Slight alterations in the intricate anatomy of the upper and lower eyelid or their underlying structures can have pronounced consequences for ocular esthetics and function. This leaves the inner eyelid surface exposed and prone to irritation. Lower eyelid blepharoplasty is almost always done for cosmetic reasons to improve puffy lower eyelid bags or to reduce wrinkling of skin. The upper eyelid generally covers mm of the upper cornea, and the lower eyelid typically rests at, or near the lower limbus. The thickest part of the upper eyelid is just below the. Understanding the anatomy of the lower eyelid and the lidcheek junction is important for surgical and nonsurgical approaches. Openning,clouser,bli nking and winking,bells dynamics of eyelid. The following anatomic information concerning the complex structure of the eyelids is distilled from gross and histologic study as well as surgical experience. Knowledge of periorbital anatomy, topography, proportions, and volume distribution are critical in surgical planning. Thieme ebooks, i found this uptodate factual book to be wellwritten and relatively concise. Eight lower eyelid specimens from patients with involutional entropion and five from patients with involutional ectropion were studied also. The microscopic anatomy of the lower eyelid in nonasians was well studied, but in asians, despite the presence of gross differences, there were very limited studies on the microscopic anatomy.
The lower eyelid retractors are smoother, and form the inferior tarsal muscles, giving some shape and mobility to the lower eyelids. The lower eyelid is composed of very thin skin, a small tarsal plate, and muscles that close protractors and open retractors the lid. Grays anatomy for students 3rd edition pdf free download. Attenuation of the orbital septum results in herniation of fat and appearance of an eye bag. Surgical anatomy of the lower eyelid relating to lower. Furthermore, precise anatomic knowledge is a prerequisite for both reconstructive and cosmetic lower eyelid surgery in order for it to be performed appropriately.
I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an overaggressive lower blepharoplasty in the past. Surgical anatomy of the lower eyelid relating to lower blepharoplasty. Lecture outline eyelid anatomy gross anatomy layers of the eyelid eyelid arterial supply and venus and lymphatic drainage eyelid nerve supply eyelid physiology functions of eyelids eyelid movements. Anatomy of the eyelid the description above only offers a superficial overview of the anatomy of the eyelid. Surgeons who perform blepharoplasty should feel comfortable identifying those patients at risk for postoperative scleral show and ectropion. Numerous surgical procedures have been reported for repair of entropion. The surgical microscopic images linked to the master operation table have been recorded. Surgical anatomy of the eyelids plastic surgery key. Changes in the brow and cheek strongly influence the upper and lower eyelids, respectively.
The lower eyelid is among the most delicate and unforgiving structures encountered in facial aesthetic surgery. The understanding of periorbital structures and their interrelationships continues to evolve and requires consideration when performing. Understanding these relationships is essential in eyelid surgery. Pdf eyelid anatomy, including thickness measurements, was examined in numerous age groups. Failure to appreciate its intricate anatomy and the nuances of surgical technique during a blepharoplasty can lead to the unfortunate complication of lower eyelid retraction. Anatomic studies have provided further insight into the anatomy and function of the lower eyelid.
In the lower eyelid, the oom is supplied by, among others, the zygomatic branch of the facial nerve and its many branches zygomatic branches, along with a few buccal branches of the facial nerve see also chap. The upper and lower eyelids, along with the upper and lower puncta. Accurate intraoperative identification of anatomy is fundamental in performing eyelid surgery and preventing complications. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Lower blepharoplasty is only indicated in fat herniation as the predominant problem, for the rest of the lower eyelid problems, they can be corrected by non surgical means. Ankit punjabi doms final year dept of ophthalmology, kims hospital, bangalore, karnataka, india email. The eyelid is structurally divided into two anatomical lamellae. The superior and inferior marginal vessels that arise from the ophthalmic artery together form the marginal arcade. Feb 23, 2016 lower eyelid malposition is one the most common and devastating complications of lower eyelid blepharoplasty.
Common after upper lid surgery esp post op due to edema and orbicularis paresis. Ageing of lower eyelid rhytids, lower lid laxity, and crows feet are due to the progressive loss of soft tissue around the orbits. Tao surface anatomy the eyelids provide globe protection, contribute to tear production, and distribute tears. Feb 08, 2017 the surgical anatomy of the eyelid is one of the most complex in the head and neck, and a thorough understanding of the intricacies is paramount for facial plastic surgeons. Pdf surgical anatomy of the upper eyelid relating to upper. Lower eyelid malposition is one the most common and devastating complications of lower eyelid blepharoplasty. It is composed of two spheres with different radii, one set into the other figs 1. Prevention of lower eyelid malposition after blepharoplasty. Its easy readability will make it both appealing and useful for students, trainees, and experts. Lower eyelid anatomy, the lower eyelid entropionectropion surgical techniques, subciliary incision and transconjunctival approach to lower eyelid blepharoplasty, complication prevention and management methods are shown on the fresh frozen cadaveric eyelids.
The layers of the upper eyelid vary depending on the location in the eyelid fig. Twentytwo normal lower eyelids were studied microscopically to examine the normal anatomy of the lower eyelid retractors. Pdf surgical anatomy of the lower eyelid relating to lower. The contents include 1 the lacrimal canaliculus in the lower eyelid. An eyelid is a thin fold of skin that covers and protects an eye. Proper diagnosis and management of eyelid disorders, both functional and cosmetic, hinge upon a thorough understanding of the location of critical eyelid structures and the anatomic relationships between them.
The adjacent forehead and midface influence correct eyelid positioning. The eyelid functions to provide lubrication to the cornea while also serving as a barrier to foreign bodies. In severe ectropion, the entire length of the eyelid is turned out. Update on the treatment of postblepharoplasty lower eyelid retraction daniel g. The understanding of periorbital structures and their interrelationships continues to evolve and requires consideration when performing complex eyelid interventions. Tear trough deformity is a triangular depression at the medial aspect of the lower eyelid. Dec 29, 2010 chapter 82 clinical anatomy of the eyelids jonathan j. Lower blepharoplasty is only indicated in fat herniation as the predominant problem, for the rest of the lower eyelid problems, they can be corrected by nonsurgical means. The branch that supplies the lower eyelid is in fact a branch that arises from the superior marginal vessel that supplies the upper eyelid. Eyelid surgery anatomy of the eyelid cosmetic surgery. Pdf surgical anatomy of the lower eyelid relating to.
The eyelids anatomically contain both superficial musculocutaneous elements anteriorly. Such complications are usually secondary to excessive resection of the. Pulling the lower eyelid more than 6mms away from the globe signifies laxity of the lower eyelid. Anatomy of lower eyelid and eyelidcheek junction sciencedirect. In 1932, whitnall first described the lower eyelid depression as a fascial interstice fixed to the bone between the orbicularis oculi and angular head of the quadrates labii superioris muscles. Involves removal of excess skin and fat in both the upper as well as lower eyelids with smoothing of the muscle and other tissues. Title type anatomy of the eye and eyelids pdf anatomy of the eyelids pdf.
Chapter 82 clinical anatomy of the eyelids jonathan j. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. Blepharoplasty eyelid surgery explained video animation duration. Sufficient knowledge of eyelid and orbit anatomy is essential for. There are many text books on eyelid surgery, but a manual of systematic. The brow is positioned anterior to the superior orbital rim. If one were to look at the eyelid in a more detailed manner, a sagittal section taken across the eyelid will offer a clear view of the various structures that form it. Feb 11, 20 i see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an overaggressive lower blepharoplasty in the past. A thorough knowledge of the asian lower eyelid anatomy is essential for surgical exploration of the eyelid.
Lower eyelid cadaveric anatomical dissection techniques. What i liked about the videos, especially the new ones. Blepharoplasty or eyelift surgery is a plastic surgical procedure that is used for correcting defects, deformities, and disfigurations of the eyelids, and more recently, it has been used for achieving aesthetic modification of the periorbital region of the face surgery involves removal or repositioning of excess tissue as well as reinforcement of surrounding muscles and tendons to reshape. Fat herniation, tear trough deformities, hypertrophic orbicularis muscle, lax skin, wrinkles or even black eye circles are common presentations. The human eyelid features a row of eyelashes along the eyelid margin, which serve to heighten the protection of the eye from dust and foreign debris, as well as from. The marginal arcade arteries are located at the front of the tarsus, 4 mm from the upper. The upper eyelid crease falls 610 mm from the eyelid lash line. Jan 11, 2019 ectropion ektrohpeeon is a condition in which your eyelid turns outward.
Relevant anatomy article pdf available in seminars in plastic surgery 293. Pdf surgical anatomy of the upper eyelid relating to. An eye lift is a surgical procedure that reduces bagginess from lower eyelids and removes excess skin from the upper eyelids. Dutton definition the eyelids are mobile, flexible, multilamellar structures that cover the globe anteriorly. Both upper and lower eyelids should be assessed in the context of the surrounding periorbital area. Transconjunctival approach in lower eyelid blepharoplasty. Fat pads your upper eyelids have two fat pads, one located centrally that is relatively broad and made up of yellow coloured fat, and one located more towards your nose or medial and is made up of a paler yellow. The microscopic anatomy of the lower eyelid retractors jama. At times, despite recognition of all these concerns and having planned surgical techniques to prevent. Anterior to the tarsus, the structures from anterior to posterior include skin, orbicularis oculi muscle, tarsus, and conjunctiva.
Malone md, in master techniques in facial rejuvenation second edition, 2018. The microscopic anatomy of the lower eyelid retractors. Mar 31, 2010 a through understanding of the anatomy of the lower eyelids and the surrounding structures is mandatory to achieve satisfactory surgical results and avoid potential complications. Learn more from webmd about eyelid surgery called blepharoplasty. Dissection of the eyelid and orbit with modernised.
The gross anatomy of the lower eyelid is analogous to that of the upper eyelid, however, the lower eyelid has a more simplified structure with less dynamic movement. Upper and lower eyelid anatomy american academy of. Illustrated guide to eyelid and periorbital surgery. Jan 17, 20 numerous surgical procedures have been reported for repair of entropion. In the lower lid one should look specifically for elasticity of the lid by doing snap test to establish need for horizontal tightening. The understanding of periorbital structures and their interrelationships continues to evolve and. Chapter 82 clinical anatomy of the eyelids free medical. Blepharoplasty surgery details cosmetic eyelid surgery. Key features the eyelids provide protection from desiccation and airborne foreign matter. It is composed of two spheres with different radii, one set into the other figs 11 and 12. For involutional entropion, successful corrective surgery usually combines horizontal tightening of the eyelid usually via the lateral tarsal strip procedure, advancing the lower eyelid retractors, and, when needed, the creation of a fullthickness eyelid scar to prevent. In this part of the article, you will be able to access grays anatomy for students 3rd edition pdf for free by using our direct download links. The anterior lamella is the skin and orbicularis oculi muscle, the middle lamella is the tarsal plate and orbital septum, and the posterior lamella is the conjunctiva. Ectropion is more common in older adults, and it generally affects only the lower eyelid.
The shape of the lower eyelid is determined by the attachment of the medial and lateral canthal tendons as well as the tone and contraction of the oom. Update on the treatment of postblepharoplasty lower eyelid. The capsulopalpebral fascia cpf and the inferior tarsal muscle are directly comparable to the upper eyelid retractors of the levator aponeurosis and lower eyelids. In some case lower lid bags can be improved by repairing or reinforcing the soft tissues that normally hold them back. Aug 31, 2017 eyelid surgical anatomy gianfranco frojo.
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