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Lids

Anatomy
Boundary:
• Anteriorly: skin
• In between (transition): margin
• Posteriorly: tarsal conjunctiva

Contents (bound by connective t/s)


• m/s, b/vs, nerves, glands

Tarsus: bounding connective t/s is dense posteriorly


forming a stiff plate
Peculiarities of Skin
• Thin
• Loosely attached
• Absence of fat in its corium
• Covered with fine downy hairs provided with
small sweat & sebaceous glands

(thin, loose, +hairs, +glands, no -fat)


Margin/free edge of lid/intermarginal
strip
• Str. Sq. ep.
• Transition betn skin & conjunctiva
• Well differentiated hairs & larger sweat &
sebaceous glands
• Hair: cilia/eyelashes
• Sebaceous glands: Zeis glands (zeis lia ulta :
sebaceous)
• Sweat glands: Moll glands (bazaar ma vau moll
garna jada dherai paisa sunera pasina ayo)
• Identical to skin glands except in size
• Definition: “ well differentiated
larger…..glands of hair follicles of lid margin” is
……..
• Sweat glands: Moll glands (situated
immediately behind hair follicles; their ducts
don’t open up directly onto skin surface; their
ducts open up into hair follicles or ducts of
Zeis glands)
Margin
• Anterior border: rounded
• Posterior border: sharp (lying in contact with
globe)
• Sharp angle of contact: induce capillarity
(proper moistening of eye surface)
• Immediately ant to post border: single row of
minute visible orifices of ducts of Meibomian
glands
• “Fine grey line” : between orifices & ant.
Border (importance during operations of
spilitting lids: indicates position of loose,
relatively avascular fibrous t/s betn orbicularis
palpebrarum & tarsus)
Tarsus
• Consists of dense fibrous t/s
• No cartilage
• Embedded enormously developed sebaceous
glands: Meibomian (tarsal) glands
(ei/sebaceous/vowel/GMT)
• 20-30 glands/lid
• Straight vertically directed tubes; each opening by
a single duct on lid margin (importance: vertical
inner incision on conjunctiva during I & C of
chalazion; horizontal incision on skin for small
scar)
Muscles
• Striped muscles (orbicularis palpebrarum;
levator palpebrae superioris, inferior rectus &
oblique muscles) LIDS (LIO ---Striped)
• Unstriped muscles (superior & inferior tarsal
muscles of Muller) (MU: muller; unstriped)
• Orbicularis palpebrarum: occupies space
between tarsus & skin
• LPS:
- main central band inserted into upper tarsus
border
- an anterior slip: between OP m/s; insert into
middle of lid skin
- a posterior slip: insert into conjunctiva (fornix)
- lateral attachments to medial & lateral
palpebral ligaments
• inferior rectus & oblique muscles: send fibrous
strands forward into lower lid; atttached to
tarsus & palpebral ligaments
• Capsulopalpebral fascia (Whitnall ligament):
origin (IR) to inferior tarsal border (insertion
by aponeurosis)
• Tarsal muscles of Muller:
• Superior: arise among striped levator fibres;
pass down behind it & insert into upper
border of tarsus
• Inferior: lies below IR; insert into lower tarsus
Blood supply
• Upper lid arteries form: 2 main arches
(superior betn upper tarsus border & O m/s;
inferior in similar position just above hair
follicles)
• Lower lid: 1 arch near free edge
• 2 venous plexuses in each lid: post-tarsal into
ophthalmic veins & pre-tarsal into
subcutaneous veins
Lymphatics
• Medial third of upper lid & two-thirds of lower
lid: submandibular nodes
• Lateral two-thirds of upper lid & one-third of
lower lid: pre-auricular nodes
Nerve supply
• Sensory: trigeminal nerve (upper lid:
ophthalmic division; lower lid: maxillary
division)
• 3rd nerve: LPS
• 7th nerve: OP
• Sympathetic nerves: Muller muscles
Eyelids
• Thin structures
• Comprised of skin, m/s, fibrous t/s
• Function: serve to protect eye
• Great mobility d/t thin skin
• s/c t/s (thin fibroadipose layer thru which septa pass &
closely adhere to OO m/s)
• OO m/s: straited m/s; innervated on deep surface by
facial nerve; lid closure; 3 parts: orbital, preseptal,
pretarsal divisions
• Orbital: forcible closure
• Preseptal, pretarsal: invountary lid movements (blink);
sup & deep medial heads that participate in lacrimal
pump function