the eye; in tear film maintenance, by distributing a protective and optically important tear film over the cornea during blinking; and in tear flow by their pumping action on the conjunctival and lacrimal sacs4
. The structures that must be considered in eyelid
anatomy are the skin, subcutaneous tissue, the orbicularis oculi muscle, the submuscular areolar tissue, the fibrous layer consisting of both the upper and lower tarsus and the orbital septum; the lid retractors of the upper and lower lids; and the retroseptal fat pads and the conjunctiva. The orbital septum represents the anatomic boundary
between the tissue of the lid and the orbital tissue. The upper and lower lids can be considered similar structures with differences mainly in the lid retractor arrangement. The upper eyelid extends superiorly to the eyebrow,
which separates it from the forehead. The upper eyelid skin crease (superior palpebral sulcus) is approximately 8–11 mm superior to the eyelid margin and is formed by the attachments of the superficial insertion of levator aponeurotic fibres (8–9 mm in men, 9–11 mm in women). The inferior eyelid fold (inferior palpebral sulcus), which is seen more frequently in children, runs from 3 mm inferior to the medial lower lid margin to 5 mm inferior to the lateral lid margin.
The nasojugal fold runs inferiorly and laterally from the
inner canthal region along the depression of separation of the orbicularis oculi, forming the tear trough. The malar fold runs inferiorly and medially from the outer canthus toward the inferior aspect of the nasojugal fold. The open eye represents the palpebral fissure between
the lid margins, which is 28–30 mm in length and approximately 9 mm in maximum height. The distance between the medial canthus to the mid-line of the nose is approximately 15 mm. The skin of the eyelids is the thinnest of the body
(≤ 1 mm). The nasal portion of the eyelid skin has fine hairs and more sebaceous glands than the temporal aspect. The transition from this thin eyelid skin to the thicker skin of the eye brow and the cheek skin is evident. Fat is sparse in pre-septal and pre-orbital skin, and is
entirely absent from pre-tarsal skin. Subcutaneous tissue is absent over the medial and lateral palpebral ligaments, where the skin is adherent to the underlying fibrous tissue.
The orbicularis oculi muscle The orbicularis oculi muscle is one of the superficial muscles of facial expression. Invested by the superficial muscle-aponeurotic system (SMAS), muscle contracture is translated to movement of the overlying tissues by the
Facial ageing
reflects the cumulative effects of time on the skin, soft tissues, and deep structural components of the face, and is a complex synergy of textural changes to the skin and loss of facial volume.
prime-journal.com | January/February 2013 ❚ 31
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