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The EyelidsThe EyelidsDR. NAILA ALIDR. NAILA ALI
ASSISTANT PROFESSOR ASSISTANT PROFESSOROPHTHALMOLOGYOPHTHALMOLOGY
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S+RFA,E ANATOMYS+RFA,E ANATOMY
S$%eriorS$%eriorPal%ebral S$l"$sPal%ebral S$l"$s
La#eral ,ah$sLa#eral ,ah$s
Medial ,ah$sMedial ,ah$s
Pal%ebral Fiss$rePal%ebral Fiss$re
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ON THE MEDIAL SIDEON THE MEDIAL SIDE
La"$s la"rimalisLa"$s la"rimalis,ar$&"$la la"rimalis,ar$&"$la la"rimalisPli"a semil$&arisPli"a semil$&aris
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THE STRUCTURETHE STRUCTURE
The mar'i& o ea"h eyelid isThe mar'i& o ea"h eyelid is -mm #hi" a&d /0mm lo&'-mm #hi" a&d /0mm lo& 'I# "oai&sI# "oai&seyelashese yelashes a&d ($s# %os#erior #o i# are #hea&d ($s# %os#erior #o i# are #he meibomia&meibomia&
'la&ds ori i"es'la&ds ori i"es ..The tissues of the lids from anterior (cutancous) to posteriorThe tissues of the lids from anterior (cutancous) to posterior
conjunctival aspects as followsconjunctival aspects as follows 1212s i&s i&s$b"$#a&eo$s areolar #iss$es$b"$#a&eo$s areolar #iss$e
layer o s#ria#ed m$s"le 3orbi"$laris o"$li4layer o s#ria#ed m$s"le 3orbi"$laris o"$li4s$b m$s"$lar areolar #iss$es$b m$s"$lar areolar #iss$elayer o &o& s#ria#ed m$s"lelayer o &o& s#ria#ed m$s"le#he ibro$s layer5i&"l$di&' #arsal %la#e#he ibro$s layer5i&"l$di&' #arsal %la#e
"o&($&"#iva"o&($&"#iva
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THE SKINTHE SKINI# is #hi&&es# a&d mar ed byI# is #hi&&es# a&d mar ed bys$l"i.s$l"i.The s$%erior s$l"i is d$e #oThe s$%erior s$l"i is d$e #oa%o&e$rosis o levalora%o&e$rosis o levalor
%al%ebrae s$%erior i&ser#ed%al%ebrae s$%erior i&ser#edio #he s i&.io #he s i&.The less obvio$s lo!er s$l"iThe less obvio$s lo!er s$l"iis d$e #o #he s i& bei&'is d$e #o #he s i& bei&'#e#hered #o #he $&derlyi&'#e#hered #o #he $&derlyi&'%erios#e$m.%erios#e$m.His#olo'i"ally i# "o&sis# oHis#olo'i"ally i# "o&sis# oe%idermis6 seba"eo$s a&de%idermis6 seba"eo$s a&ds!ea# 'la&d a&ds!ea# 'la&d a&dmela&o"y#es.mela&o"y#es.
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EYE LASHESEYE LASHES
700 i& $%%er lid700 i& $%%er lid80 i& lo!er lid80 i& lo!er lid
Ori'i&a#e rom aerior lamella i& #!o orOri'i&a#e rom aerior lamella i& #!o or#hree irre'$lar ro!s.#hree irre'$lar ro!s.The $%%er lid lashes are dire"#ed $%!ard6The $%%er lid lashes are dire"#ed $%!ard6
a&d o$#!ardsa&d o$#!ardsThe lo!er lid lashed are dire"#ed do!&!ardThe lo!er lid lashed are dire"#ed do!&!arda&d o$#!ardsa&d o$#!ards
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THE SU CUTANEOUS AREOLARTHE SU CUTANEOUS AREOLAR
TISSUETISSUE
I# is a loose "o&&e"#ive #iss$e "oai&i&'I# is a loose "o&&e"#ive #iss$e "oai&i&'
&o a#.&o a#.I# is abse a# medial a&d la#eral a&'les6I# is abse a# medial a&d la#eral a&'les6"iliary mar'i& a&d a# s$l"i."iliary mar'i& a&d a# s$l"i.
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THE ORI ICULARIS OCULITHE ORI ICULARIS OCULI
Par#Par# Posi#io&Posi#io& F$&"#io&F$&"#io&
Orbi#alOrbi#al S$rro$&ds #he orbi#alS$rro$&ds #he orbi#al For"ed lid "los$reFor"ed lid "los$rerimrim
Prese%#alPrese%#al I& ro o #he orbi#alI& ro o #he orbi#al %$ll la"rimal as"ia%$ll la"rimal as"iaSe%#$mSe%#$m la#erally a&dla#erally a&d"rea#e a rela#ive"rea#e a rela#iveva"$$m i& la"rimalva"$$m i& la"rimalsa".sa".
Pre#arsalPre#arsal i& ro o #he #arsali& ro o #he #arsal ,lose lid a&d %$ll,lose lid a&d %$llPla#ePla#e la"rimal %$&"#ala"rimal %$&"#a
mediallymedially
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THE !I ROUS LA"ER###OR ITALTHE !I ROUS LA"ER###OR ITALSE$TUM AND TARSAL $LATESE$TUM AND TARSAL $LATE
A##a"hed #o #he orbi#al A##a"hed #o #he orbi#almar'i&.mar'i&.Lies %os# #o #he medialLies %os# #o #he medial
%al%ebral li'ame a&d%al%ebral li'ame a&dla#eral %al%ebral ra%hela#eral %al%ebral ra%hemedially a&d la#erally.medially a&d la#erally.9i#h i& #he lids i# is9i#h i& #he lids i# is
#hi" e&ed #o orm #arsal#hi" e&ed #o orm #arsal%la#es5embedded i& i#%la#es5embedded i& i#are #arsal 'la&ds.are #arsal 'la&ds.
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THE LI%AMENTSTHE LI%AMENTS
The medial %al%ebral li'ame a##a"hes #heThe medial %al%ebral li'ame a##a"hes #he
medial e&d o #arsi #o la"rimal "res# a&dmedial e&d o #arsi #o la"rimal "res# a&droal %ro"ess o ma)illa.roal %ro"ess o ma)illa.The la#eral %al%ebral li'ame a##a"h #heThe la#eral %al%ebral li'ame a##a"h #he
la#eral e&d o #arsi #o mar'i& #$ber"le o&la#eral e&d o #arsi #o mar'i& #$ber"le o&mar'i&al #$ber"le o :y'oma#i" bo&e.mar'i&al #$ber"le o :y'oma#i" bo&e.
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CON'UNCTI&ACON'UNCTI&A
Thi& m$"o$s membra&e li&ed by &o&Thi& m$"o$s membra&e li&ed by &o&
era#i&i:ed s#ra#i ied s;$amo$s e%i#heli$m.era#i&i:ed s#ra#i ied s;$amo$s e%i#heli$m.I# has a ri"hly vas"$lari:ed S$bs#aiaI# has a ri"hly vas"$lari:ed S$bs#aia%ro%ria%ro%ria
A# #he mar'i& o #he eyelids i# is "oi&$o$s A# #he mar'i& o #he eyelids i# is "oi&$o$s!i#h #he s i&.!i#h #he s i&.
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ARTERIAL SU$$L"ARTERIAL SU$$L"
The la#eral %al%ebralThe la#eral %al%ebral Ar#ery222la"rimal ar#ery. Ar#ery222la"rimal ar#ery.medial %al%ebralmedial %al%ebralar#ery222O%h#halmi"ar#ery222O%h#halmi"
Ar#ery. Ar#ery.Mar'i&al a&dMar'i&al a&d
Peri%heral ar"ades.Peri%heral ar"ades.
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&ENOUS DRANA%E&ENOUS DRANA%E
Medially < O%h#halmi" a&d a&'$lar vei&Medially < O%h#halmi" a&d a&'$lar vei&
La#erally2s$%er i"ial #em%oral vei&La#erally2s$%er i"ial #em%oral vei&
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NER&E SU$$L"NER&E SU$$L"
+%%er eyelid+%%er eyelidS$%ra orbi#al &erveS$%ra orbi#al &erveS$%ra #ro"hlear &erveS$%ra #ro"hlear &erve
I& ra #ro"hlear &erveI& ra #ro"hlear &erveLa"rimal &erveLa"rimal &erve
Lo!er eyelidLo!er eyelidI& ra #ro"hlear &erveI& ra #ro"hlear &erveI& ra orbi#al &erveI& ra orbi#al &erve
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LYMPHATI, DRAINAGELYMPHATI, DRAINAGE
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SECRETION O! THE E"ELIDSSECRETION O! THE E"ELIDS
GlandsGlands Tear Film Layer Tear Film Layer LocationLocationof glandsof glands
Meibomia& 'la&dMeibomia& 'la&d Oily layer Oily layer TarsalTarsal%la#e%la#e
Gla&ds o =ei>sGla&ds o =ei>s Oily layerOily layer EyelashesEyelashes
Gla&ds o 9ol ri&'Gla&ds o 9ol ri&' A;$eo$s layer A;$eo$s layer Tarsal %la#eTarsal %la#eGla&ds o ?ra$seGla&ds o ?ra$se A;$eo$s layer A;$eo$s layer For&i)For&i)
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lin(in)lin(in)
There are #!o mai& #y%es o bli& i&'There are #!o mai& #y%es o bli& i&'
Re le) bli& i&'Re le) bli& i&'S%oa&eo$s *li& i&'S%oa&eo$s *li& i&'
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Re*le+ lin(in)Re*le+ lin(in)
TactileTactile,or&eal To$"h,or&eal To$"h,or#i"al ,o&&e"#io&,or#i"al ,o&&e"#io&Dim$&a#io& o se&si#ivi#y i& "oa"# le&sDim$&a#io& o se&si#ivi#y i& "oa"# le&s!earer !earer
Da,,leDa,,le*ri'h# li'h#*ri'h# li'h#O%#i" &erve222 S$%erior "olli"$l$sO%#i" &erve222 S$%erior "olli"$l$s
Asso"ia#ed iber #o a"ial &$"lei Asso"ia#ed iber #o a"ial &$"lei
MenaceMenaceS$dde& %rese&"e o &ear ob(e"#S$dde& %rese&"e o &ear ob(e"#O%#i" &erve222 ,or#i"al ,o&&e"#io&O%#i" &erve222 ,or#i"al ,o&&e"#io&Predomi&aly "or#i"al i& &a#$rePredomi&aly "or#i"al i& &a#$re
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S-ontaneo.s lin(in)S-ontaneo.s lin(in) < O""$rs a# re'$lar basis !i#ho$# a& a%%are e)#er&al s#im$li.O""$rs a# re'$lar basis !i#ho$# a& a%%are e)#er&al s#im$li.
< Me"ha&i"s a"ili#a#es #he drai&a'e o #ear ilm.Me"ha&i"s a"ili#a#es #he drai&a'e o #ear ilm.
< Prese i& bli&d as &o re#i&al s#im$li are re;$ired.Prese i& bli&d as &o re#i&al s#im$li are re;$ired.
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le-h os-asmle-h os-asm
Sim$l#a&eo$s or"ible "ora"#io& oSim$l#a&eo$s or"ible "ora"#io& oorbi"$lars o"$li.orbi"$lars o"$li.
For"ible "los$re o #he lids.For"ible "los$re o #he lids.I#s role i& s$r'i"al %ro"ed$res.I#s role i& s$r'i"al %ro"ed$res.
Aerior se'me i&($ry. Aerior se'me i&($ry.
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THANK YOU