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PubMed1999

Topographic anatomy of the eyelids, and the effects of sex and age.

AIMS: To describe the effects of sex and age on eyeball, eyelid, and eyebrow position. METHODS: A cross sectional cohort study was performed in which both eyes of 320 normal subjects aged between 10 and 89 years were included. Of each 10 year age cohort, there were 20 men and 20 women. Frontal, as well as lateral, slides were taken of both eyes. On projected slides, a reference line through the medial canthi and vertical lines through the pupil centre and the lateral canthus were constructed. Using these lines, we measured the size of the horizontal eyelid fissure, the distance from the reference line to the pupil centre and to the lateral canthus, the distance between the pupil centre and the upper and lower eyelid margin, and the distance between the upper eyelid margin and the skin fold and eyebrow. On lateral slides, the distance between the lateral canthus and the anterior corneal surface was measured. RESULTS: Between the ages of approximately 12 and 25 years, the horizontal eyelid fissure lengthened 3 mm, while the position of other eyelid structures remained virtually unchanged. Between the average ages of 35 and 85 years, the horizontal eyelid fissure gradually shortened again by about 2.5 mm. Meanwhile, the distance between the lateral canthal angle and the anterior corneal surface decreased almost 1.5 mm. Aging caused an increase of the distance between the pupil centre and the lower eyelid of about 1 mm in men, and 0.5 mm in women. Aging also caused a higher skin crease and raised eyebrows in men and women, but it did not affect the position of the pupil centre and the lateral canthus. Men showed an 0.7 mm larger horizontal eyelid fissure than women. In women, however, the eyebrows were situated about 2.5 mm higher than in men. CONCLUSION: Aging mainly affects the size of the horizontal eyelid fissure, which lengthens by about 10% between the ages of 12 and 25, and shortens by almost the same amount between middle age and old age. Aging causes sagging of the lower eyelid, especially in men, and a higher skin fold and eyebrow position in both sexes. Aging does not affect the position of the eyeball proper, or of the lateral canthus.

Adolescent↗
PubMed1990

Iontophoresis for eyelid anesthesia.

Local anesthesia is appropriate for eyelid surgery, but patients fear the pain of injections. We evaluated iontophoresis of lidocaine for eyelid skin anesthesia to pinprick pain sensation in normal subjects, and prior to regional infiltration of the anesthetic agent in patients undergoing eyelid surgery. After iontophoresis of lidocaine hydrochloride 4% solution to one randomly chosen eyelid, pinprick skin sensation was tested in a double-masked manner. Subjective pain scores of 10 subjects were significantly less (P less than .008) on the iontophoresis treated eyelids (0.25) than on the untreated eyelids (2.55). Nine patients undergoing bilateral upper eyelid surgery had iontophoresis applied to one randomly chosen eyelid prior to the usual anesthetic injections. In this double-masked evaluation, patients reported significantly less pain (P less than .02) on the treated eyelids (1.4) than on the untreated eyelids (4.7). We conclude that iontophoresis is effective for achieving short-term, superficial anesthesia of eyelid skin.

Anesthesia, Local↗
PubMed1998

The distribution of primary afferent terminals from the eyelids of macaque monkeys.

Trigeminal sensory afferents from the eyelids convey two types of information that are important for the blink reflex. Movement of the lashes activates low-threshold mechanoreceptors which evoke protective blinks. Information about eyelid position is also transmitted centrally and is used to adapt the metrics of the blink reflex to changing conditions over time. This study employed transganglionic transport of horseradish peroxidase conjugated to choleratoxin-B subunit or wheat-germ agglutinin to investigate trigeminal afferents supplying the eyelids of macaque monkeys. Ganglion cells labeled from upper- and lower-lid injections were located in the ophthalmic and maxillary portions of the trigeminal ganglion, respectively. In both cases, labeled terminals were observed ipsilateral to the injected eyelid in the principal and spinal trigeminal nuclei. However, only a few labeled terminals were present in the principal nucleus, and very sparse terminal labeling was confined to a few locations along the ventral border of the pars oralis and interpolaris of the spinal trigeminal nucleus. The main concentration of label was found in the pars caudalis at and immediately below the spinomedullary junction. The terminal field from the upper eyelid was located ventrally in the pars caudalis, and that from the lower eyelid was located more dorsally. In both cases, the labeled terminal field was densest within lamina II of the spinal trigeminal nucleus. The heavy concentration of eyelid central terminals at the spinomedullary junction is surprising in light of physiological studies indicating representation of all parts of the face throughout the trigeminal nucleus. The distribution of eyelid afferent terminals in the macaque is caudal to the main concentration of corneal afferent terminals at the pars interpolaris/caudalis border. This may be a basis for differences seen in blinks produced by corneal as opposed to supraorbital stimulation. The presence of a single major site of eyelid primary afferent terminals suggests that sensory input for both eyelid proprioception and blink-reflex activation passes through this segment of the spinal trigeminal nucleus. These results provide a basis for investigation of the central connections of pars caudalis neurons in order to better establish the pathways producing trigeminally evoked blinks and blink adaptation.

Adaptation, Physiological↗
PubMed2007

Lower eyelid splinting: An alternative to the Frost suture.

OBJECTIVES: To describe a new method of postoperative eyelid suspension used for the prevention of eyelid malposition and to report its efficacy through an outcome study. STUDY DESIGN: An outcome study was performed on 10 patients who would potentially need postoperative eyelid suspension. Candidates included patients with entropion, ectropion, or orbital fractures requiring transconjunctival approaches. Patients were photographed pre- and postoperatively and followed for signs of eyelid malposition. METHODS: At the conclusion of the surgical procedure, a sheet of Xeroform gauze was folded into 6 overlapping layers and cut to conform to the shape of the inferior orbital rim. The superior edge of the gauze was sutured to the lower eyelid using interrupted 5-0 nylon suture. Sutures were placed at the medial and lateral canthi to raise the eyelid above the inferior limbus and along the inferior orbital rim. The splint was removed between postoperative days 7 and 14. RESULTS: There were no perioperative complications related to the surgery or placement of the splint. No cutaneous marks persisted after healing. No complications such as shifting of the splint, ocular damage, or recurrent eyelid malposition occurred. One patient had asymptomatic restriction of lower eyelid elevation on upward gaze, which resolved at 6 months. CONCLUSIONS: The lower eyelid splint appears effective in maintaining lower eyelid position postoperatively. There were no complications with its use, and the splint was tolerated well. Benefits of the splint over the Frost suture include less risk of corneal abrasion, ability to check visual function, and ability to use the splint bilaterally.

Adult↗
PubMed2005

[The eyelid reconstruction in situ with allograft acellular dermal matrix].

OBJECTIVE: To explore the clinical value of allograft acellular dermal matrix in the treatment of eyelid defects. METHODS: From November 2001 to November 2002, 10 patients (8 male and 2 female; age varied from 14 to 47) with 11 eyelids were treated by eyelid reconstruction in situ with implantation of 1 mm thick allograft acellular dermal matrix. In 11 eyelids with defects, 2 was totally defect, 8 was 2/3 defect, 1 was 1/3 defect. In these 10 patients, 9 were injured and 1 was congenital. These defective eyelids included 8 upper lids, 1 lower lid and 1 case with both upper and lower lids. The average follow-up time was 8 months. RESULTS: In the follow-up periods, the inflammation of the eyelid was slight and no implants shedding or infection happened postoperatively. The conjunctiva grew well on the surface of the acellular dermal matrix. Histology examination showed neovascularization and presence of fibroblasts in the acellular dermal matrix 6 months after the operation. By the end of the follow up period, the results were excellent in 8 eyelids, good in 2 eyelids and improved in 1 eyelid. The efficacy rate of this treatment was 91%. CONCLUSIONS: Acellular dermal matrix can be used as a substitute of the tarsus in supporting the eyelid, it invokes little immunological and inflammatory reaction, and therefore, it can act as a biological scaffold to guide the growth of collagen and neovascularization.

Adolescent↗
PubMed1998

Malignant tumors of the eyelid: a population-based study of non-basal cell and non-squamous cell malignant neoplasms.

OBJECTIVE: To determine the relative frequencies, average annual incidences, and patient characteristics of non-basal cell and non-squamous cell malignant neoplasms of the eyelid in a defined geographic population. DESIGN AND SETTING: A retrospective study using the Florida Cancer Data System to identify malignant tumors of the eyelid, except for basal cell and squamous cell carcinomas, from 1981 through 1994. Cases were limited to persons who resided within Florida. MAIN OUTCOME MEASURE: Incidence of histologically confirmed malignant eyelid tumors. RESULTS: Two hundred six primary malignant eyelid tumors were identified. The 3 most common, in order of frequency, were melanoma, sebaceous carcinoma, and lymphoma. The median age at diagnosis for all patients was 73 years. Only 3 of the 206 malignant neoplasms occurred in blacks. The annual incidence of eyelid melanoma and sebaceous carcinoma in whites older than 20 years was 0.6 and 0.5 per million, respectively. Kaposi sarcoma was the most common type of mesenchymal tumor. Eleven different histologic types of lymphoma were found in the eyelid. Only 2 of 27 lymphomas had T-cell lineage. CONCLUSIONS: Malignant tumors of the eyelid other than basal cell and squamous cell carcinoma are uncommon and usually occur in elderly white persons. Primary eyelid tumors of any type are rare in blacks. The risk of a non-basal cell and non-squamous cell malignant neoplasm of the eyelid in Florida is 6.4 times greater for whites than for blacks (95% confidence interval [CI], 2.1-20.2). A variety of B-cell lymphomas can be manifested as primary eyelid tumors.

Adenocarcinoma, Sebaceous↗
PubMed1987

Full-thickness bipedicle flap for total lower eyelid reconstruction.

We describe a technique for total lower eyelid reconstruction utilizing a full-thickness bipedicle flap from the upper eyelid. The levator aponeurosis and Müller's muscle are recessed to avoid upper eyelid retraction. The key to performing this operation is a thorough knowledge of eyelid anatomy and techniques for preserving its microvascular blood supply. The bipedicle flap requires meticulous surgical technique but has many advantages over standard types of total lower eyelid reconstruction, including the following: excellent tissue match and cosmesis are obtained with single-stage reconstruction; distal flaps and grafts are avoided; open palpebral fissure is maintained, resulting in rapid rehabilitation; posterior lamella of tarsus, rather than substitute, is utilized; anterior lamella of functional orbicularis is utilized for support and closure; pedicles suspend and support the eyelid, decreasing lower eyelid retraction, laxity, and ectropion; allows simultaneous reconstruction of canthal defects; and is faster than other forms of total lower eyelid reconstruction. The results of 14 total lower eyelid reconstructions are presented. Minor canthal deformities, the most frequent complication, are easily corrected. This technique should be considered as an alternative to other procedures in cases of total lower eyelid reconstruction.

Aged↗
PubMed1999

Long-term enhancement of botulinum toxin injections by upper-eyelid surgery in 14 patients with facial dyskinesias.

OBJECTIVES: To determine the effects of upper-eyelid surgery (limited myectomy, blepharoplasty, and levator aponeurotic advancement) on patients who demonstrated a suboptimal response or residual heaviness of the upper eyelids after botulinum toxin eyelid injections for facial dyskinesia. DESIGN: Retrospective study. SUBJECTS: Charts of 358 patients with a diagnosis of benign essential blepharospasm, Meige syndrome (with eyelid involvement), and hemifacial spasm were reviewed. METHODS: Data were retrospectively analyzed and included subjective and objective responses about botulinum toxin injections (number and duration of effect of injections before and after eyelid surgery). RESULTS: Of 358 patients with facial dyskinesias, 14 (3.91%) underwent upper-eyelid limited myectomy with or without upper-lid blepharoplasty (n = 5), upper-lid blepharoplasty alone (n = 6), or levator advancement with or without blepharoplasty (n = 3). Mean subjective improvement was 68.75% after limited myectomy combined with blepharoplasty and 58.33% after levator and/or blepharoplasty surgery. Average duration of effect of injections increased from 122.1 days in the patients prior to undergoing eyelid surgery to 210.5 days after surgery. CONCLUSIONS: Upper-eyelid surgery, including limited myectomy, enhanced the effect of the botulinum toxin in this small group of patients. Patients with a suboptimal response to injections in terms or moderate to marked dermatochalasis with subjective heaviness of the eyelids, upper-eyelid blepharoplasty, and/or limited myectomy should be considered.

Aged↗
PubMedDate not supplied

Scanning electron microscopic study on double and single eyelids in Orientals.

The conventional theory is that Occidentals have a terminal insertion of the levator aponeurosis at the anterior portion, resulting in a double eyelid, whereas in Orientals this fiber is not present, and therefore results in a single eyelid have been anatomically demonstrated. However, there have been more than a few reports indicating that the anatomical difference between a single eyelid and double eyelid in Orientals cannot be explained by this theory. Therefore, in order to verify the direction of the levator aponeurosis in the eyelids of Orientals, we observed Japanese eyelids using a scanning electron microscope (SEM). As a result of three-dimensional, cross-sectional observations using SEM, we were able to confirm the existence of a branch of the levator aponeurosis that runs through the layer of the orbicularis oculi muscle and connects with the levator aponeurosis in the double eyelid, as in the occidental eyelid. This was not seen in the single eyelid. It is thought that this new anatomical finding will become an important fundamental for double eyelid operations in Orientals.

Aged↗
PubMed1985

Changes in lower eyelid resting position, movement, and tone with age.

In a study of lower eyelid movement, resting position, and tone in 185 normal white patients ranging in age from 15 to 89 years, the mean vertical eyelid excursion from downgaze to upgaze was 5.29 mm. There was, however, a decrease in vertical eyelid movement with age of 0.05 mm/yr. The mean horizontal lower eyelid excursion with eyelid closure or gentle blink was 3.3 mm and horizontal eyelid movement decreased 0.015 mm/yr. The decrease in vertical and horizontal eyelid movement with aging was closely correlated with the increase in eyelid laxity in elderly patients (P less than .001). The lower eyelids of elderly patients rested against the globe at a position inferior to that of younger patients, a finding that correlated with increased eyelid laxity (P less than .001).

Adolescent↗
PubMed2000

Effect of eyelid botulinum toxin injection on lacrimal drainage.

PURPOSE: To determine the effect of eyelid botulinum toxin injection on the lacrimal drainage and to assess the use of botulinum toxin in dry eye conditions. METHODS: Prospectively, three test groups were examined and one lacrimal system investigated in each person in each group. Botulinum toxin A (3.75 IU) was injected into the medial part of 13 lower eyelids of 13 normal test subjects and the medial part of nine lower eyelids in nine patients with dry eyes. A dose of 2.5 IU was injected into the medial part of 10 lower eyelids and the medial part of 10 upper eyelids of 10 patients with dry eyes. The drop test was used to determine the lacrimal drainage capacity and the blink output, before and after the injection. The subjective effect of the botulinum toxin injection on eye comfort was investigated. RESULTS: Three weeks after lower eyelid botulinum toxin injection, the mean blink output was reduced to 64% (1.19 of 1.87; P <.001) and 70% (0.94 of 1.35; P <.001) of the baseline values in the groups of normal subjects and patients, respectively. After injection in both the upper and lower eyelid, the mean blink output was reduced to 38% (0.54 of 1.41; P <.001) of the baseline value. The patients with dry eyes reported an improved eye comfort in six of nine cases after injection in the lower eyelid and in seven of 10 cases after injection in both the upper and lower eyelid. Adverse effects included one case of increased discomfort for 3 weeks after injection. CONCLUSION: Injection of botulinum toxin into the medial part of the eyelids decreased the lacrimal drainage, suggesting a new way to treat dry eye conditions. Further studies are required to assess the clinical value of this treatment.

Adult↗
PubMed2001

Basal cell carcinoma of the eyelid associated with Gorlin-Goltz syndrome.

PURPOSE: To describe the ophthalmic and systemic features in a series of patients initially seen with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Of 105 consecutive patients with eyelid basal cell carcinoma managed at an Ocular Oncology Center between January 1973 and December 1999, four patients with Gorlin-Goltz syndrome were identified. METHODS: The ophthalmic and systemic features, management, and outcome of patients with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome were analyzed. The published literature on Gorlin-Goltz syndrome, specifically related to genetics, systemic features, ophthalmic associations, and prophylactic management strategies, was reviewed. MAIN OUTCOME MEASURES: Response of the eyelid basal cell carcinoma to treatment and the final systemic condition were the main outcome measures. RESULTS: All four patients had a family history of Gorlin-Goltz syndrome. The systemic manifestations included multiple basal cell carcinomas in all the patients, frontal bossing or increased occipitofrontal circumference in three patients, palmar pits in two patients, odontogenic keratocyst in one patient, ectopic calcification in one patient, and bifid rib in one patient. The mean age at the detection of the first basal cell carcinoma was 30 years (range, 16-38 years). All four patients had multiple basal cell carcinomas on the face and elsewhere. The eyelid basal cell carcinoma was advanced with orbital infiltration in three patients, one of whom opted for palliative radiotherapy, whereas the other two underwent orbital exenteration. The fourth patient, who had localized recurrent basal cell carcinoma in the upper eyelid, was treated with excision and eyelid reconstruction. At the final follow-up (mean, 41 months), eyelid basal cell carcinoma was cured in three patients and stable in one patient. No patient had life-threatening sequelae of Gorlin-Goltz syndrome. CONCLUSIONS: Gorlin-Goltz syndrome is a rare autosomal dominant cancer predisposition syndrome that may be associated with eyelid basal cell carcinoma. The associated systemic findings may be a clue to the diagnosis of this condition. It is important to recognize Gorlin-Goltz syndrome when a patient has multiple basal cell carcinomas or when a young patient with eyelid basal cell carcinoma is seen by an ophthalmologist, because lifelong monitoring is essential for patient management.

Age of Onset↗
PubMed1994

Fixation duress in the pathogenesis of upper eyelid retraction in thyroid orbitopathy. A prospective study.

BACKGROUND: Upper eyelid retraction in thyroid eye disease may be caused by proptosis, levator and Müller's muscle infiltration with fibrosis or individual fiber enlargement, excessive sympathetic innervation, abnormal adhesions between levator palpebrae muscle and surrounding tissues, or fixation duress. Fixation duress refers to upper eyelid retraction while fixating with an eye with inferior rectus muscle restriction due to excessive simultaneous firing of the ipsilateral superior rectus and levator palpebrae muscles. METHODS: The authors prospectively examined six patients with strabismus and thyroid eye disease associated with inferior rectus restriction and upper eyelid retraction in whom the eyelid retraction was suspected clinically to be a result of fixation duress. All six patients underwent recession of both inferior recti ranging from 3 to 6.5 mm (mean, 4.5 mm) to improve the ocular motility and alignment, reduce the diplopia, and mitigate the upper eyelid retraction. RESULTS: Reduction of upper eyelid retraction measured as the preoperative versus postoperative difference in corneal light reflex-upper eyelid margin measurements was achieved in all patients postoperatively, ranging from 1.5 to 5.5 mm (mean, 3.2 mm). Only one patient showed significant residual retraction to warrant consideration of upper eyelid surgery. CONCLUSION: Fixation duress plays a significant role in upper eyelid retraction of thyroid eye disease in a subset of patients with restriction of the inferior rectus muscle. In this selected group of patients, the upper eyelid retraction may be reduced or eliminated upon proper recession of the tight inferior rectus muscle(s).

Diplopia↗
PubMed1996

Laser Doppler perfusion imaging of eyelid skin.

We report an initial laser Doppler perfusion study of the eyelids and compare the results with those of other cutaneous regions. Eleven healthy subjects with no prior medical or surgical history, or eyelid malposition underwent laser Doppler perfusion scanning of six skin locations: right forearm, right middle fingertip, right upper eyelid, right lower eyelid, left upper eyelid, and left lower eyelid. Cutaneous perfusion in the four eyelid locations and right middle fingertip were statistically similar to each other but significantly higher than that in the right forearm (p = 0.002). Also, mean perfusion in pretarsal skin was > 50% than that in preseptal skin (p = 0.002). In addition, in an eyelid with histopathologically documented basal cell carcinoma, cutaneous perfusion was significantly higher than the mean of the normal eyelids (p = 0.002). Eyelids are perfused at the same high rate as are other regions of the head, and significantly higher than low flow regions, such as the extremities. Future application of this laser Doppler perfusion scanning include assessing burn depth, postoperative monitoring of periorbital tissue transfer, distinguishing benign and malignant adnexal skin lesions, and establishing the pathologic margins of lid tumors.

Adult↗
PubMed2002

Lower eyelid reverse ptosis repair.

PURPOSE: To report the results of the surgical repair of lower eyelid reverse ptosis. METHODS: Retrospective case series. Eight patients ranging in age from 31 to 77 years underwent surgical repair of lower eyelid reverse ptosis. The pupillary axis of the affected eye(s) in each patient was obscured in downgaze, interfering with reading. The lower eyelid reverse ptosis resulted from involutional changes in 3 patients, previous orbital decompression in 3 patients, multiple prior retinal and extraocular muscle operations in 1 patient, and previous orbital floor fracture and repair in 1 patient. Transcutaneous advancement of the lower eyelid retractors was performed in 12 eyelids of the 8 patients. RESULTS: The mean preoperative vertical eyelid fissure was 6.2 mm (median, 6 mm; range, 3-9 mm), increasing after surgery to a mean of 7.7 mm (median, 8 mm; range, 5-11 mm). The mean preoperative distance between the central light reflex and the lower eyelid margin was 1.7 mm (median, 1.25 mm; range, 1-4 mm); this distance increased to a mean of 3.3 mm (median, 3.25 mm; range, 2.5-4.5 mm) after surgery. Symptoms improved in all patients, and there were no perioperative complications. Follow-up intervals ranged from 2 months to 24 months (mean, 9 months; median, 13 months). CONCLUSIONS: Analogous to upper eyelid ptosis repair by advancement of the levator aponeurosis, lower eyelid reverse ptosis may be corrected effectively and safely by advancing the lower eyelid retractors.

Adult↗
PubMed2002

Eyelid lymphatics II: a search for drainage patterns in the monkey and correlations with human lymphatics.

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey through the use of lymphoscintigraphy. METHODS: Lymphoscintigraphy with 500 microCi of 99mTechnetium sulfur colloid injected at specific sites around the eyelids was performed with five cynomolgus monkeys in lateral and ventral positions. RESULTS: Lymphoscintigraphy of the monkey eyelid and periocular tissue revealed lymphatic drainage to the parotid lymph nodes from the entire upper eyelid, medial canthus, and lateral lower eyelid and drainage to the submandibular lymph nodes from the medial and central lower eyelid. In addition to draining to the parotid lymph nodes, the central upper eyelid was also seen to drain to the submandibular lymph nodes. CONCLUSIONS: Lymphoscintigraphy of the cynomolgus monkey eyelids reveals discrete lymphatic drainage pathways for the upper and lower eyelids and a dual pathway for the central upper eyelid. Future studies will help to clarify the lymphatic drainage pathways of human eyelids.

Animals↗
PubMed2004

Microscopic anatomy of the lower eyelid in asians.

PURPOSE: To study the microscopic anatomic relation of the capsulopalpebral fascia, orbital septum, and tarsus of the lower eyelid in Asians. The anatomic differences between the Asian and non-Asian upper eyelid have been well described by various authors, but the differences of the lower eyelid have not been well characterized microscopically. The microscopic anatomy of the lower eyelid in non-Asians was well studied, but in Asians, despite the presence of gross differences, there were very limited studies on the microscopic anatomy. A thorough knowledge of the Asian lower eyelid anatomy is essential for surgical exploration of the eyelid. It may also explain the higher prevalence of eyelid disorders such as epiblepharon and entropion in Asians. METHODS: Ten normal Asian lower eyelids from 10 formalin-fixed cadavers (mean age, 67.5 years) were harvested and studied with light microscopy after staining with Masson trichrome. RESULTS: There was no fusion of the orbital septum and the capsulopalpebral fascia at the lower border of the tarsal plate in 7 specimens and a very limited fusion of these tissues in 3 specimens. The average distance from the inferior tarsal border to the first observable smooth muscle nuclei of the inferior retractors was 1.44 mm. The average tarsal plate thickness was 1.36 mm and the average tarsal plate height was 4.12 mm. CONCLUSIONS: The Asian lower eyelid anatomy differs from its non-Asian counterpart. There was no consistent fusion between the capsulopalpebral fascia and the orbital septum inferior to the inferior tarsal border. No extension of the capsulopalpebral fascia to the skin was observed. The average distance between the inferior retractors and the inferior tarsal plate was 1.44 mm in the normal Asian lower eyelid.

Aged↗
PubMedDate not supplied

Microscopic anatomy of Asian lower eyelids.

PURPOSE: To elucidate the microscopic anatomy of the Asian lower eyelid. METHODS: Specimens (full-thickness sections of lower eyelids from 19 postmortem lower eyelids) from 11 Asians aged 73 to 96 years at death were fixed in 10% buffered formalin and microscopically examined. After pretreatment, sagittal sliced sections of the central part were stained with Masson trichrome. RESULTS: The distinct junction of the orbital septum to the capsulopalpebral fascia (CPF) was confirmed in 7 eyelids in which orbital septum was clearly stained, with an average distance from the tarsus to the junction of 2.38 mm. The other 12 eyelids did not show a distinct junction, and the orbital septum was poorly defined anteriorly and indistinct posteriorly. There was a distinct layer between the orbicularis oculi muscle and the orbital septum. The inferior and the posterior attachments of the CPF to the tarsus were seen in all eyelids. Seventeen of the 19 eyelids had attachment of the CPF on the anterior aspect of the tarsus, from which an extension of the CPF through the pretarsal orbicularis oculi muscle was observed. All eyelids had anterior extension of the CPF through the preseptal orbicularis oculi muscle, which was overridden on the pretarsal orbicularis oculi muscle. CONCLUSIONS: The microscopic findings of Asian lower eyelids, especially fascial components, were mostly similar to those of non-Asian eyelids, but differences existed in higher or indistinct septum fusion, anterior and superior orbital fat projection, and the overriding of the preseptal orbicularis oculi muscle.

Aged↗