Ocular: Eyelids Flashcards
Eyebrows
Hair bearing skin running roughly parallel to the superior orbital rim
Functions of eyebrows :
-protection
-shield eye from dust, sweat, and light
-underlying fat layer (eyebrow protrudes)
-sensitive enough to elicit a blink
-facial expressions
Orbicularis muscle eyebrow movement:
Primary lateral depressor
Procerus muscle eyebrow function:
Medial depressor
Original and insertion of procerus muscle:
Origin: nasal bone
Insertion: frontals on each side of midline
Corrugator muscle eyebrow function:
Medial depressor
Origin and insertion of corrugator muscle:
Origin: frontal bone
Insertion: skin above medial eyebrows
Depressor supercilii muscle function:
Medial depressor (distinct from orbicularis and corrugator muscle)
Frontalis muscle eyebrow function:
Primary elevator
Origin and insertion of frontalis muscle:
Origin: high on scalp
Insertion: near superior orbital rim
CN VII temporal nerve innervates:
-upper lid orbicularis
-frontalis muscle
-corrugator muscle
CN VII zygomatic nerve innervates:
-lower lid orbicularis
CN VII angular nerve innervates:
-procerus
-corrugator
Angular nerve is formed by:
Buccal and zygomatic nerve
Epicranius muscle:
-aka frontal belly
-paired muscles running vertically
-frontalis contraction elevates eyebrows
Eyebrows elevated causes:
-horizontal forehead wrinkles
-look of surprise
Clinical correlation of epicranius muscle:
In upper lid ptosis, the frontalis muscle will be used to compensate
Corrugator supercilii muscle causes:
-vertical furrows in between brows
-sorrow, concentration, frown
-reduces sun glare
Procerus muscle causes:
-horizontal furrow across nose bridge
-menace, aggression
All muscles in the eyebrow region are sites of…
Botulinum toxin injections for blepharospasm
Shape of eyelid
Elliptical
Eyelids have complex anatomy composed of:
Skin, muscles, nerves, and blood vessels
Eyelids can be divided into 7 layers:
- Skin and subcutaneous connective tissue
- Muscles of protraction
- Orbital septum
- Orbital fat
- Muscles of retraction
- Tarsus
- Conjunctiva
In primary gaze, upper eyelid covers about ___ of the cornea
1/6th
Upper eyelid is more mobile and can be raised ____mm by _________ muscle and an additional 2mm of lift by the _______muscle
15mm, levator palpebrae superioris , 2mm, mullers muscle
Skin and subcutaneous connective tissue is the…
Thinnest skin in the human body, limits the options for skin graft donor sites
Skin and subcutaneous connective tissue contains no__________________, instead made of __________________
Subcutaneous fat layers, loose aerolar connective tissue
Absence of fat in the eyelid causes..
Dissension by edema/blood
Epidermis of skin an subcutaneous connective tissue of eyelid:
-keratinizsed stratified squamous epithelium
-location of melanocytes and langerhan’s cells
Dermis of skin and subcutaneous connective tissue of eyelid:
-two layers: papillary and reticular
-high [ ] of elastic fibers
-highly vascularized
-contains glands/hair follicles
Hypodermic/subcutaneous aerolar layer of skin and subcutaneous layer of eyelid:
-not fat in portion anterior to tarsus
-tight and thin tissue
Palpebral sulci divide lid into:
Tarsal portion and orbital portion
Tarsal portion rests on the _________
Globe`
Characteristics of tarsal portion of lid surface:
-thin skin layer, tightly adhered
-connective tissue layer that lacks adipose
Orbital portion of lid surface:
-loose skin layer
-connective tissue later contains fat
Inferior palpebral fold/sulcus starts about ____ inferior to medial lower lid margin and ends ____ inferior to the lateral lid margin
3mm,5mm
Palpebral fissure
Area between eyelids
Vertical palpebral fissure measurement
About 6-10mm
Upper lid should cover the superior limbus by about ______
2mm
Lower lid typically within ____ above or below lower limbus
1mm
MRD 1
Distance from upper eyelid margin to corneal refraction of transilluminator
Average MRD 1
4 to 4.5mm
MRD stands for..
Marginal reflex distance
Marginal reflex distance is used clinically and is smaller in _________ and larger in ______________
Ptosis, eyelid retraction
MRD 2
Distance from corneal reflex to lower eyelid margin
Average MRD 2
5-5.5mm
Regardless s of measurement used, negative number denotes…
Crossing over the purkinji image
Epicanthal folds
Vertical or oblique folds of skin towards the medial canthus that arises from the upper eyelid
Epicanthal folds are typically:
-bilateral
-seen commonly in Asians and aboriginals
Epicanthal folds become less noticeable with age as…
Nasal bridge develops
Pseudoesotropia in children is due to…
Epicanthal folds
Muscles of protraction:
Orbicularis oculi that is divided into two parts: orbital and palpebral portion
Palpebral portion of orbicularis oculi is responsible for…
Spontaneous/reflex blinking and can be further divided into two parts
Orbicularis oculi orbital portion is responsible for..
Forces, voluntary blinking
Preseptal part of palpebral orbicularis oculi divides medially into:
A deep head and a superficial head
Deep head of Preseptal part attaches to:
Fascia around lacrimal sac and posterior lacrimal crest
Superficial head of Preseptal part of palpebral attaches to…
Anterior limb of medial canthus ligament
Preseptal part of palpebral orbicularis laterally attaches to…
Whitnall’s orbital tubercle forming lateral palpebral raphe
Preseptal part of palpebral orbicularis have fibers that are arranged in ____________attaching at ____________ region where the fibers contract at each blink
Half eclipses, medial/lateral canthal region
Pretarsal portion of orbicularis divides medially into a…
Deep and superficial head
Deep head of pretarsal portion of orbicularis attaches.. .
Behind the posterior lacrimal crest and the medial canthal tendon
Superficial head attaches to the…
Anterior lacrimal crest
Deep posterior head of pretarsal portion of orbicularis is the…
Horners muscle
Horners muscle contraction draws…
Eyelids medial and posterior
Lateral pull on lacrimal diaphragm creates negative pressure drawing…
Tears from the cancliculi into the sac
Muscle of riolan is also called
Pars ciliaris
Muscle of riolan is located along the _________ and part of the _______________ muscle
Lid margin, palpebral orbicularis
Muscle of riolan function
Supplies tension to keep lid wiper region/eyelids tight against the globe
Orbital portion of orbicularis originates from the…
Periosteum of the frontal and maxillary bone
Orbital septum
Thin,fibrous, mutilayed sheath that arises from anterior Periorbita and extends to the tarsal plates
Orbital septum separates the…
Eyelids from the orbit
Superior portion of orbital septum blends with the…
Tendon of the levator palpebrae superiors
Inferior portion of orbital septum blends with the…
Tarsal plate
Most structures passing from extraconal compartment to the face muscat piece the..
Orbital septum
Orbital/eyelid fat:
-serves as a protective cushion and facilitates movement
-2 preaponeurotic fat pads superiorly
-3 preaponeurotic fat pads inferiorly
Muscle of retraction:
-levator palpebrae superioris
-muller muscle (superior tarsal muscle)
Another name for mullers muscle
Superior tarsal muscle
Levaotr palpebrae superioris primary function:
Elevation and retraction (15mm)
Levator palpebrae superioris arises from the ____________ bone
Sphenoid
Levator palpebrae superioris is innervated by
Superior division of CN 3
Levator direction changes direction at..
The superior transverse ligament
Muller muscle originates from the…
Undersurface of the levator
Muller muscle is _______muscle innervated by ___________________
Smooth, sympathetic nervous system
Muller muscle is _______muscle innervated by ___________________
Smooth, sympathetic nervous system
Muller muscle attaches to the…
Upper border of the superior tarsus and conjunctiva in the superior fornix
Another name for Whitnall’s ligament
Superior transverse ligament
Superior transverse (Whitnall’s) ligament is a..
Fulcrum/sleeve that changes the anterioposterior direction of levator muscle to superioinferior
Whitnall’s ligament allows levator contraction to be in an ___________ vector, about ____ elevation
Upward, 15mm
Medial/lateral palpebral ligaments can also be called _________ligaments and are made of ______________________
Canthal, dense connective tissue
Function of medial/lateral palpebral ligaments
Connect tarsal plates to orbital margin
Functions specific to medial palpebral ligaments:
-acts as tendon for the orbicularis muscle
-anterior and posterior limbs that together with he pretarsal portion of orbicularis muscle change pressure dynamic of lacrimal sac for tear drainage
Posterior limb of medial palpebral ligament is adjacent to …
Deep pretarsal head (Horners muscle)
Anterior limb of medial palpebral ligament merges with…
Superficial pretarsal
Palpebral ligaments are attachments points for..
Tarsus and orbicularis
Check ligaments limit the…
The action of MR and LR
Muscles of retraction:
-capsulopalpebral fascia
-inferior tarsal muscle
Capsulopalpebral fascia is analogous to the _____________ and originates from attachments to ________________
Levator aponeurosis , inferior oblique muscle
Capsulopalpebral fascia encircles the inferior oblique muscle and fuses with…
It’s sheath
Capsulopalpebral fascia forms the________________anterior to inferior oblique
Lockwood suspensory ligament
Capsulopalpebral fascia extends anteriorly and connects to the:
-inferior fornix
-inferior tarsal border
-skin
Inferior tarsal muscle is analogous to…
Muller muscle
Inferior tarsal muscle runs behind the __________________ and extends into the inferior ______________________
Capsulopalpebral fascia, conjunctival fornix
Tarsal plates consist of what type of tissue?
Dense, fibrous connective tissue
Tarsal plates serve as the main __________________of the eyelids and are attached to the orbital rim by ______________________
Structural component, Medial/lateral canthal regions
Tarsal plates serve as the main __________________of the eyelids and are attached to the orbital rim by ______________________
Structural component, Medial/lateral canthal regions
Tarsal plates contain:
-eyelash follicles
-meibomain glands
Tarsal muscles are also called..
The muscle of muller
Tarsal muscle (or muscle of muller) is a ________ muscle and is under ______________ innervation with a function to________________________
Smooth, sympathetic, widen palpebral fissure (out of fear or surprise)
Superior tarsal muscle origin and insertion:
Origin: inferior aspect of levator
Insertion: superior tarsal plate edge
Inferior tarsal muscle origin and insertion:
Origin: capsulopalpebral fascia and fascial extensions of inferior EOMs that form Lockwood ligaments
Insertion: inferior tarsal plate edge
Suspensory ligament of lockwood:
A blending and extension of the inferior rectus and inferior oblique muscle fascial sheaths forming a hammock to support the globe inferiorly
What are the hammock supports for the suspensory ligament of Lockwood?
Medial and lateral check ligaments
Eyelid glands:
-Holocrine (sebaceous)
-apocrine
-merocrine (lacrimal)
Holocrine gland means that the..
Whole cell detached upon secretion
Holocrine glands in the eyelid:
-meibomian
-zeiss
Apocrine gland:
Th stop if the cell is lost upon secretion
Apocrine gland in eyelid:
-moll
Merocrine gland:
No part of the cell is lost with secretion
Merocrine glands in the eyelid:
-wolfring
-krause
Location of krause gland
Fornix (more UL than LL)
Location of Wolfring glands
Adjacent to edge (non-lid margin) of tarsus
*less in number than krause
Function of the two accessory lacrimal glands (krause and wolfring):
-autonomic regulation
-help secrete aqueous tear portion including antimicrobial peptides, lactoferrin, and immunoglobin
Meibomian glands are..
Large sebaceous Holocrine glands arranged vertically in tarsus that secrete sebum that forms lipid layer of tear film
Glands of moll:
Apocrine secretions of antimicrobial proteins onto the lid
Glands of zeiss
Lubricates eyelash shaft so cilia are not brittle (about 2 zeiss glands secrete into one cilia follicle)
External hordeolum
Acute infection of zeiss or moll gland
Internal hordeolum
Acute infection of meibomian glands
Chalazoin
Non-infectious swelling of an obstructed meibomian gland
Plica semilunaris
Folded bulbar conjunctive that slack during lateral eye movements
Caruncle is a mixture of:
Skin and conjunctiva
Punctum:
-opening for tears to go into nasolacrimal system
There is no cilia _______ to the punctum
Medial
Two main sources of blood tot he eyelids are from;:
Common carotid artery
There is collateral circulation and anastomoses in eyelid blood supply by:
Marginal and peripheral arteries
Superior eyelid blood support:
ICA-> ophthalmic artery -> supraorbital artery -> superior marginal arcade
Marginal arcade lies 2mm superior to _____ and _________ to tarsal plate
Lid, anterior
Superior peripheral arcade lies _______ to tarsus, between the _________________ and________________
Superior, levator aponeurosis and muller muscle
Inferior eyelid blood supply pathway:
ECA-> facial artery -> angular artery -> inferior marginal arcade
Inferior eyelid often only has 1…
Arterial arcade inferior to tarsal border
Venous drainage of the eyelid is not well defined but there are two plexuses and two veins involved:
-pretarsal and postarsal plexus
-external and internal jugular vein
What are you at risk for when directly injecting facial artery?
Skin necrosis, very rare, results from filler injection and can cause focal brain infarctions
Injections into vulnerable areas of the face can lead to neurological symptoms:
-hemiplegia
-dysarthria
-ophthalmoplegia
-ptosis
Two systems of lymphatic drainage of the eyeball:
Superficial and deep system
Superficial lymph system of the eyelid drains the:
Skin and orbicularis oculi
Deep lymph system of the eyelid drains:
Tarsi and conjunctiva
Preauricular lymph node and deep parotid lymph node drain the:
-Upper lid
-lateral 1/3 of lower lid
-lateral canthus
Submandibular lymph node drains:
-medial part of upper eyelid
-medial 2/3 of lower lid
-medial canthus
