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Duke Elder - Anatomy 5: Ocular appendages > Eyelids > Flashcards

Eyelids Flashcards

1
Q

What are the eyelids?

A

thin curtains of skin, muscle, fibrous tissue and mucous membrane

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2
Q

What are the 2 key functions of the eyelids?

A
  1. protect eyes from injury and excessive light
  2. distribute tears over ocular surface during blinking
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3
Q

What is the position of the upper eyelid when open?

A

normally just overlaps the corneoscleral junction

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4
Q

Which eyelids undergoes the most displacement during eyelid closure?

A

upper lid (lower lid moves only minimally during normal blinking)

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5
Q

On external examination, which 2 portions can each lid be divided into?

A
  1. orbital portion
  2. tarsal portion
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6
Q

What divides each lid into orbital and tarsal portinos?

A

horizontal palpebral sulcus (most evident on uppder lid)

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7
Q

Where is the horizontal palpebral sulcus most evident?

A

upper lid (superior palepbral sulcus)

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8
Q

What limits the upper and lower lids?

A

upper lid limited superiorly by eyebrow, lower lid blends with skin of cheek

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9
Q

What are the names of the points at which upper and lower lids meet?

A

medial and lateral canthi or angles

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10
Q

What separates the medial and lateral canthi from each other?

A

palpebral fissure (elliptical opening)

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11
Q

What is the positioning of the lateral canthus?

A

acute angle (60 degrees) and lies close to the eyeball

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12
Q

What is the shape and positioning of the medial canthus?

A

rounded, elongated medially, lies 6mm from the eyeball

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13
Q

What separates the medial canthus from the eye?

A

lacus lacrimalis (lake of tears)

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14
Q

What is located within the lacus lacrimalis?

A

small raised red swelling, the curuncula lacrimalis

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15
Q

What is the most conspicious racial difference in the shape and form of the eyelids and canthi?

A

vertical epicanthal fold in oriental and asian races

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16
Q

How long are the eyelid margins?

A

30mm

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17
Q

How thick are the eyelid margins?

A

2mm

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18
Q

What shape are the eyelid margins for their length?

A

relatively square in profile along most of their length, except medial one-sixth, which is rounded and lacks eyelashes

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19
Q

What are eyelashes?

A

modified, thick, stiff hairs that occur as double or triple rows close to the anterior lid margin

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20
Q

What is the arrangement of eyelashes?

A

double or triple rows, close to anterior lid margin

curl away from lashes of opposite lid

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21
Q

What are 4 notable features on the lid margins?

A
  1. lacrimal puncta
  2. tarsal (meibomian) glands
  3. skin/conjunctival transition zone
  4. grey line
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22
Q

Where are lacrimal puncta located?

A

at the medial ends of the upper and lower lids

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23
Q

What is the function of the lacrimal puncta?

A

drain tears from the lacus lacrimalis

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24
Q

How can the lacrimal puncta be more easily identified?

A

if tension is places on the lids, causing the papillae to blanch

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25
Q

What are the tarsal (meibomian) glands?

A

visible to the naked eye as a row of minute openings on the lid margin posterior to the eyelash follicles

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26
Q

How many tarsal (meibomian) glands are there on the eyelids?

A

around 30 in the upper lid, slightly fewer in the lower lid

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27
Q

What and where is the skin/conjunctival transition zone?

A

mucocutaneous junction, occurs at level of opening of the tarsal glands

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28
Q

What is the grey line?

A

marks anterior boundary of the tarsal plate (useful landmark for surgical incisions)

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29
Q

What type of secretion do sweat glands on the eyelid employ?

A

eccrine secretion

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30
Q

What is the function of the loose areolar layer of the eyelid?

A

fluids can track down into the eyelids from subaponeurotic layer of scalp

nerve and vessels of eyelid mostly found in this layer

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31
Q

What are ciliary glands (of Moll)?

A

modified sweat glands, unbranched tubular type, apocrine secretion

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32
Q

In which layer of the eyelid are nerves and vessels mostly found?

A

loose areolar layer

33
Q

Between which layers is the loose areolar layer of the eyelid found?

A

between the tarsal plate and orbicularis oculi

34
Q

What are the sebaceous glands (of Zeis)?

A

associated with eyelashes, sebaceous glands in follicle of holocrine type

35
Q

What is another name for the glands of Moll?

A

ciliary glands

36
Q

What type of secretion is performed by ciliary glands (of Moll)?

A

apocrine secretion

37
Q

What is another name for glands of Zeis?

A

sebaceous glands

38
Q

What type of secretion is performed by sebaceous glands of Zeis?

A

holocrine

39
Q

Are there arrector pili muscles associated with eyelashes?

A

no

40
Q

What are 2 accessory lacrimal gland types?

A

glands of Krause and Wolfring

41
Q

What type of tissue forms the tarsal plate?

A

dense fibrous connective tissue

42
Q

What are tarsal glands?

A

modified sebaceous glands, holocrine-type secretion

43
Q

What type of secretion is performed by tarsal glands?

A

holocrine

44
Q

What lines the ducts of tarsal glands?

A

stratified epithelium

45
Q

What is the function of the subtarsal sulcus?

A

traps particles in tear film/conjunctival sac

46
Q

What structure forms the fibrous framework of the eyelids?

A

orbital septum arising from the orbital margin and the tarsal plates

47
Q

What are the tarsal plates?

A

modified regional thickenings of the orbital septum that provide rigidity to the upper and lower lids and separate the orbit and its contents from the lids

48
Q

What ageing changes can affect the orbital septum?

A

herniation of orbital fat through weakened regions of septum produces bulging, sagging lids (blepharochalasis)

49
Q

What is the width of the tarsal paltes from medial to lateral borders?

A

25-30mm

50
Q

How thick are the tarsal plates?

A

1mm thick

51
Q

What are the heights of the upper and lower tarsal plates?

A

upper plate 10-12mm, lower plate 5mm

52
Q

What are the attachments of the tarsal plates at either end?

A

continuations, the medial and lateral palpebral ligaments

53
Q

What are the attachments to the anterior and posterior surfaces of the tarsal paltes?

A

skin moves freely over anterior surface

conjunctiva tightly bound to posterior surface

54
Q

What can be seen on external examination fo an everted eyelid?

A

vertical rows of yellowish tarsal glands

55
Q

What type of glands are tarsal glands?

A

modified sebaceous glands

56
Q

Wher are tarsal glands situated?

A

embedded in the matrix of the tarsal plate

57
Q

What is the histology of the tarsal glands?

A

acinar cells are replete with lipid droplets that are secreted in a holocrine manner on to the eyelid margin, which retains tears in the conjunctival sac and contributes to the lipid layer of the precorneal tear film

58
Q

How do the tarsal glnds secrete droplets?

A

lipid droplets secreted in holocrine manner onto the eyelid margin

59
Q

Which 2 places do lymphatics from the eyelids drain to?

A
  • superficial parotid lymph nodes
  • submandibular lymph nodes
60
Q

Where does the pretarsal portion of the eyelid derive its aterial supply?

A

superficial temporal and facial arteries (branches of external carotid)

61
Q

What is the arterial blood supply to the post-tarsal portion of the eyelid?

A

branches of the ophthalmic artery (branch of internal carotid artery)

62
Q

What is the venous drainage of the eyelid?

A

follows similar pattern to arterial supply

consideration of anastomoses between the internal and external carotid arteries

post-tarsal venous drainage is via ophthalmic veins to cavernous sinus

63
Q

What are 8 arteries that supply the eyelids and identify them on the image

A
  1. Lacrimal artery
  2. branch of superficial temporal artery
  3. Lateral palpebral arteries (branches of lacrimal artery)
  4. Transverse facial artery
  5. Infraorbital artery
  6. Supraorbital artery
  7. Supratrochlear artery
  8. Medial palpebral arteries (branches of ophthalmic artery) –> form marginal and peripheral arterial arches
64
Q

What are 6 enrves which supply the eyelids and identify them on the diagram

A
  1. Lateral palpebral branch of lacrimal nerve (V1)
  2. Zygomatico-facial nerve (V2)
  3. Supraorbital nerve (V1)
  4. Supratrochlear nerve (V1)
  5. Infratrochlear nerve (V1)
  6. Infraorbital nerve (V2)
65
Q

What is a chalazion?

A

localised, painless swelling in the lid caused by obstruction and chronic inflammation of a tarsal gland

66
Q

What is another term for a hordeolum?

A

sty

67
Q

What is a hordeolum?

A

acute infection of an eyelash follicle or its sebaceous gland, infection fo a ciliary sweat gland (exernal hordeolum) or acute infection of a tarsal gland (internal hordeolum)

68
Q

What is an external hordeolum?

A

acute infection of eyelash follicle or its sebaceous gland / infection of ciliary sweat gland

69
Q

What is an internal hordeolum?

A

acute infection of a tarsal gland

70
Q

What is an ectropion?

A

drooping of the lower lid owing to paralysis of orbicularis oculi

71
Q

Why can ectropion cause epiphora (excessive tearing)?

A

paralysis of fibres of orbicularis that enloses the lacrimal sac means the puncta no longer suck up tears, which may pass over the lid margin

72
Q

What causes eyelids to close?

A

action of the palpebral fibres of the orbicularis oculi, and relaxation of levator palpebrae superioris

73
Q

What causes the eyelids to open?

A

pull of levator palpebrae superioris on the skin, tarsal plate and forniceal conjunctiva

74
Q

What are the 3 innervation sources to the muscles that move the eyelids?

A
  1. Facial nerve - orbicularis oculi (007)
  2. Oculomotor nerve - levator palpebrae superioris
  3. Sympathetic nerves - smooth muscle component, superior tarsal (Müller’s) muscle
75
Q

When is the sympathetic supply to the superior tarsal (Müller’s) muscle important?

A

times of fear or excitement, when the width of the palpebral fissure is further increased

76
Q

What is a common clinical condition causing drooping of the eyelid (ptosis)?

A

Horner syndrome

77
Q

What are the 4 classic symptoms of Horner syndrome?

A
  1. unilateral ptosis
  2. unilateral miosis
  3. unilateral dry facial skin (anhidrosis)
  4. blushing on affected side
78
Q

What are 4 examples of lesions that can cause Horner syndrome?

A
  1. iatrogenic interruption of the sympathetic chain in the neck
  2. dissection of the internal carotid artery
  3. cervical disc dislocation
  4. lysis of the first rib affecting the stellate ganglion associated with Pancoast tumour
79
Q

In addition to the classic 4, what are 2 further possible symptoms of Horner syndrome?

A

(4 = ptosis, miosis, anhidrosis, blushing)

  1. heterochromia
  2. enophthalmos

Duke Elder - Anatomy 5: Ocular appendages (4 decks)

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