Dr Mohamed abdulkadir abdullahi

Bsc hons optometry

Doctor of optometry (OD)

Ocular physiology
the eyelids have a complex structure to allow their various
essential function. The upper and lower lid Margins each
consist of both anterior and posterior lamellae
1. The anterior lamella is comprised of skin, muscle, and
glands.
2. The posterior lamella is composed of the tarsal plate,
conjunctiva and glands.
The eyelid skin is amongst the thinnest and most mobile
skin in the body. The eyelid skin receives its sensory
innervation from the first and second deviation of the
trigeminal nerve.

Melanocytes in the epidermis allow for increased pigment

production resulting from sun exposure or inflammatory
states.
Underneath the skin is loose areolar tissue with very little
subcutaneous fat. This loose connective tissue plane
provides a potential space for considerable accumulation
of fluid.
The largest muscle of the eyelid is the orbicularis oculi which
lies just deep to the eyelid skin and anterior to the tarsal
plate and septum. It circumferentially surrounds the
palpebral fissure.
The orbicularis oculi is considerably larger than the reminds
of the eyelid, allowing rapid eyelid closure. Functionally, the
orbicularis is divided into three concentric components. From
outermost to innermost, these are orbital, preseptal, and
pretarsal portions.
The deep heads of the pretarsal orbicularis oculi join
together near the common canaliculus to form Horner’s
muscle which inserts on the posterior lacrimal crest.
The orbicularis oculi serves to protract or close the upper and
lower lids and also assists in the function of the lacrimal
pump system.
The muscle of Riolan
is a small aggregate of orbicularis fibers separated from the
orbicularis. The muscle of Riolan is visible through the thin lid
margin skin as the gray line. Its thought to rotate the lashes
during eyelid closure.
The upper eyelid retractors consist of the levator palpebrae
superiors and Mueller's muscle. The levator shares a common
sheath with the superior rectus. Both are innervated by the
superior division of the oculomotor nerve.
The levator originates from the lesser wing of the sphenoid
bone, in the superomedial apex.
The distal 14 to 20 mm of the muscle are tendinous and are
referred to as the levator aponeurosis
The aponeurosis sends attachments through the orbicularis
onto the upper eyelid dermis and also inserts onto the
anterior tarsal plate. The tarsal plate of each lid is composed
of dense connective tissue and provides support for the lid.
Normal levator excursion from down gaze to up gaze should
measure approximately 14-17mm
Mueller's muscle originates from the undersurface of the
levator and inserts into the superior border of the upper lid
tarsus. It is composed of sympathetically innervated smooth
muscle fibers.
Mueller’s muscle provides 2mm of additional elevation of the
upper eyelid. It may be stimulated by sympathetic responses
such as fear, or pharmacologically by the instillation of
phenylephrine hydrochloride drops.
The palpebral fissure of the average adult measures about 10
to 12 mm vertically and 30 mm horizontally. In normal adults,
the upper eyelid is 1.5 to 2 mm below the upper limbus, and
the lower eyelid sits at the level of the inferior limbus. The
lateral canthal angle is typically 2 mm higher than the
medial canthal angle.
The eyelid margins are the surface of the lids that opposes
each other during closure. The anterior most distinguishing
feature of the eyelids margin is the lashes. The upper lid
contains five or sex rows of cilia, whereas the lower lid
contains three to four. Cilia serve a protective function for
the ocular surface.
Loss of lashes, or madarosis, may be an indication of an
eyelid neoplasm. Whitening of lashes, or poliosis, may be a
sign of blepharitis, medicamentosa, or vogt-koyanagi-harada
syndrome. Posterior to the cilia of eyelid margin there is a
meibomian gland orifices.
The tarsal plate of the upper and lower lids contain
approximately 30-40, and 20-30 meibomian glands
respectively.
There are about 100-150 lashes in upper lid, and 50-70 lashes
in the lower lid.
 Function of the eyelids
1) The eyelids contribute significantly to facial features.
They are important in the expression of emotion, as well as
in facial recognition, and they indicate states of attention
and emotion. Eyelid opening is produced primarily by the
levator palpebral superiors, which is innervated by the
superior division of the oculomotor nerve which elevates the
upper eyelid.
2) Maintain the integrity of the corneal surface, the blinking
action of the lids serves to spread the tear film across the
cornea. A loss of blinking action will result in an immediate
degradation of the health of corneal surface.
3) Serve to maintain proper position of the globe within the
orbital contents.
4) Serve to regulate the amount of light entering the eye.
5) Protection from air-born particles, this is achieved by the
spontaneous and reflex blinking.
6) Blinking eliminate the discomfort of dryness of the eye
Eyelid opening is produced primarily by the levator palpebral
superiors, which is innervated by the superior division of the
oculomotor nerve which elevates the upper eyelid.
Eyelid closure is attained by the action of the three
segments of orbicularis muscle.
During closure, the upper lid moves down, and the lower lid
moves both up and nasally in normal patients.
Blinking :-
Is the most common form of eyelid closure, although most
blinks do not result in complete eyelid closure. Blink rates
decrease with visual attention and increase with stress and
decreased attention.
Contraction of orbicularis oculi is responsible for the
generation of a blink. However, the levator is inhabited
during a blink.
Three types of blink are generally described:
Spontaneous, reflex, and voluntary.
1) Spontaneous blinks: are the baseline involuntary blinks
that have no external stimulus. The rate of spontaneous
blinking varies among individuals and may be influenced by
the environment. The average rate is roughly 15 spontaneous
blinks per minute.
2) Reflex blinks : resulting from contraction of the pretarsal
orbicularis, may be elicited by corneal tactile sensation. The
corneal reflex blink pathway begins with afferent fibers from
the first division of the trigeminal nerve, which pass through
the brainstem and activate the seventh nerve. Cutaneous
stimulation, auditory stimuli, and bright visual stimuli may
also trigger reflex blinks. The afferent limbs for these stimuli
are the trigeminal, auditory, and optic nerves, respectively,
interestingly, reflex blinks have been noted in blind patients.
3) Voluntary blinks : involve recruitment of the orbital
portion of the orbicularis muscle.. Winking (voluntary closure
of one eye) is a form of voluntary blink.
Vertical eye movements induce vertical movement in the
upper lid. In up gaze, the upper lid moves upward as a result
of contraction of the levator along with the superior rectus.
The lower lid also moves up during up gaze.
Bell’s phenomenon: is the upward rotation of the globe
during eye closure. This phenomenon is commonly observed
during forced eyelid closure and serves to protect the cornea
from exposure in cases of lagophalmos.
Aging and disease states :
The skin laxity associated with aging causes dermatochalasis
of the eyelids. Advanced upper eyelid dermatochalasis,
known as pseudoblepharaptosis, may obstruct the visual axis.
Horner’s syndrome: is a clinical tried of unilateral meiosis,
ptosis, and anhydrases. Horner’s syndrome is caused by a
lesion somewhere in the sympathetic pathway.
The ptosis is attributed to decreased sympathetic enervation
of Mueller’s muscle.
Blepharospasm: is the idiopathic involuntary closure of both
eyelids. Although its etiology is unknown. Sympathetic
dysfunction has been implicated. Benign essential
Blepharospasm consists of idiopathic forceful contraction of
the orbicularis oculi muscle.
Thank you