Anatomy of Eyelid

1. Anatomy of Eyelid
Tanat Tabtieang, MD
Fellowship of Royal College of Radiologists ofThailand
Diploma of theThai Board of Diagnostic Radiology
Lecturer, Department of Anatomy
Faculty of Medicine, Chulalongkorn University

2. Contents
• Surface anatomy
• Skin and subcutaneous tissue
• Orbicularis oculi muscle
• Submuscular areolar tissue
• Tarsi and orbital septum
• Retractors and post septal fat pads
• Fat pads
• Conjunctiva
• Nerves, vessles and lymphatics

3. Eyelids
• Movable folds covering the eyeball anteriorly
• Protecting injury and excessive light, keeping cornea moist

4. Surface anatomy
• Superior eye lid crease (superior palpebral sulcus)
– Attachment of superficial insertion of levator aponeurotic fibers
• Inferior eye lid crease (inferior palpebral sulcus)
• Nasojugal fold
– From medial canthal region along depression of separation of
orbicularis oculi and levator labii superioris
• Malar fold
– Groove in the skin that extends downward and medially from the
lateral canthus.
• Lateral canthus
• Madial canthus

7. Skin and subcutaneous tissue
• Thinnest of the body
– Very elastic and recovers rapidly after being distended by fluids
• Nasal part: finer hairs, more sebaceous gland
• Sparse fat in preseptal and preorbital skin, Absent fat in
pretarsal skin
– Easily be lifted by effusion with blood
• Absent subcutaneous tissue over medial and lateral palpebral
ligaments

8. Eyelashes
• Anterior border of margin of the eyelid
• Found in the lateral part of the lid margin
• Punctum: at the junction of the ciliary and nonciliary parts of
the lid margin

9. Glands of eyelid
Glands of Moll
• 1–2 mm long
• Simple spiral, modified sweat glands
• Obliquely in contact with and parallel to the bulbs of the cilia.
• Duct passes through the dermis and epidermis
• Terminate separately between two lashes or may open into the
duct of a sebaceous gland of Zeis.
Sebaceous glands of Zeis
• Modified sebaceous glands
• Attached directly to the follicles of the eyelashes
• Stye: suppurative inflammation of the Zeis gland

11. Orbicularis oculi muscle
• Muscle of facial expression
• Superficial musculoaponeurotic system
• Orbital part: forced eye closure
• Palpebral part: blinking and voluntary winking
superficial to the tarsi, deep to the skin
– Preseptal portion
– Pretarsal portion

13. Orbicularis oculi muscle
Orbital portion
• Around the orbit
• Origin: medial orbital margin
• Insertion:
– Superomedial orbital margin
– Maxillary process of frontal bone
– Medial palpebral ligament
– Frontal process of maxilla
– Inferomedial orbital margin
• Extending and intermixing with
other facial muscles

14. Orbicularis oculi muscle
Preseptal portion
• Overlie orbital septum
• Origin: superficial and deep head at medial palpebral
ligament
• Insertion: joining laterally forming lateral palpebral raphe

15. Orbicularis oculi muscle
Pretarsal portion
• Anterior to tarsus
• Origin: superficial and deep heads at medial palpebral
ligament
• Insertion: deep to lateral palpebral raphe, insert into lateral
orbital tubercle through lateral canthal tendon

18. Submuscular areolar tissue
• Loose connective tissue between
the orbicularis oculi and the tarsal
plate
• Splitting anterior and posterior
portion
• Main nerves lies in this tissue
• Upper lid: traversed by fibers of
levator aponeurosis
– Attach to skin forming lid crease
• Superior continuing at retro-
orbicularis oculi fat (ROOF)
• Lower lid: traversed by fibers of
orbitomalar ligament

20. Tarsal plate
• Dense fibrous tissue: “skeleton” of the eyelid
– Crescentic superior tarsus
– Rectangular inferior tarsus
• Posterior surface adhering conjunctiva
• About 25 Meibomian glands: lipid secretion
– Run from attached margin of tarsal to their free margins
– Vertically, parallel with each other, at a right angle to the lid margin
– Open at just anterior to posterior lid margin, posterior to gray line,
anterior to mucocutaneous junction
• Medial and lateral ends attaching to orbital rim by
medial and lateral palpebral ligaments

23. Medial canthal tendon
• Triangular band
• Connecting tarsi to medial margin of orbit, stabilizing medial tarsi
• Attached to the frontal process of the maxilla from the anterior
lacrimal crest to near its suture with the nasal bone
• Upper border: adherent to and continuous with the periosteum
• Anterior portion
– Continued at the medial canthus and divided into two bands, passing
across the lacrimal fossa
• Posterior portion
– Continuous with the lacrimal fascia
– Helps to place a roof over the upper part of lacrimal sac.

25. Medial canthal ligament
• Superficial head of pretarsal orbicularis oculi lies anterior to
canaliculi, forming anterior limb of MCT
• Deep head of pretarsal orbicularis oculi inserts into posterior
lacrimal crest and fascia of lacrimal sac
• Superficial head of preseptal orbicularis oculi inserting into
and augmenting MCT
• Deep head of preseptal orbicularis oculi inserting into
lacrimal sac fascia

28. Lateral canthal tendon
• Attach tarsi to lateral margin of orbit
– Not provide direct muscle attachment
• Dense fibrous connective tissue from tarsi
– Passing laterally deep to orbital septum
– Inserting into lateral orbital tubercle (Whitnall’s tubercle) on the
zygomatic bone
– Upper border continuous with lateral horn of levator aponeurosis
– Lower border continuous with the expansion from the inferior oblique
and inferior rectus muscles
• Eisler fat pocket
– Between orbital septum and LCT

30. Orbital septum (septum orbitale)
• Connective tissue span from tarsi to superior margin of orbit
(arcus marginalis), continuous with periosteum of orbital rim
• Thicker and stronger on lateral side and in the upper lid
• On the lateral side: superficial, anterior to the lateral
palpebral ligament
• On the medial side: deeper, behind the lacrimal part of
orbicularis
• Fuse with lid retractor structures at midline
• Septal extension
– From line of fusion with levator aponeurosis extending to cover tarsal
plate up to ciliary margin
– Adjunct to levator aponeurosis

32. Upper eyelid retractors
• Levator palpebrae superioris
• Müller muscle

33. Levator palpebrae superioris
• Origin: orbital apex, from undersurface of lesser wing of
sphenoid bone
• Whitnall (superior transverse) ligament
– Primary suspensory ligament support upper lid
– Near junction of muscular and aponeurotic levator
– Spanning the anterosuperior orbit between trochlea and lacrimal
gland fascia
– Passes between orbital and palpebral lobes of lacrimal gland

34. Levator palpebrae superioris
• Insertion
– Medial horn attaching to posterior lacrimal crest
– Lateral horn divide lacrimal gland into orbital and palpebral lobes,
attaching lateral retinaculum at lateral orbital tubercle
– Fusion with orbital septum before reaching level of superior tarsal
plate border
– Some aponeurotic fiber descend to insert into lower 1/3 of anterior
surface of tarsal plate

36. Müller muscle
• Smooth muscle, sympathetic
nervous system
• Origin: undersurface of levator, at
aponeurosis-muscle junction
• Travel between levator
aponeurosis and conjunctiva
• Insertion: superior margin of tarsus
• Vascular arcade adhering to lower
border of anterior surface
• Action: widen palpebral fissure
with increased sympathetic tone

37. Lower eyelid retractor
• Fascial extension from inferior rectus muscle and tendon, as
capsulopalpebral head
• Lockwood (inferior transverse) fascia
– Thickened lower part ofTenon capsule
– Serves as suspensory ligament for globe
– Blends with lateral canthus and lateral check ligament laterally and
attaches to lacrimal crest medially
• Capsulopalpebral fascia
– Insert on inferior border of inferior tarsus
– Pass forward to unite withTenon’s capsule and inferior fornix
conjunctiva, to subcutaneous tissue forming lower eyelid crease
– Fusion with orbital septum below inferior tarsal border

39. Fat pads
• Upper eyelid fat pads
– Immediately posterior to orbital septum
– Anterior to levator aponeurosis
– Medial and central fat pads (Lacrimal gland occupies lateral
compartment)
• Lower eyelid fat pads
– Medial, central and lateral fat pads
– Inferior oblique separates medial and central fat pads

41. Conjunctiva
• Smooth translucent mucous membrane
• Palpebral conjunctiva
– Lies posterior surface of eyelid
– Reflect onto the eyeball, continuous with bulbar conjunctiva
• Conjunctival sac
– Space bound by palpebral and
bulbar conjunctivae

42. Nerve supplies
Sensory innervation
• Frontal branch of CNV1
– Between periorbita of retro-orbicularis oculi fat and levator palpebrae
superioris
– Sensation of upper eyelid and forehead
– Divides into supraorbital nerve and supratrochlear nerve
• Supraorbital nerve: through supraorbital notch
• Supratrochlear nerve: exits just lateral to origin of corrugator supercilii
• Lacrimal nerve of CNV1
– Between lateral rectus and periorbita
– Lacrimal gland, lateral part of upper lid, lateral forehead, lateral
canthus

46. Nerve supplies
Sensory innervation
• Infratrochlear nerve
– Terminal branch of nasociliary nerve (CNV1)
– Sensation of skin and conjunctiva of medial canthus and nasolacrimal
sac
• Infraorbital nerve (CNV2)
– Through infraorbital foramen
– Palpebral branch supplies central lower eyelid skin and conjunctiva
• Zygomaticofacial nerve (CNV2)
– Supplies skin to the lateral lower lid

48. Nerve supplies
Motor innervation
• Orbicularis oculi muscle
– Frontal and zygomatic branches of CNVII
• Levator palpebrae superioris
– Superior branch of CN III
• Müller muscle
– Postganglionic sympathetic fiber from superior cervical ganglion
– Travels in carvenous sinus and superior orbital fissure via cranial nerve
branches

50. Vascular supplies
Internal carotid artery
• Medial:Terminal branches of ophthalmic artery
– Two medial palpebral arteries: superior & inferior marginal vessels
• Inferior marginal vessels: branch of superior marginal vessels, deep to
MCT
– Forming marginal arcades: lie on anterior tarsal surface
– Upper lid: Superior marginal arcade from superior marginal arcade
• Lateral: Lacrimal artery
– Two lateral palpebral arteries: superior and inferior marginal arteries

53. Vascular supplies
External carotid artery
• Facial artery:Angular artery
– Passes to medial canthal region
– Anastomosis with dorsal nasal artery
• Superficial temporal artery
– Supplies eyelid anastomosis via transverse facial and zygomatic
branches
• Infraorbital artery
– Exits infraorbital foramen
– Anastomosis with vessels of lower eyelid

55. Lymphatic drainage
• Preauricular lymph node
– Most of upper eyelid
– Lateral half of lower lid
• Submandibular node
– Medial portion of upper lid
– Medial half of lower lid

56. Thank you for your attention