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