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What are the primary functions of the eyelids?
What are the primary functions of the eyelids?
Eyelids protect the eyeball from injury, control light entry, and lubricate the eyeball with tears during blinking.
Describe the location and role of the gray line in eyelid anatomy.
Describe the location and role of the gray line in eyelid anatomy.
The gray line divides the eyelid margin into anterior and posterior parts, and it corresponds to the most superficial portion of the orbicularis oculi muscle.
How does the structure of the eyelashes contribute to protecting the eyes?
How does the structure of the eyelashes contribute to protecting the eyes?
Eyelashes heighten the protection of the eye by filtering dust and foreign debris.
What is the typical width of the normal adult interpalpebral fissure?
What is the typical width of the normal adult interpalpebral fissure?
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Explain the role of the orbicularis oculi muscle in eyelid function.
Explain the role of the orbicularis oculi muscle in eyelid function.
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What is the significance of Meibomian gland orifices in eyelid anatomy?
What is the significance of Meibomian gland orifices in eyelid anatomy?
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Identify two types of blinks and their nature.
Identify two types of blinks and their nature.
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What changes in the eyelid fissure can indicate thyroid disease?
What changes in the eyelid fissure can indicate thyroid disease?
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What is the effect of high sympathetic tone on the muscle controlling the palpebral fissure?
What is the effect of high sympathetic tone on the muscle controlling the palpebral fissure?
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How does the palpebral conjunctiva contribute to eye health?
How does the palpebral conjunctiva contribute to eye health?
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What role do sebaceous (meibomian) glands play in eyelid function?
What role do sebaceous (meibomian) glands play in eyelid function?
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Define the orbital septum and its significance in relation to the orbit.
Define the orbital septum and its significance in relation to the orbit.
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Explain the anatomical relationship between the septum and the eyelids.
Explain the anatomical relationship between the septum and the eyelids.
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What condition is described by baggy eyelids with indistinct lid creases in the elderly, and what is its treatment?
What condition is described by baggy eyelids with indistinct lid creases in the elderly, and what is its treatment?
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What happens to the orbital septum as people age, and what is the clinical significance of this change?
What happens to the orbital septum as people age, and what is the clinical significance of this change?
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What anatomical features can be found perforating the orbital septum?
What anatomical features can be found perforating the orbital septum?
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What are lacrimal puncti and their function?
What are lacrimal puncti and their function?
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How do the eyelids prevent debris from entering the eye?
How do the eyelids prevent debris from entering the eye?
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Describe the arterial supply of the eyelids.
Describe the arterial supply of the eyelids.
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Where does pretarsal venous drainage occur?
Where does pretarsal venous drainage occur?
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What is the route for lymphatic drainage of the medial eyelid?
What is the route for lymphatic drainage of the medial eyelid?
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Which nerve innervates the orbicularis oculi muscle?
Which nerve innervates the orbicularis oculi muscle?
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What is trichiasis?
What is trichiasis?
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What branches contribute to lymphatic drainage in the lateral eyelid?
What branches contribute to lymphatic drainage in the lateral eyelid?
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What distinguishes distichiasis from metaplastic lashes?
What distinguishes distichiasis from metaplastic lashes?
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What are the primary causes of both acquired and congenital ectropion?
What are the primary causes of both acquired and congenital ectropion?
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Explain the etiology of posterior blepharitis.
Explain the etiology of posterior blepharitis.
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Differentiate between neurogenic and developmental causes of blepharoptosis.
Differentiate between neurogenic and developmental causes of blepharoptosis.
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What is madarosis and how does it differ from poliosis?
What is madarosis and how does it differ from poliosis?
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What condition is characterized by a detachment of the levator muscle from the upper border of the tarsus despite good levator function?
What condition is characterized by a detachment of the levator muscle from the upper border of the tarsus despite good levator function?
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Describe the appearance of epicanthal folds and how they may affect visual perception.
Describe the appearance of epicanthal folds and how they may affect visual perception.
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What distinguishes telecanthus from hypertelorism in relation to eye anatomy?
What distinguishes telecanthus from hypertelorism in relation to eye anatomy?
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What are some myogenic conditions associated with ptosis?
What are some myogenic conditions associated with ptosis?
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Explain the significance of coloboma in relation to eyelid anatomy.
Explain the significance of coloboma in relation to eyelid anatomy.
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What is the average rate of spontaneous blinking?
What is the average rate of spontaneous blinking?
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What conditions can increase the blink rate?
What conditions can increase the blink rate?
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What do tarsal plates contribute to the eyelids?
What do tarsal plates contribute to the eyelids?
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How many Meibomian glands are present in the upper and lower tarsal plates?
How many Meibomian glands are present in the upper and lower tarsal plates?
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What is the function of the tarsal muscle (Muller muscle)?
What is the function of the tarsal muscle (Muller muscle)?
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At what age does spontaneous blinking begin to occur in infants?
At what age does spontaneous blinking begin to occur in infants?
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What is the height of the upper and lower tarsus?
What is the height of the upper and lower tarsus?
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What type of muscle is the tarsal (Muller) muscle?
What type of muscle is the tarsal (Muller) muscle?
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What anatomical feature separates the eyelids from the contents of the orbit?
What anatomical feature separates the eyelids from the contents of the orbit?
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What is the role of sebaceous glands in the eyelid?
What is the role of sebaceous glands in the eyelid?
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What condition is characterized by baggy eyelids in the elderly?
What condition is characterized by baggy eyelids in the elderly?
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How does high sympathetic tone affect the muscle controlling the palpebral fissure?
How does high sympathetic tone affect the muscle controlling the palpebral fissure?
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What happens to the orbital septum as people age?
What happens to the orbital septum as people age?
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What structural components maintain the connection of the orbital septum to the eyelids?
What structural components maintain the connection of the orbital septum to the eyelids?
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What function does the palpebral conjunctiva serve during blinking?
What function does the palpebral conjunctiva serve during blinking?
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Why is the orbital septum considered an important anatomical barrier?
Why is the orbital septum considered an important anatomical barrier?
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What condition involves the complete loss of eyelashes?
What condition involves the complete loss of eyelashes?
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What is the main feature distinguishing distichiasis from normal eyelash growth?
What is the main feature distinguishing distichiasis from normal eyelash growth?
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What are the two main types of entropion?
What are the two main types of entropion?
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What causes posterior blepharitis?
What causes posterior blepharitis?
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What features are associated with ectropion?
What features are associated with ectropion?
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What are the two main systems supplying blood to the eyelids?
What are the two main systems supplying blood to the eyelids?
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What is the function of the lacrimal puncti in the eyelids?
What is the function of the lacrimal puncti in the eyelids?
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Which nerve innervates the levator palpebrae superioris muscle?
Which nerve innervates the levator palpebrae superioris muscle?
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What is trichiasis and how does it affect the eye?
What is trichiasis and how does it affect the eye?
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How is venous drainage categorized in the eyelids?
How is venous drainage categorized in the eyelids?
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Where do lymphatic vessels from the medial side of the eyelid drain?
Where do lymphatic vessels from the medial side of the eyelid drain?
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What is the role of eyelashes in relation to the eyes?
What is the role of eyelashes in relation to the eyes?
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What is the primary function of the orbicularis oculi muscle?
What is the primary function of the orbicularis oculi muscle?
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What condition can result from a lower lid coloboma and is frequently associated with systemic anomalies?
What condition can result from a lower lid coloboma and is frequently associated with systemic anomalies?
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What is the most common age for capillary hemangioma to present, and what is its typical course?
What is the most common age for capillary hemangioma to present, and what is its typical course?
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What is a characteristic feature of keratoacanthoma and who is more likely to develop it?
What is a characteristic feature of keratoacanthoma and who is more likely to develop it?
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What is the most common type of skin cancer, where does it typically occur, and is it metastasizing?
What is the most common type of skin cancer, where does it typically occur, and is it metastasizing?
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What are the three main clinical types of squamous cell carcinoma of the eyelid?
What are the three main clinical types of squamous cell carcinoma of the eyelid?
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Study Notes
Eyelid Anatomy
- The eyelids are a protective layer of skin and soft tissue that cover the eyeball.
- They protect from injury, regulate light entering the eye, and lubricate the eyeball with tears.
- They have the thinnest skin in the body, excluding the prepuce and labia minora.
- Eyelashes help protect the eye from dust, foreign debris, and perspiration.
- The gray line divides the eyelid margin into anterior and posterior portions.
- The interpalpebral fissure is the exposed area between upper and lower eyelids.
- The normal adult fissure width is 8-11 mm and 27-30 mm long.
Muscles
- Orbicularis oculi muscle is a circular striated muscle with concentric bands around the fissure.
- Orbital portion (voluntary) acts as a sphincter for forceful lid closure.
- Palpebral (preseptal & pretarsal) acts voluntarily and involuntarily for normal and reflex blinking.
- Its fibers run around the eye within the eyelid, contraction leads to eye closure.
- The lid fold (crease) is near the upper border of the tarsus where the levator aponeurosis inserts.
- The gray line corresponds to the most superficial portion of the orbicularis oculi muscle.
- Blinking is voluntary and involuntary, with an average rate of 6 per minute.
- Involuntary blinks include spontaneous and reflex blinks.
- Increased sympathetic tone contracts the orbicularis oculi muscle, widening the palpebral fissure.
- Decreased sympathetic tone relaxes the muscle and narrows the palpebral fissure.
Palpebral Conjunctiva
- Firmly attached to the tarsal plate.
- Acts like a windshield wiper during blinking, distributing glandular secretions and tears.
Sebaceous glands (meibomian)
- Tubular structures in the cartilage of the eyelid (tarsal plates).
- Lubricate the margin of the eyelid.
- Prevent the escape of tear fluid.
Orbital Septum
- A fibrous membranous sheet of connective tissue that retains orbital fat.
- The anterior boundary of the orbit.
- Located between the tarsal plate and orbital margin.
- Extends from orbital margin to the eyelids.
- Medially attaches to the lacrimal bone.
- Separates eyelids from the contents of the orbital cavity.
- Stronger on the lateral side than the medial.
Structures and Adnexa of the Eylids
- Lacrimal puncti are tiny openings in both eyelids, located in free margins.
- Eyelids meet at the angles (canthi).
- Hair in the free ends (eyelashes/cilia) are arranged in irregular rows, extending from the anterior margin.
- The upper eyelid has 150 eyelashes in 3-4 rows, while the lower eyelid has 75 in two rows.
- Eyelashes prevent dust and sweat from entering the eye.
Arterial Supply
- A network of vessels derived from the internal and external carotid arteries vascularize the eyelids.
- There is collateralization between internal and external systems, contributing to rapid wound healing and low infection rates after surgery.
- Branches of the ophthalmic artery (internal carotid) and facial arteries (external caratoid) form the marginal and peripheral vascular arcades of the eyelids.
Venous Drainage
- Divided into pretarsal and postarsal.
- Pretarsal drains into the angular vein medially and superficial temporal vein laterally.
- Postarsal drainage is into orbital veins and cavernous sinus.
Lymphatic Drainage
- Lymphatic vessels on the medial side drain to the submandibular lymph nodes.
- Lymphatic vessels on the lateral side drain into the preauricular deep cervical lymph nodes.
Nerves
-
Motor Nerves
- Facial nerve innervates the orbicularis oculi muscle.
- Oculomotor nerve innervates the levator palpebrae superioris muscle.
-
Sensory Nerves
- Derived from V1 and V2.
- Supraorbital, supratrochlear, infratrochlear, lacrimal, infraorbital nerves provide sensation.
-
Sympathetic Nerves
- Innervate Muller’s muscle, which initiates lid opening.
Disorders of the Eyelashes
- Trichiasis - Misdirection of eyelashes from their normal site, causing them to rub against the cornea.
- Metaplastic Lashes - Eyelashes originating from meibomian gland orifices.
- Distichiasis - Partial or complete second row of lashes arising from or behind the meibomian gland orifices.
- Madarosis - Decrease in number or complete loss of lashes.
- Poliosis - Premature whitening of eyelashes, sometimes involving eyebrows.
Blepharitis
- A common, bilateral, symmetrical condition.
- Anterior form usually results from staphylococcal infection in seborrheic patients.
- Posterior form is associated with meibomian gland dysfunction.
- Ocular rosacea, or blepharitis associated with rosacea of the face, is a common form.
Entropion
- Inversion of the eyelid margin.
- Types: acquired and congenital.
- Acquired entropion can result from aging (involutional) or scarring (cicatricial) of the eyelid.
Ectropion
- Eversion of the eyelid margin.
- Types: congenital and acquired.
- Acquired forms can result from aging (involutional), mechanical causes (tumors), scarring (cicatricial), or weakness of the orbicularis muscle (paralytic).
Blepharoptosis
- Abnormally low position (drooping) of the upper eyelid.
- Types: neurogenic, developmental, and myogenic.
- Neurogenic - Third nerve palsy, Horner’s syndrome, Marcus Gunn jaw-winking syndrome, third nerve misdirection.
- Developmental - Congenital ptosis caused by dystrophy of the levator muscle.
- Myogenic - Myasthenia Gravis, myotonic dystrophy, ocular myopathy, simple congenital blepharophimosis syndrome.
Epicanthal Folds
- Common, bilateral vertical skin folds that overhang from the upper or lower lid towards the medial canthus.
- May cause a pseudo-esotropia (apparent inward turning of the eye).
Telecanthus
- Uncommon condition with increased distance between the medial canthi due to abnormally long medial tendons.
- Not to be confused with hypertelorism (wide separation of the orbits).
Coloboma
- Uncommon congenital partial or full-thickness eyelid defect.
Spontaneous Blinking
- A common form of blinking that occurs without any obvious external stimulus
- Very infrequent during the first few months of life
- Average rate: 15 times/minute
- Increased blink rate is associated with:
- Extremely dry conditions
- Strong air currents
- Certain emotional stress situations (surprise, anger, or fight)
- Decreased blink rate occurs during times of visual observations
Eyelid Structure
-
Tarsal Plates:
- Two plates of dense fibrous connective tissue, one for each lid
- Form the skeleton of eyelids
- Give shape and firmness to the lids
- Upper Tarsus: 10mm in height
- Lower Tarsus: 5mm in height
- Tarsal plates have rigid attachments to periosteum via canthal tendons
-
Meibomian Glands:
- Distributed in the tarsal plates in a parallel pattern
- Aligned vertically
- Secrete oil and lubricate the margin of the eyelid
- Prevent the escape of tear fluid
Eyelid Smooth Musculature
-
Muller's Muscle:
- Smooth, nonstriated muscle
- Originates from just under the levator muscle in the upper lid and from the capsulopalpebral head of the inferior rectus in the lower lid
- Inserts into the tarsal plates
- Supplied by the sympathetic nervous system
- Regulates the width of the palpebral fissure
- High sympathetic tone contracts the muscle and widens the palpebral fissure
- Low sympathetic tone relaxes the muscle and narrows the palpebral fissure
Palpebral Conjunctiva
- Firmly attached to the tarsal plate
- Acts like a windshield wiper during blinking
- Uniformly distributes glandular secretions and tears over the conjunctiva and cornea
Orbital Septum
- Fibrous membranous sheet of connective tissue that retains the orbital fat
- Anterior boundary of the orbit
- Located between the tarsal plate and orbital margin
- Extends from the orbital margin to the eyelids
- Medially attaches to the lacrimal bone (posterior crest)
- Separates the eyelids from the contents of the orbital cavity
- Stronger on the lateral side than medial
Structures & Adnexa of the Eyelids
- Lacrimal Puncti: Two tiny openings in both eyelids, located in the free margins
- Canthi: The angles where both eyelids meet
-
Eyelashes (Cilia): Hair in the free ends of the eyelids
- Arranged in irregular rows
- Project from the anterior aspect of the margin
- Upper eyelid: 150 eyelashes in 3-4 rows
- Lower eyelid: 75 in two rows
- Function of Eyelashes: Prevent dust and sweat from entering the eye
Eyelid Arterial Supply
- Network of vessels derived from the internal and external carotid arteries
- Richly vascularizes the eyelids
- Collateralization between the internal and external systems contributes to rapid wound healing and low incidence of infection following eyelid surgery.
- Branches of the ophthalmic artery (internal carotid artery) and branches of the facial arteries (maxillary branch of the external carotid artery) form the marginal and peripheral vascular arcades of the eyelids
Eyelid Venous Drainage
- Divided into pretarsal and postarsal drainage systems
- Pretarsal: Drains into the angular vein medially and superficial temporal vein laterally
- Postarsal: Drains into the orbital veins and cavernous sinus
Eyelid Lymphatic Drainage
- Lymphatic vessels serving the medial side of the eyelid drain to the submandibular lymph nodes
- Lymphatic vessels serving the lateral portions of the eyelids drain into the preauricular deep cervical lymph nodes
Eyelid Nerves
-
Motor Nerves:
- Facial Nerve: Innervates the orbicularis oculi muscle (lid closer)
- Oculomotor nerve: Innervates the levator palpebrae superioris muscle (lid opener)
-
Sensory Nerves:
- Derived from V1 and V2 (trigeminal nerve): Supraorbital, supratrochlear, infratrochlear, lacrimal, infraorbital nerves
- Sympathetic Nerves: Innervate Muller's muscle
Disorders of the Eyelashes
-
Trichiasis: Posterior misdirection of eyelashes from their normal sites of origin
- Metaplastic lashes: originate from the meibomian gland orifices
- Distichiasis: Partial or complete second row of lashes arises from or behind the meibomian gland orifices.
- Madarosis: Decrease in number or complete loss of eyelashes
- Poliosis: Premature whitening of lashes, sometimes involving eyebrows
Blepharitis
- Common bilateral symmetrical condition
- Anterior Blepharitis: Usually caused by staphylococcal infection in seborrheic patients
- Posterior Blepharitis: Associated with meibomian gland dysfunction (ocular rosacea)
Entropion
- Inversion of the eyelid margin
-
Types: Acquired and congenital
- Acquired: Result of aging changes (involutional entropion), cicatricial changes (cicatricial entropion)
Ectropion
- Eversion of the eyelid margin
-
Types: Congenital and acquired
- Acquired: Result of aging changes (involutional ectropion), mechanical reasons (caused by tumors), scarring of the anterior lamella (cicatricial ectropion), or weakness of the orbicularis muscle (paralytic ectropion)
Blepharoptosis
- Abnormally low position (drooping) of the upper eyelid
-
Types:
-
Neurogenic:
- Third nerve palsy
- Horner syndrome
- Marcus Gunn jaw-winking syndrome
- Third nerve misdirection
- Developmental: Congenital ptosis caused by a developmental dystrophy of the levator muscle, upper lid coloboma is not associated with systemic anomalies, lower lid coloboma is frequently associated with systemic anomalies such as Treacher Collins Syndrome
-
Neurogenic:
Sturge-Weber Syndrome / Port-wine Hemangioma
- Unilateral, red, raised lesion
- Most common during the first year of life
- Resolves spontaneously by the age 4-7
- Steroid injections can be given for vision-threatening cases
Pyogenic Granuloma
- Fast-growing granulomaous hemangioma
- Usually occurs after surgery or trauma
Keratoacanthoma
- Uncommon, benign, but rapidly growing tumor
- Most common in immunosuppressive patients
Basal Cell Carcinoma
- Most common human malignancy
- 90% of cases occur in the head and neck, 10% involve the eyelid
- Slow growing, locally invasive, but non-metastasizing
Squamous Cell Carcinoma
- 5-10% of eyelid malignancies
- Potentially more aggressive than basal cell carcinoma
-
Types:
- Plaque-like
- Nodular
- Ulcerating
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Description
Test your knowledge on the anatomy and function of eyelids, including their protective role and muscular structure. This quiz covers the essential features and details about the eyelids and the muscles that control them. Perfect for anyone studying anatomy or ophthalmology.