ORBIT & OCULAR ADNEXAE - Eyelids

Question 1

What is the grey line of the eyelid? What does it divide?

Answer 1

Gray line divides the eyelid margin into the anterior lamina and posterior lamina

Question 2

What is the difference between the gland of zeiss and the gland of moll in terms of
1. Location
2. Lobularity
3. Function

Answer 2

1. Zeiss : margin of the eyelid,
   Moll: between cilia (eyelash) and anterior lid margin
2. Zeiss: unilobular
   Moll: unbranched spiral shape
3. Zeiss: modified sebaceous gland that produces sebum to prevent eyelashes from becoming dry and brittle
   Moll: apocrine sweat gland

Question 3

What is the horizontal and vertical measurement of the palpebral fissure?

Answer 3

horizontal - 30mm
vertical - 9-11mm

Question 4

What is a mongoloid slant? Which strabismus pattern does it exhibit

Answer 4

Elevation of lateral canthus > 2mm
Pseudo A pattern strabismus

Question 5

What conditions have mongoloid slant?

Answer 5

Down’s syndrome
Noonan’s syndrome

Question 6

What conditions have Anti-mongoloid slant? What strabismus pattern?

Answer 6

Treacher collin syndrome
Coffin lowry syndrome
Zygomatic maxillary complex fracture
Pseudo V pattern strabismus

Question 7

What are the 7 layers of the eyelid from outside to inside?

Answer 7

1. Skin - v thin loosely adhered to muscle
2. Subcutaneous areolar tissue - only fat
3. Striated muscle layer (orbicularis + LPS)
4. Submuscular areolar tissue
5. Fibrous layer (tarsal plate and orbital septum
6. Non-striated muscle layer - Muller’s muscle
7. Conjunctiva

Question 8

What are the two parts of the orbicularis muscle? What is their function?

Answer 8

1. Orbital part - forced closure of eyelid
2. Palpebral part - gentle closure of eyelid

Question 10

Which layer consists of the nerves and vessels of the eyelid? What does this layer connect with?

Answer 10

Submuscular areolar tissue

Communicates with striatum of scalp - dangerous area of scalp and can act as communication for pus/blood between two areas

Question 11

What is the tarsal plate?

Answer 11

Dense fibrous tissue of the eyelid giving strength and firmness, has meibomian glands embedded within it

Question 12

What is the upper and lower tarsal height?

Answer 12

Upper : 10mm
Lower: 4-5mm

Question 13

How many meibomian glands are there?

Answer 13

20-30 on each lid

Question 14

What do meibomian glands produce?

Answer 14

Sebaceous glands (like Zeiss glands) Produce lipids (meibum) that forms the outer layer of tear film to stop evaporation

Question 15

What is attached to the superior tarsal border? (2)
What structure is attached below the superior tarsal border?

Answer 15

1.Orbital septum and muller’s muscle
2. LPS aponeurosis attaches 3-4mm below,

Question 16

What is attached to the inferior tarsal border? (3)

Answer 16

Orbital septum
capsulopalpebral fascia
inferior palpebral/tarsal muscle (lockwood ligament) which connects to the inferior rectus

Question 17

What are the lateral ends of the tarsus attached to?
What are the medial ends of the tarsus attached to?

Answer 17

Lateral: whitnal tubercle by lateral palpebral ligament
Medial: attach to anterior lacrimal crest and frontal process of maxillla by medial palpebral ligament

Question 18

What is the muller’s muscle and inferior palpebral muscle supplied by?

Answer 18

sympathetic nerve fibres – irritation leads to retraction of lids –> paralysis leads to horner’s syndrome