Ptosis (drooping) upper eyelid is an uncontrolled disorder of the muscles that lift and lower upper eyelid. Muscle weakness is expressed as a cosmetic defect, in the form of asymmetry in the size of the palpebral fissures, which develops into a mass of complications, including loss of vision.
The disease affects patients of any age, from newborns to pensioners. All treatment methods, including the main surgical therapy for ptosis, are aimed at increasing the tone of the eye muscles.
Blepharoptosis (drooping of the upper eyelid) is a pathology of the muscular system in which the eyelid partially or completely covers the iris or pupil, and in advanced stages, completely covers the palpebral fissure. Normally, the right and left eyelids should cover no more than 1.5-2 mm top edge irises. If the muscles are weak, poorly innervated, or damaged, the eyelid loses control and droops below normal.
Ptosis is a disease of only the upper eyelid, since the lower eyelid lacks the levator muscle, which is responsible for lifting. There is a small Müller muscle located there, which is innervated in cervical spine and is only capable of widening the palpebral fissure by a couple of millimeters. Therefore, with paralysis of the sympathetic nerve, which is responsible for this small muscle in the lower eyelid, ptosis will be insignificant, completely unnoticeable.
Physical obstruction of the visual field leads to a number of complications that are especially dangerous in childhood when the visual function is just developing. Ptosis in a child leads to impaired development of binocular vision.
All these complications are typical for adults, but when they appear in infant contribute to the brain's incorrect learning to make comparisons visual images. Subsequently, this will lead to the impossibility of correcting or restoring correct vision.
Classification and reasons
Muscle weakness can be acquired or congenital. Congenital ptosis of the upper eyelid is a disease of young children, its causes are underdevelopment or absence of the muscles that lift the eyelid, as well as damage to nerve centers. Congenital ptosis is characterized by bilateral damage to the upper eyelid of the right and left eyes simultaneously.
Look interesting video about the congenital form of the disease and methods of treatment:
Unilateral lesions are characteristic of acquired ptosis. This type of ptosis develops as a complication of another, more serious pathological process.
Classification of ptosis of the upper eyelid depending on the cause of its appearance:
- Aponeurotic blepharoptosis – excessive stretching or relaxation of muscles, loss of tone.
- Neurogenic ptosis is a violation of the passage of nerve impulses to control muscles. Neurogenic ptosis is a symptom of a central nervous system disease; the appearance of neurology is the first signal for additional examination of brain structures.
- Mechanical blepharoptosis is post-traumatic muscle damage, tumor growth, and scarring.
- Age-related – the natural physiological processes of aging of the body provoke weakening and stretching of muscles and ligaments.
- False blepharoptosis – observed with a large volume of skin folds.
Other causes of blepharoptosis in adults include:
- damage, bruises, ruptures, eye injuries;
- diseases of the nervous system or brain: stroke, neuritis, multiple sclerosis, tumors, neoplasms, hemorrhages, aneurysms, encephalopathy, meningitis, cerebral palsy;
- paresis, paralysis, ruptures, muscle weakness;
- diabetes mellitus or other endocrine diseases;
- exophthalmos;
- consequence of unsuccessful plastic surgery, Botox injections.
By stages:
- partial;
- incomplete;
- full.
Ptosis has 3 degrees, which are measured in the number of millimeters of distance between the edge of the eyelid and the center of the pupil. In this case, the patient’s eyes and eyebrows should be relaxed and in a natural position. If the location of the edge of the upper eyelid coincides with the center of the pupil, this is the equator, 0 millimeters.
Degrees of ptosis:
- First degree – from +2 to +5 mm.
- Second degree – from +2 to -2 mm.
- Third degree – from –2 to –5 mm.
Symptoms of the disease
Eyelid ptosis is characterized by the main, most obvious visual symptom - drooping with a partially or completely closed palpebral fissure. At the early stage of the disease, pay attention to the symmetry of the location of the eyelids of the right and left eyes relative to the edge of the cornea.
Other manifestations of blepharoptosis:
- decreased visual acuity in one eye;
- fast fatiguability;
- astrologer pose, when the patient has to throw his head back to get a clear image;
- double vision;
- the pathological eye stops blinking, this leads to;
- the resulting pocket under the drooping eyelid contributes to the accumulation of bacteria, subsequently the development of frequent inflammation;
- double vision;
- unconsciously the patient tries to lift the upper eyelid using the brow ridges or forehead muscles;
- gradual development of strabismus.
Diagnostics
Diagnostics is aimed at identifying the root cause of the disease, purpose adequate treatment. drooping eyelid early stages hardly noticeable, but it's extremely important sign beginning of development serious illnesses, such as a brain tumor. Therefore, it is important for the ophthalmologist to find out whether ptosis is congenital or appears suddenly. To do this, the patient is interviewed and an anamnesis is collected.
It happens that the patient has not noticed the prolapse before or cannot say exactly when it appeared. In this case, it is necessary to carry out additional examinations to exclude everything possible reasons diseases.
Stages of diagnosing blepharoptosis:
- Visual inspection, measurement of the degree of ptosis.
- Measurement of acuity, visual field, intraocular pressure, fundus examination.
- Biomicroscopy of the eye.
- Measurement of muscle tone, fold symmetry and blinking.
- Ultrasound of the eye, electromyography.
- Radiography.
- MRI of the head.
- Checking for binocular vision.
- Examination by a neurosurgeon, neurologist, endocrinologist.
How to cure upper eyelid ptosis
It is necessary to fight ptosis only after finding out the cause. In the early stages congenital pathology in the absence of visual impairment or a small cosmetic defect, it is recommended not to treat, but to carry out comprehensive prevention.
Treatment of ptosis is divided into conservative and surgical. Conservative methods goes well with homemade folk recipes.
For ptosis due to injury or nerve dysfunction, it is recommended to wait about a year after the incident. During this time effective treatment can restore all nerve connections without surgery or significantly reduce its volume.
What to do if your eyelid droops after Botox
Botox (botulinum toxin) is medicine, derived from botulinum bacteria, which disrupts the neuromuscular connection. The drug contains a neurotoxin, which in small dosages, when applied locally, attacks and kills nerve cells in the muscles, due to which they completely relax.
When using the drug in the cosmetic industry, a complication of incorrect or inaccurate administration can be ptosis of the upper eyelid after Botox injection, the treatment of which is very long. Moreover, the first few procedures can be successful, but each subsequent one requires an increase in the amount of the drug, which can lead to an overdose, as the body learns to develop immunity and antibodies to botulinum toxin.
Removing prolapse (blepharoptosis) is difficult, but possible. The first option for the simplest non-surgical treatment is to do nothing or just wait. After about 2-3 months, the body will build additional lateral branches of the nerves, which will allow it to regain control of the muscle on its own.
The second method helps to speed up this process; for this, physiotherapeutic procedures (UHF, electrophoresis, massage, darsonval, microcurrents, galvanotherapy), injections of proserine, taking large doses of B vitamins, and neuroprotectors are actively used. All this accelerates the restoration of innervation and promotes rapid resorption of Botox residues.
Operation
Surgery to correct ptosis (drooping) of the upper eyelid is called blepharoplasty. The operation is indicated in cases of advanced ptosis with impaired quality of vision. The intervention is carried out under local anesthesia outpatient. Rehabilitation period lasts about a month, during which the patient is observed by the operating surgeon.
There are many methods of operation, but the essence is the same - to shorten the relaxed muscle either by cutting and removing a part, or by folding it in half and stitching it. The cosmetic suture is hidden in a natural fold of skin, and over time it completely dissolves.
The cost of the operation depends on:
- complexity of the operation;
- stages of ptosis;
- additional research;
- the medical institution you have chosen;
- number of specialist consultations;
- number of laboratory diagnostics;
- type of anesthesia;
- accompanying pathologies.
On average, the amount per operation varies from 20 to 60 thousand rubles. You can find out the exact figure directly at your appointment, after examination by a specialist.
Watch the video to see how the operation (blepharoplasty) goes:
Home treatment
Ptosis of the upper eyelid can be treated conservatively at home. Treatment without surgery uses medications, massage, alternative medicine, physiotherapeutic procedures.
Methods for treating drooping eyelids using folk remedies:
- raw mask chicken egg With sesame oil applied to the skin once a day, washed off with warm water;
- lotions or warm compresses from infusions of chamomile, calendula, rose hips, black tea, birch leaves;
- applying “dry heat” using a cloth bag with super-fried sea salt;
- a potato mask made from grated raw potatoes is applied for 20 minutes once a day;
- a mask of honey with aloe pulp is applied 2 times a day.
Traditional medications used internally, mainly B vitamins, neuroprotectors, drugs that stimulate growth, as well as regeneration of nerve tissue, enhancing nutrition nerve cells. Everything is prescribed individually and depends on the stage, form, and cause of ptosis.
Physiotherapy:
- vacuum massage for ptosis of the upper eyelid;
- electrophoresis;
- warming up;
- myostimulation with currents.
All procedures and medications must be clarified and agreed upon with your attending ophthalmologist. The information on the site is for informational purposes only; do not use it as a guide to action.
Additionally, we invite you to watch a video about ptosis. Elena Malysheva will tell you in detail about the disease and ways to combat it.
Translated from Latin, this name has the following meaning: levare - lift up, palpebral - century-old, superior - upper.
Considering its location and innervation, this muscle is usually classified as an orbital muscle. It is unusual in that it contains visceral and somatic muscle fibers, and is considered to be an antagonist of the eyelid portion of the entire orbicularis oculi muscle, causing palsy of the levator muscle to promote drooping of the eyelid over the eyeball.
Muscle that lifts the upper eyelid - functions and features
Clinical features
This muscle is striated, innervated third pair cranial nerves . The tarsal superior muscle is very smooth and innervated by sympathetic postganglionic fibers cervical node. In the treatment of sympathetic reflex dystrophy (Sudek's atrophy), blockade of this node will affect the drooping of the ipsilateral eyelid. When the muscle is paresis, the upper eyelid also droops. Paresis leads to ptosis.
Ptosis is a pathology in which drooping of the eyelid develops. The most common cases are unilateral ptosis, but cases of drooping eyelids on both sides are possible. When ptosis of the upper eyelid occurs from 1.5 to 2.0 mm, there is an asymmetrical position of the eyelids, which is an aesthetic problem. In severe cases of ptosis, the pupil is closed by the eyelid, which can lead to visual impairment.
Functions
- raises the eyelid;
- takes part in blinking;
- controls the width of the palpebral fissure (however, the width of the palpebral fissure is most accurately controlled by the sympathetic nervous system and tarsal muscles);
- is an active muscle when awake.
Structural features
This muscle is attached to the orbital superior edge of the cartilage. It starts from the periosteum, which is located in the area of the optic opening. It goes forward along the wall of the orbit, slightly approaching its upper edge, and neatly passes into the tendon, the width of which differs in size in a larger direction.
The anterior fibers of the tendon are attached to the cartilage and directed to the palpebral bundle of the main orbicularis oculi muscle, as well as to the skin of the eyelid itself. The fibers of the posterior part are attached to the conjunctiva of the transitional superior fold. As for the fibers of the middle part of this tendon, they are also attached to the cartilage and are the end of the muscle. The muscle itself, which raises the upper eyelid, has a close connection with the levator and is located at its anterior end. With such a harmonious distribution of tendons, the simultaneous lifting of all components of the eyelid is ensured, namely: cartilage, skin and conjunctiva transitional upper fold.
This distribution is usually called three portions of muscles. In other words, the muscle that lifts the upper eyelid provides simultaneous movement of the eyelid through cartilage (this is the middle portion), the conjunctival superior fornix (posterior portion) and skin (anterior portion).
As for innervation, the middle part consists of fibers of distinctive smoothness and is the sympathetic nerve, while the other two legs are oculomotor nerve.
The rear surface of the eyelid is covered with conjunctiva, which is tightly fused with cartilage.
The upper eyelid, with correct levator tone, occupies a position that promotes corneal closure by 2 mm. "Lift" function may be impaired due to ptosis, and also due to the smoothness of the orbitopalpebral superior sulcus.
The movement of the muscle is located lateral to the superior oblique muscle and slightly superior to the rectus muscle. Anterior to the superior part of the orbit, the entire levator is surrounded by a thin layer of fatty tissue and accompanied by the superior orbital artery, trochlear and frontal nerves. These nerves separate the levator muscle from the roof of the orbit.
The rectus superioris muscle and the levator of the eyelid are separated from each other quite easily, despite the fact that they are in close proximity; but not in the medial part, there they are connected by the fascial membrane. These muscles equally emerge from the mesoderm and are innervated by a branch that belongs to the oculomotor nerve. The nerve enters the muscles from below at a distance of approximately 12 mm from the apex of the orbit. The nerve trunk can also approach the levator muscle on the other side of the rectus muscle.
A small area is attached to the levator on the posterior side of the upper edge of the orbit fibrous thick fabric which supports the eyeball. This tissue is called the superior transverse ligament of Withnell.
The connection between the levator and the posterior aspect of the superior edge of the orbit is very strong; in the inner and outer parts especially, this means that they can only be separated in areas located in the center.
On the medial side, the Withnell ligament ends closer to the trochlea, but still passes under the appearance of fibrous cords under the superior oblique muscle posteriorly, after which it mixes with the fascia that covers the supraorbital notch. Externally, the ligament of Withnell connects the fibrous capsule of the lacrimal gland and the periosteum of the frontal bone.
Withnell believes that the main function of his ligament is ability to limit displacement(tension) of the muscle on the back side. The author of his theory put forward this assumption, based on the localization and distribution of this function, as an analogue of the limiting ligaments of the external muscles. He thought there were similarities. By straining, the ligament helps support the upper eyelid. If it is destroyed, the levator of the eyelid will become sharply thickened and ptosis will occur inside.
From the transverse ligament to the very bottom of the cartilaginous plate, the distance is from 14 to 20 mm; from the levator aponeurosis to the skin circular insert - no more than 7 mm.
The levator aponeurosis, in addition to the palpebral insert, forms a fibrous cord (quite wide), which attaches to the edge of the orbit behind the external and internal ligaments of the eyelid. These links are called: inner "horn", outer "horn". Due to the fact that they are rigid, during the period of levator resection, the supporting function of the upper eyelid is noted in correct position by fixing the “horn” with an additional tool.
The external “horn” is a bundle of fibrous tissue that differs in power and in some places divides the inner part of the lacrimal gland into two parts. It is located below, attached in the area of the tubercle of the orbit from the outside to the external ligament of the eyelid. If you don't take this into account anatomical feature, if it is necessary to perform surgery and remove the tumor of the lacrimal gland, ptosis (of the lateral part of the eyelid) may occur.
The internal “horn,” on the contrary, is thin and looks like film. The location of this film is above the oblique tendon superior muscle, towards the internal ligament of the eyelid and to the posterior lacrimal crest.
As for the fibers of the levator tendon of the upper eyelid, they are woven into connective tissue cartilaginous plate at the third level. When the muscles contract, the eyelid rises, as a result of which the preaponeurotic eyelid shortens and the postaponeurotic eyelid lengthens.
In general, the eyelids are well supplied with blood vessels thanks to the branches of the ophthalmic artery in the carotid internal artery system and the anastomoses of the maxillary and facial arteries in the carotid system external artery. When these vessels branch, arterial arches are formed, one in the lower eyelid and two in the upper.
The eyelids have an anterior and posterior surface and two edges: the orbital (margo orbitalis) and the free (margo liber) - forming the palpebral fissure, the length of which is about 30 mm, height - 10-14 mm. When looking straight ahead, the upper eyelid closes top part cornea, and the lower one does not reach the limbus 1-2 mm. The upper eyelid is limited at the top by the eyebrow. The free (ciliary) edge of the eyelids is arched anteriorly. It distinguishes the anterior and posterior ribs and the intermarginal space lying between them, which has a thickness of up to 2 mm. In the medial region, the eyelids are connected by an internal commissure, forming a rounded medial corner of the eye. At the inner corner of the palpebral fissure there is a lacrimal lake (lacus lacrimalis), at the bottom of which there is a lacrimal caruncle (caruncula lacrimalis - anatomically it has the structure of the skin with rudimentary sebaceous glands, hairs and muscle fibers). More laterally, a duplication of the conjunctiva is visible - the semilunar fold. The free edge of the eyelid passes into the anterior and posterior surfaces of the eyelid, separated from them by the anterior and posterior ribs, respectively. At the inner corner, the edge of the upper and lower eyelids, at the level of the outer periphery of the lacrimal caruncle, bears lacrimal papillae with lacrimal puncta. The orbital margin is the point of transition of its skin into the skin of adjacent areas.
Eyelids perform protective function, protecting the eyeball from harmful external influences and the cornea and conjunctiva from drying out. With great mobility, the eyelids have significant strength, thanks to plates that have the consistency of cartilage. The normal blinking frequency is 6-7 times per minute, with tears evenly distributed over the surface of the cornea.
Eyelid layers:
1) skin with subcutaneous tissue - the skin of the eyelids is thin, easily removable, the subcutaneous tissue is weakly expressed, loose, devoid of fat, which is its peculiarity. Beneath the skin is the superficial fascia covering the orbicularis eyelid muscle. The rounded anterior rib has eyelashes. Modified sweat (Moll) and sebaceous (Zeiss) glands open into the hair follicles of the eyelashes.
2) muscle layer - consists of the orbicularis oculi muscle.
The circular muscle of the eye (musculus orbicularis oculi) consists of two parts:
a) palpebral (pars palpebralis) part of the upper and lower eyelids - has a semilunar shape, begins at the internal ligament and, without making a full circle, reaching the outer canthus, connects into a tendon bridge, under which lies the outer ligament of the eyelid. Some of the fibers of the palpebral part begin from the posterior process of the internal ligament and lie behind the lacrimal sac - Horner's muscle (lacrimal muscle), which expands the lacrimal sac. The muscle fibers of the palpebral part at the edge of the eyelids between the roots of the eyelashes and the gland ducts are called the ciliary muscle of Riolan (m. subtarsalis Riolani), which presses the edge of the eyelid to the eyeball and helps remove the secretion of the tarsal glands. This muscle is more pronounced in the lower eyelid and in pathological cases causes entropion of the eyelid.
b) orbital part (pars orbitalis) – begins at the inner corner of the eye from the frontal process upper jaw and, making a full circle, is attached at the place of its origin.
The orbital portion, contracting twice as slowly, has a stronger effect. Contraction of the palpebral part causes blinking movements of the eyelids and slight closure. Tight squinting, both voluntary and reflex, is ensured by contraction of the orbital portion together with the palpebral portion. The mechanism of closing the eyelids also involves facial muscles faces. The orbicularis muscle of the eyelids is innervated by the facial nerve, the fibers of which pass at great depths - almost at the level of the periosteum.
Lifting of the eyelids is carried out by the levator of the upper eyelid and smooth muscles - the superior and inferior tarsal muscles of Müller. The function of raising the lower eyelid is performed by the inferior rectus oculi muscle, which provides an additional tendon to the thickness of the lower eyelid.
The levator (musculus levator palpebrae), or muscle that lifts the upper eyelid, begins at the apex of the orbit, from the tendon ring of Zinn, and goes forward under the upper wall of the orbit. Not far from the upper edge of the orbit, the muscle passes into a broad tendon in the form of three plates, which is located behind the orbicularis muscle and the tarsoorbital fascia. The most anterior part of the tendon is directed to the tarso-orbital fascia, slightly below the upper orbito-palpebral fold, penetrates in thin bundles through this fascia and the fibers of the orbicularis muscle, reaches the anterior surface of the cartilage and spreads under the skin of the upper eyelid, where it is lost. The middle part of the tendon consists of a thin layer of fibers that are woven into the upper edge of the cartilage. The third, posterior portion is directed to the upper fornix of the conjunctiva. Attaching the levator in three places ensures simultaneous elevation of all layers of the eyelid. The levator is innervated by the oculomotor nerve (n. oculomotorius).
On the posterior surface of the levator, approximately 2 mm posterior to the junction with the tendon, the Müller muscle begins, consisting of smooth muscle fibers and attached to the upper edge of the cartilage. Its isolated contraction causes a slight widening of the palpebral fissure. Because The Müller muscle is innervated by sympathetic fibers; with paralysis of the sympathetic nerve, slight ptosis is observed. With paralysis or with transection of the levator, complete ptosis is observed.
The lower eyelid also has a Müller muscle located under the conjunctiva, from the arch to the edge of the cartilage.
The main structures that make up the levator complex include the levator body, aponeurosis, transverse ligament of the upper eyelid (Whitnall ligament), and Müller's muscle.
Whitnall's ligament (Whitnall S. E., 1932) is interesting in the following way - its superficial part, covering the muscle from above, immediately behind the aponeurosis becomes denser, forming the designated cord of the ligament, which extends in the transverse direction and, crossing the orbit, reaches its walls on both sides; the ligament is located parallel to the aponeurosis, but is attached at a higher level; medially, the main place of attachment of the ligament is the trochlea, but behind it some fascicles go to the bone, while at the same time a clearly visible strip extends forward to bridge over the superior orbital notch; Laterally, the ligamentous cord is connected to the stroma of the lacrimal gland, cutting into it like lateral horn aponeurosis, and outside the gland it reaches the outer edge of the orbit; for the most part it lies freely over the aponeurosis, but dense threads of connective tissue can bind them. In front of the ligamentous seal, the leaf suddenly becomes so thin that it forms a free edge, but it can still be traced as it extends forward in a thin layer to the upper orbital edge. This cord is well expressed in the fetus. When force is applied posteriorly to the levator, the cord becomes tense and thus acts as a limiting ligament for the muscle, preventing its excessive action - a function which, by reason of its position and attachment, it performs better than the aponeurosis, the horns of which are fixed at a level below, and which, in in the general understanding, they perform in commonwealth. The action of the levator is thus limited to the attachment of its fascial layers, as is the case with all extraocular muscles.
3) cartilage (however, there are no cartilage elements in it) - a dense fibrous plate (tarsal), which gives the eyelids their shape. Its posterior surface is tightly fused with the conjunctiva, and its anterior surface is loosely connected to the orbicularis muscle. The free edges of the plates are facing each other, the orbital edges are arched. The length of the free edge is about 20 mm, the thickness of the tarsal plate is 0.8-1 mm, the height of the lower cartilage is 5-6 mm, the upper one is 10-12 mm. The orbital margins are fixed at the edge of the orbit by the tarso-orbital fascia (anterior border of the orbit). In the region of the corners of the palpebral fissure, the tarsal plates are connected to each other and fixed to the corresponding bone walls by means of the internal (ligamentum palpebrarum mediale) and external (ligamentum palpebrarum laterale) ligaments of the eyelids. It should be noted here that the internal ligament has three processes: two go anteriorly and merge with the inner ends of the cartilages of the upper and lower eyelids, and the third bends backward and attaches to the posterior crest of the lacrimal bone. The posterior part of the ligament, together with the main anterior part and the lacrimal bone, bounds the lacrimal fossa. The external ligament is attached to the outer edge of the orbit at the level of the suture between the frontal and zygomatic bone. Dissection of the external commissure of the eyelids with scissors during canthotomy should not reach the bone, since it is here, under the external commissure in the thickness of the orbital part of the orbicularis muscle of the eyelid, that arterial and venous vessels pass in the vertical direction. In the thickness of the cartilage there are meibomian glands (about 30 in each eyelid) - modified sebaceous glands, the excretory ducts of which open in the intermarginal space, closer to the posterior rib.
4) conjunctiva - covers the posterior surface of the cartilage of the eyelids, runs up the posterior surface of the muscles to the levator, and downwards approximately 1 cm above the fascial processes of the inferior rectus muscle and, wrapping further onto the eyeball, forms the conjunctival fornix.
Skin of the eyelids very thin and mobile, since their subcutaneous tissue is extremely loose and devoid of fat. This contributes easy occurrence and rapid spread of edema with local inflammatory processes, at venous stagnation and some common diseases. Looseness subcutaneous tissue also explained rapid spread bruising and subcutaneous emphysema of the eyelids.
Sensory nerves of the skin of the eyelids come from trigeminal nerve. The upper eyelid is innervated by terminal branches coming from the first branch of the trigeminal nerve, and the lower eyelid is innervated by the second branch.
Located under the skin orbicularis eyelid muscle(m. orbicularis oculi), innervated by the facial nerve, consists of two parts - palpebral and orbital. When only the palpebral part is contracted, the eyelids slightly close; their complete closure is achieved by contraction of both parts of the muscle. Muscle fibers running parallel to the edge of the eyelids between the roots of the eyelashes and around excretory ducts meibomian glands, form the Riolan muscle; it presses the edge of the eyelid to the eye and promotes the removal of secretions from the meibomian glands to the surface of the intermarginal edge of the eyelid. Excessive tension of the orbicularis muscle leads to blepharospasm, and often to spastic volvulus, which can also be caused by contraction of the Riolan muscle, especially in the elderly.
It should be noted that with pronounced and prolonged spasm of the muscle, significant swelling of the eyelids also develops, since this greatly compresses the eyelid veins that pass between the fibers of the orbicularis muscle. Paralysis facial nerve can lead to inversion of the lower eyelid and non-closure of the palpebral fissure (lagophthalmos).
TO eyelid muscles This also includes the muscle that lifts the upper eyelid (m. levator palpebrae superior), innervated by the oculomotor nerve. Starting deep in the orbit, the levator reaches the cartilage and attaches to its upper edge and anterior surface. Between the two tendon layers of the levator there is a layer of smooth fibers - the Müller muscle, innervated by the sympathetic nerve; it is also attached to the upper edge of the cartilage. In the lower eyelid there is no muscle similar to the levator, but there is a Müller muscle (m. tarsalis inferior). An isolated contraction of the Müller muscle causes only a slight widening of the palpebral fissure, therefore, with sympathetic nerve palsy, slight ptosis is observed, while ptosis with levator palsy is more pronounced and may even be complete.
A solid foundation for the century forms cartilage (tarsus), consisting of dense connective tissue. Physiological significance The cartilage of the eyelids, in addition to its protective function, is due to the presence of meibomian glands in its thickness, the secretion of which lubricates the intermarginal edge of the eyelid, protecting the skin of the eyelids from maceration by tear fluid. The most important feature The structure of the eyelids is their extremely rich blood supply. Numerous arteries anastomosing among themselves originate from two systems - from the ophthalmic artery system and from the facial artery system. Arterial branches running towards each other merge and form arterial arches - arcus tarseus. There are usually two of them on the upper eyelid, and often one on the lower eyelid.
The abundant blood supply to the eyelids is, of course, of great practical importance; in particular, this explains the excellent healing of eyelid wounds both with extensive damage and during plastic surgery.
Veins of the eyelids even more numerous than arteries; outflow from them occurs both in the veins of the face and in the veins of the orbit. It is necessary to emphasize that the orbital veins do not have valves, which are to a certain extent a natural barrier to the flow of venous blood. Because of this, it is difficult infectious diseases eyelids (abscess, erysipelas, etc.) can spread directly through the venous bed not only into the orbit, but also into the cavernous sinus and cause the development of purulent meningitis.
The eye muscles perform an important function.
They control the movement of the eyeballs, close the eyelids, and perform a protective function.
Focusing of vision depends on their work.
They are an indispensable element of the visual apparatus. The structure depends on many important elements.
Structure
The structure of the eyelids is very interesting and unique. Each part is responsible for many functions. The functionality and structure of these should be studied in detail. amazing muscles. The eyelids cover the outside of the eyes and protect from exposure external factors. Main functions:
- protection against the ingress of small particles and foreign objects;
- uniform distribution tear fluid;
- responsible for moisturizing the cornea and conjunctiva;
- washes away small particles from the surface of the mucosa;
- protect eyes from drying out during sleep;
- are responsible for the blinking process.
The edges of the eyelids are 2 mm thick. The lower and upper eyelids close tightly when closing the eyes. Eyelashes grow on the smoothed anterior rib. The inner one is sharper and fits tightly to the eyeball. The intermarginal space is located along the length of the eyelids between the anterior and posterior parts. The skin is thin, so it tends to gather in folds. When the eyes open, it folds inward with the help of the muscles that are responsible for raising the eyelids. This creates a deep crease. Another less pronounced one is located on the lower eyelid.
There is also a circular muscle, which is located under the skin in the orbital or palpebral part. In the process of closing the eyelids, both muscles contract. The dense tuft that emanates from the frontal origin of the maxilla is the internal ligament of the eyelid. It bifurcates and connects to the ends of the cartilage of the eyelids.
Detailed structure century is presented in this image:
Peculiarities
The muscle is striated. The upper muscle is surprisingly smooth and is called the tarsal muscle. Functions with the help of fibers of the cervical nodes. In the treatment of Sudeck atrophy, the risk of blockade of such nodes increases. The occurrence of paresis leads to drooping of the upper eyelid. Against this background, ptosis occurs.
Ptosis is a pronounced pathology, which is accompanied by drooping of the eyelid (mainly the upper one). In most cases, the disease is unilateral. Bilateral lesions are rarely observed. Asymmetry of the eyelids not only causes an aesthetic defect, but can also impair vision. In a pronounced form, severe ophthalmological diseases can develop.
The muscle is attached to the orbit of the superior cartilage. The beginning is the area of the optic opening. It passes into a tendon, the width of which is much greater. Its anterior part is attached to the cartilage and goes to the orbicularis muscle. The fibers, which are located on the back, connect to the conjunctiva and pass into the upper fold. The fibers are located on the middle part of the tendon. They complete the structure of the muscle.
The muscle that raises the eyelid is closely related to the levator muscle. It is located near its front end. In addition, this structure ensures the elevation of not only the eyelid, but also all its parts: cartilage, skin, conjunctiva, which passes into the upper fold.
The innervation of the middle part of the upper eyelid has smooth fibers. Therefore it is considered a sympathetic nerve. The posterior surface is completely covered with conjunctiva connected to cartilage. If the levator tone is normal, then the upper eyelid covers the cornea by about 2 mm. The function that is responsible for raising it is impaired with ptosis.
Interestingly, the levator is surrounded by a slight layer of adipose tissue. In addition, the trochlear, frontal nerves and arteries are located there. This separates it from the apex of the orbit.
It is very easy to distinguish the levator muscle from the superior muscle. They are connected by a fascial membrane. They are also innervated by a branch attached to optic nerve . It passes into the inferior muscles and is located approximately 12 mm from the top of the orbit. The nerve trunk approaches the levator. The back side of the top edge is connected to the fabric supporting eyeballs. In medicine it is called the ligament of Withnell. Features a strong connection. They can only be separated in one place - in the center.
This ligament passes under the oblique muscle at the back. It then mixes with the fascia and covers the area above the eye. From the outside it is attached to the capsule of the lacrimal gland. The main function limits muscle displacement on the posterior side. This theory is confirmed by the localization of such functionality. When tense, the ligament supports the upper eyelid. If this function is not performed, ptosis will appear.
The distance from the transverse ligament to the cartilage is a maximum of 20 mm. The levator is responsible for creating a wide fibrous band. It connects to the eye socket. The ligaments are divided into internal and external horns. They are rigid and support the upper eyelid in the correct position with the help of fixation. Also responsible for the blinking process.
The horn is a combination of fibrous tissues that have a very powerful effect. Located in the lower part of the eye socket on the outside of the eyelid. If you do not pay attention to such features and do not perform surgery on time, ptosis may develop. The inner horn resembles a film. Localized over the tendon of the superior oblique muscle. Performs at least important functions. Abnormal development may cause the development of ophthalmic pathologies.
The levator consists of tendon fibers. They are woven into the connective tissue of cartilage. At the moment of muscle contraction, the eyelid rises. The eyelids are well equipped with blood vessels. When the vessels divide into branches, peculiar arterial arches appear. They are located behind a certain pattern. One goes under the lower eyelid, and two go above the upper. The functionality of each structure is very important. The work of all the muscles that are responsible for raising and lowering the eyelids depends on each part.
Functions
The eyelids are an indispensable part of the visual apparatus. They perform very important functions:
- lift eyelids;
- responsible for the blinking process;
- active muscle is responsible for wakefulness;
- moisturizes the mucous membrane;
- prevents drying of the cornea during sleep.
The condition of the eyelids is very important for healthy eyes. Control of the width of the palpebral fissures is also determined by them. Subject to various pathological diseases and processes. The most common is a pathology called ptosis. May manifest itself in varying degrees lesions and cause severe complications.
During sleep, the eyes have the opportunity to relax and rest. The eyelids provide this rest. They control the distribution of tear fluid, moisturize the mucous membrane, and prevent drying out during sleep. In addition, they protect the eyes from small particles and foreign objects.
