense fibrous connective tissue from tarsi – Passing laterally deep to orbital septum – Inserting into lateral orbital tubercle (Whitnall’s tubercle) on the zygomatic bone – Upper border continuous with lateral horn of levator aponeurosis – Lower border continuous with the expansion from the inferior oblique and inferior rectus muscles • Eisler fat pocket – Between orbital septum and LCT
Orbital septum (septum orbitale) • Connective tissue span from tarsi to superior margin of orbit (arcus marginalis), continuous with periosteum of orbital rim • Thicker and stronger on lateral side and in the upper lid • On the lateral side: superficial, anterior to the lateral palpebral ligament • On the medial side: deeper, behind the lacrimal part of orbicularis • Fuse with lid retractor structures at midline • Septal extension – From line of fusion with levator aponeurosis extending to cover tarsal plate up to ciliary margin – Adjunct to levator aponeurosis
Upper eyelid retractors • Levator palpebrae superioris • Müller muscle
Levator palpebrae superioris • Origin: orbital apex, from undersurface of lesser wing of sphenoid bone • Whitnall (superior transverse) ligament – Primary suspensory ligament support upper lid – Near junction of muscular and aponeurotic levator – Spanning the anterosuperior orbit between trochlea and lacrimal gland fascia – Passes between orbital and palpebral lobes of lacrimal gland
Levator palpebrae superioris • Insertion – Medial horn attaching to posterior lacrimal crest – Lateral horn divide lacrimal gland into orbital and palpebral lobes, attaching lateral retinaculum at lateral orbital tubercle – Fusion with orbital septum before reaching level of superior tarsal plate border – Some aponeurotic fiber descend to insert into lower 1/3 of anterior surface of tarsal plate
Müller muscle • Smooth muscle, sympathetic nervous system • Origin: undersurface of levator, at aponeurosis-muscle junction • Travel between levator aponeurosis and conjunctiva • Insertion: superior margin of tarsus • Vascular arcade adhering to lower border of anterior surface • Action: widen palpebral fissure with increased sympathetic tone
Lower eyelid retractor • Fascial extension from inferior rectus muscle and tendon, as capsulopalpebral head • Lockwood (inferior transverse) fascia – Thickened lower part ofTenon capsule – Serves as suspensory ligament for globe – Blends with lateral canthus and lateral check ligament laterally and attaches to lacrimal crest medially • Capsulopalpebral fascia – Insert on inferior border of inferior tarsus – Pass forward to unite withTenon’s capsule and inferior fornix conjunctiva, to subcutaneous tissue forming lower eyelid crease – Fusion with orbital septum below inferior tarsal border
Fat pads • Upper eyelid fat pads – Immediately posterior to orbital septum – Anterior to levator aponeurosis – Medial and central fat pads (Lacrimal gland occupies lateral compartment) • Lower eyelid fat pads – Medial, central and lateral fat pads – Inferior oblique separates medial and central fat pads
Conjunctiva • Smooth translucent mucous membrane • Palpebral conjunctiva – Lies posterior surface of eyelid – Reflect onto the eyeball, continuous with bulbar conjunctiva • Conjunctival sac – Space bound by palpebral and bulbar conjunctivae
Nerve supplies Sensory innervation • Frontal branch of CNV1 – Between periorbita of retro-orbicularis oculi fat and levator palpebrae superioris – Sensation of upper eyelid and forehead – Divides into supraorbital nerve and supratrochlear nerve • Supraorbital nerve: through supraorbital notch • Supratrochlear nerve: exits just lateral to origin of corrugator supercilii • Lacrimal nerve of CNV1 – Between lateral rectus and periorbita – Lacrimal gland, lateral part of upper lid, lateral forehead, lateral canthus
Nerve supplies Sensory innervation • Infratrochlear nerve – Terminal branch of nasociliary nerve (CNV1) – Sensation of skin and conjunctiva of medial canthus and nasolacrimal sac • Infraorbital nerve (CNV2) – Through infraorbital foramen – Palpebral branch supplies central lower eyelid skin and conjunctiva • Zygomaticofacial nerve (CNV2) – Supplies skin to the lateral lower lid
Nerve supplies Motor innervation • Orbicularis oculi muscle – Frontal and zygomatic branches of CNVII • Levator palpebrae superioris – Superior branch of CN III • Müller muscle – Postganglionic sympathetic fiber from superior cervical ganglion – Travels in carvenous sinus and superior orbital fissure via cranial nerve branches
Vascular supplies Internal carotid artery • Medial:Terminal branches of ophthalmic artery – Two medial palpebral arteries: superior & inferior marginal vessels • Inferior marginal vessels: branch of superior marginal vessels, deep to MCT – Forming marginal arcades: lie on anterior tarsal surface – Upper lid: Superior marginal arcade from superior marginal arcade • Lateral: Lacrimal artery – Two lateral palpebral arteries: superior and inferior marginal arteries
Vascular supplies External carotid artery • Facial artery:Angular artery – Passes to medial canthal region – Anastomosis with dorsal nasal artery • Superficial temporal artery – Supplies eyelid anastomosis via transverse facial and zygomatic branches • Infraorbital artery – Exits infraorbital foramen – Anastomosis with vessels of lower eyelid
Lymphatic drainage • Preauricular lymph node – Most of upper eyelid – Lateral half of lower lid • Submandibular node – Medial portion of upper lid – Medial half of lower lid
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