Eyelid muscles and their innervation. Facial anatomy: area around the eyes, upper and lower eyelids

The eyelids, in the form of movable flaps, cover the front surface of the eyeball and perform a number of functions:

A) protective (from harmful external influences)

B) tear distribution (tears are distributed evenly during movements)

B) maintain the necessary moisture of the cornea and conjunctiva

D) wash away small particles from the surface of the eye foreign bodies and promote their removal

The free edges of the eyelids are about 2 mm thick and, when the palpebral fissure is closed, fit tightly to each other.

The eyelid has an anterior, slightly smoothed edge from which the eyelashes grow, and a posterior, sharper edge facing and fitting tightly to the eyeball. Along the entire length of the eyelid between the anterior and posterior ribs there is a strip of flat surface called Intermarginal space. The skin of the eyelids is very thin, easily folded, has delicate vellus hairs, greasy and sweat glands. Subcutaneous tissue loose, completely devoid of fat. When the palpebral fissure is open, the skin upper eyelid slightly below the brow ridge, it is retracted deeper by the fibers of the levator muscle attached to it. upper eyelid, as a result, a deep superior orbitopalpebral fold is formed here. A less pronounced horizontal fold is present on the lower eyelid along the lower orbital margin.

Located under the skin of the eyelids Orbicularis oculi muscle, in which the orbital and palpebral parts are distinguished. The fibers of the orbital part begin from the frontal process upper jaw on the inner wall of the orbit and, having made a full circle along the edge of the orbit, are attached at the place of their origin. The fibers of the palpebral part do not have a circular direction and spread in an arcuate manner between the internal and external ligaments of the eyelids. Their contraction is caused by the closure of the palpebral fissure during sleep and during blinking. When you close your eyes, both parts of the muscle contract.

The internal ligament of the eyelid, starting as a dense bundle from the frontal process of the upper jaw, goes to the inner corner of the palpebral fissure, where it bifurcates and is woven into the inner ends of the cartilages of both eyelids. The posterior fibrous fibers of this ligament turn back from the internal angle and attach to the posterior lacrimal crest. As a result, a fibrous space is formed between the anterior and posterior knees of the internal ligament of the eyelids and the lacrimal bone, in which the lacrimal sac is located.

The fibers of the palpebral part, which start from the posterior knee of the ligament and, spreading through the lacrimal sac, are attached to the bone, are called the lacrimal muscle (Horner). During blinking, this muscle stretches the wall of the lacrimal sac, in which a vacuum is created, sucking tears from the lacrimal lake through the lacrimal canaliculi.

The muscle fibers that run along the edge of the eyelids, between the fibers of the eyelashes and the excretory ducts of the meibomian glands, make up the ciliary muscle (Riolan). When it is pulled, the posterior edge of the eyelid is tightly adjacent to the eye.

The orbicularis oculi muscle is innervated by the facial nerve.

Posterior to the palpebral portion of the orbicularis muscle is a dense connective plate called eyelid cartilage, although it does not contain cartilaginous cells. The cartilage serves as the skeleton of the eyelids and, due to its slight convexity, gives them the appropriate appearance. Along the orbital margin, the cartilages of both eyelids are connected to the orbital margin by the dense tarso-orbital fascia. In the thickness of the cartilage, perpendicular to the edge of the eyelid, there are meibomian glands that produce fatty secretions. Their excretory ducts exit through pinholes into the intermarginal space, where they are located in a regular row along the posterior edge of the eyelid. The secretion of meibomian gland secretion is facilitated by the contraction of the ciliary muscle.

Functions of grease:

A) prevents tears from flowing over the edge of the eyelid

B) directs the tear inwards into the lake of tears

C) protects the skin from maceration

D) retains small foreign bodies

D) when the palpebral fissure is closed, creates its complete sealing

E) participates in the formation of the capillary layer of tears on the surface of the cornea, delaying its evaporation

Along the front edge of the eyelid, eyelashes grow in two or three rows; on the upper eyelid they are much longer and there are more of them in number. Near the root of each eyelash there are sebaceous glands and modified sweat glands, the excretory ducts of which open into the hair follicles of the eyelashes.

In the intermarginal space at the inner corner of the palpebral fissure, due to the bending of the medial edge of the eyelids, small elevations are formed - lacrimal papillae, at the top of which lacrimal puncta gape with small holes - the initial part of the lacrimal canaliculi.

Attached along the superior orbital margin of the cartilage Levator superioris muscle, which starts from the periosteum in the area of ​​the optic foramen. It runs forward along the upper wall of the orbit and, not far from the upper edge of the orbit, passes into the broad tendon. The anterior fibers of this tendon are directed to the palpebral bundle of the orbicularis muscle and to the skin of the eyelid. The fibers of the middle part of the tendon are attached to the cartilage, and the fibers of the posterior part approach the conjunctiva of the superior transitional fold. The middle part is actually the end of a special muscle consisting of smooth fibers. This muscle is located at the anterior end of the levator and is closely connected with it. Such a harmonious distribution of the tendons of the muscle that lifts the upper eyelid ensures the simultaneous lifting of all parts of the eyelid: skin, cartilage, conjunctiva of the upper transitional fold of the eyelid. Innervation: the middle part, consisting of smooth fibers, is the sympathetic nerve, the other two legs are the oculomotor nerve.

The posterior surface of the eyelid is covered with conjunctiva, tightly fused with cartilage.

The eyelids are richly supplied with vessels due to branches of the ophthalmic artery from the internal system carotid artery, as well as anastomoses from the facial and maxillary arteries from the external carotid artery system. Branching out, all these vessels form arterial arches - two on the upper eyelid and one on the lower.

Sensitive innervation of the eyelids - first and second branches trigeminal nerve, motor – facial nerve.

Ptosis of the eyelid, or blepharoptosis, is a drooping of the upper eyelid in relation to the edge of the iris by more than 2 mm. It is not only a cosmetic defect, but can be a symptom of a certain pathology and lead, especially in children, to a persistent decrease in visual acuity.

Symptoms and Classification of ptosis and the occurrence of ptosis of the upper eyelid

The main symptoms are:

• visually noticeable blepharoptosis;
• sleepy facial expression (with bilateral lesions);
• formation of forehead skin wrinkles and slight eyebrow lifting when trying to compensate for ptosis;
• rapid onset of eye fatigue, a feeling of discomfort and pain when straining the organs of vision, excessive tearing;
• the need to make an effort to close the eyes;
• over time or immediately occurring strabismus, decreased visual acuity and double vision;
• “Stargazer pose” (slightly throwing the head back), especially characteristic of children and being an adaptive reaction aimed at improving vision.

The mechanism of development of these symptoms and ptosis itself is as follows. The motor functioning of the eyelid and the width of the palpebral fissure depend on the tone and contractions:

• The levator superior eyelid (levator muscle), which controls vertical position last;
• The orbicularis oculi muscle, which allows you to close the eye steadily and quickly;
• The frontalis muscle, which promotes contraction and compression of the eyelid with maximum upward gaze.

Tone and contraction are carried out under the influence of nerve impulses arriving to the circular and frontal muscles from facial nerve. Its nucleus is located in the brainstem on the corresponding side.

The levator palpebrae superioris muscle is innervated by a group of neurons (right and left bundles of the central caudal nucleus), which are part of the nucleus oculomotor nerve, also located in the brain. They are directed to the muscles of their own and the opposite side.

Video: Ptosis of the upper eyelid

Classification of ptosis

It can be bilateral and unilateral (in 70%), true and false (pseudoptosis). False ptosis is caused by excess volume of skin and subcutaneous tissue, eyelid hernia, strabismus, decreased elasticity of the eyeballs and, as a rule, is bilateral, with the exception of unilateral endocrine pathology eyes.

In addition, a distinction is made between physiological and pathological drooping of the eyelids. The above groups of nerves are associated with the sympathetic nervous system, the retina, the hypothalamus and other structures of the brain, as well as the frontal, temporal and occipital regions of the cerebral cortex. Therefore the degree muscle tone and the width of the palpebral fissure in physiological state are in close relationship with a person’s emotional state, fatigue, anger, surprise, reaction to pain, etc. Blepharoptosis in this case is bilateral and is unstable, relatively short-term in nature.

Pathological ptosis occurs due to injuries or inflammatory processes of the eyeball or muscles that move the eyelid, during inflammatory processes meninges and with disorders at various levels (nuclear, supranuclear and hemispheric) in the conductive nervous system with infarctions and brain tumors, disorders of sympathetic innervation and transmission of nerve impulses to muscles, with damage to the upper roots spinal cord, lesions of the brachial plexus (plexopathy), etc.

Depending on the degree of the pathological condition, there are:

1. Partial ptosis, or degree I, in which 1/3 of the pupil is covered by the upper eyelid.
2. Incomplete (II degree) - when half or 2/3 of the pupil is covered.
3. Full ( III degree) - complete coverage of the pupil.

Depending on the cause, blepharoptosis is divided into:

1. Congenital.
2. Acquired.

Congenital pathology

Congenital ptosis of the upper eyelid occurs:

• With congenital Horner's syndrome, in which ptosis is combined with constriction of the pupil, dilation of the conjunctival vessels, weakening of sweating on the face and a barely noticeable deeper location of the eyeball;
• With Marcus-Hun syndrome (palpebromandibular synkinesis), which is a drooping eyelid that disappears during opening of the mouth, chewing, yawning or displacement lower jaw in the opposite direction. This syndrome is a consequence of a congenital pathological connection between the nuclei of the trigeminal and oculomotor nerves;
• With Duane's syndrome, which is a rare congenital form of strabismus, in which there is no ability to shift the eye outward;
• As isolated ptosis caused by complete absence or abnormal development levator or its tendon. This congenital pathology very often inherited and almost always bilateral;
• With congenital myasthenia or anomalies of levator innervation;
• Neurogenic etiology, in particular with congenital paresis of the third pair of cranial nerves.

Video: Congenital ptosis of the upper eyelid in children

Congenital ptosis of the upper eyelid in children

Acquired ptosis

Acquired ptosis, as a rule, is unilateral and develops most often as a result of injuries, age-related changes, tumors or diseases (stroke, etc.), which result in levator paresis or paralysis.

Conventionally, the following main forms of acquired pathological condition are distinguished, which can also be of a mixed nature:

Aponeurotic

The most common cause is involutional age-related drooping of the upper eyelid as a consequence of dystrophic changes and weakness of the muscle aponeurosis. Less commonly, the cause may be traumatic injury or long-term treatment with corticosteroid drugs.

Myogenic

Occurring usually with myasthenia gravis or myasthenic syndrome, muscular dystrophy, blepharophimosis syndrome or as a result of ocular myopathies.

Neurogenic

It occurs mainly as a result of disturbances in the innervation of the oculomotor nerve - with aplasia syndrome of the latter, its paresis, Horner's syndrome, multiple sclerosis, stroke, diabetic neuropathy, intracranial aneurysms, ophthalmoplegic migraine.

In addition, neurogenic ptosis also occurs when the sympathetic pathway is damaged, which begins in the hypothalamic region and the reticular formation of the brain. Blepharoptosis associated with damage to the oculomotor nerve is always combined with pupil dilation and impaired eye movement.

A disturbance in the transmission of impulses from nerve to muscle often occurs, like its analogues (Dysport, Xeomin), in the upper third of the face. In this case, blepharoptosis may be associated with impaired function

ctions of the eyelid itself as a result of diffusion of the toxin into the levator. However, most often this condition develops as a result of local overdose, penetration or diffusion of the substance into the frontal muscle, its excessive relaxation and aggravation of the overhang of the skin fold.

Mechanical

Or completely isolated ptosis caused by inflammatory process and edema, isolated lesions of the levator, scars, pathological process in the orbit, for example, a tumor, damage to the anterior part of the orbit, unilateral atrophy of the facial muscles, for example, after a stroke, significant tumor formation of the eyelid.

Blepharoptosis of the upper eyelid after blepharoplasty

It may be in the form of one of the listed forms or a combination of them. It occurs as a result of postoperative inflammatory edema, damage to the outflow pathways of intercellular fluid, as a result of which its outflow is disrupted and tissue edema also develops, damage to muscles or muscle aponeurosis, as well as hematomas that limit their function, damage to the endings of nerve branches, and the formation of rough adhesions.

How to treat this pathological condition?

Acquired ptosis of the upper eyelids

There are conservative treatment methods and various surgical techniques. Their choice depends on the cause and severity of the pathology. As a very short term auxiliary method Correction of ptosis of the upper eyelid can be used by fixing the latter with an adhesive plaster. This method is used primarily as a temporary and additional method when it is necessary to eliminate complications in the form of inflammatory phenomena of the conjunctiva, as well as for complications after botulinum therapy.

Treatment of ptosis of the upper eyelid after Botox, Dysport, Xeomin

It is carried out by administering proserine, taking increased doses of vitamins “B 1” and “B 6” or introducing them in solutions by injection, performing physiotherapy (electrophoresis with a solution of proserine, darsonval, galvanotherapy), laser therapy, massage the area of ​​the upper third of the face. At the same time, all these measures only slightly contribute to the restoration of muscle function. Most often it occurs on its own within 1-1.5 months.

Non-surgical therapy

Treatment of ptosis of the upper eyelid without surgery is also possible with false blephroptosis or, in some cases, the neurogenic form of this pathological condition. Correction is carried out in physiotherapy rooms through the use of the above physiotherapy procedures and massage. Treatment at home is also recommended - massage, gymnastics to tone and strengthen the muscles of the upper third of the face, lifting cream, lotions with an infusion of birch leaves, a decoction of parsley root, potato juice, treatment with ice cubes with an infusion or decoction of appropriate herbs.

Gymnastic exercises for ptosis of the upper eyelid include:

• circular movement of the eyes, looking up, down, right and left with the head fixed;
• open your eyes as much as possible for 10 seconds, after which you need to close your eyes tightly and tense your muscles for 10 seconds (repeat the procedure up to 6 times);
• repeated sessions (up to 7) of rapid blinking for 40 seconds with the head tilted back;
• repeated sessions (up to 7) of lowering the eyes with the head thrown back, holding the gaze on the nose for 15 seconds and followed by relaxation, and others.

It should be noted that all conservative treatment methods are mainly not therapeutic, but preventive in nature. Sometimes, in the first degree of the above forms of blepharoptosis, conservative therapy contributes only to a slight improvement or slowdown in the progression of the process.

In all other cases of pathological condition and with blepharoptosis of II or III degree, the use of surgical methods is necessary.

Contents of the article: classList.toggle()">toggle

Ptosis of the eyelid is a pathology of the location of the upper eyelid, in which it droops down and partially or completely covers the palpebral fissure. Another name for the anomaly is blepharoptosis.

Normally, the eyelid should overlap the iris of the eye by no more than 1.5 mm. If this value is exceeded, they speak of pathological drooping of the upper eyelid.

Ptosis is not only a cosmetic defect that significantly distorts appearance person. It interferes with the normal functioning of the visual analyzer, as it interferes with refraction.

Classification and causes of eyelid ptosis

Depending on the moment of occurrence, ptosis is divided into:

• Acquired
• Congenital.

Depending on the degree of drooping of the eyelid, it happens:

• Partial: covers no more than 1/3 of the pupil
• Incomplete: covers up to 1/2 of the pupil
• Full: The eyelid completely covers the pupil.

The acquired type of the disease, depending on the etiology (the cause of the appearance of ptosis of the upper eyelid), is divided into several types:

As for cases of congenital ptosis, it can occur due to two reasons:

• Anomaly in the development of the muscle that lifts the upper eyelid. May be combined with strabismus or amblyopia (lazy eye syndrome).
• Defeat nerve centers oculomotor or facial nerve.

Symptoms of ptosis

The main clinical manifestation of the disease is drooping of the upper eyelid, which leads to partial or complete closure of the palpebral fissure. At the same time, people try to tense the frontalis muscle as much as possible so that the eyebrows rise and the eyelid stretches upward.

For this purpose, some patients throw back their heads and take a specific pose, which in the literature is called the stargazer pose.

A drooping eyelid prevents blinking movements, which leads to soreness and eye fatigue. A decrease in blink frequency causes tear film damage and development. Infection of the eye and development of an inflammatory disease can also occur.

Features of the disease in children

Ptosis is difficult to diagnose in infancy. This is largely due to the fact that most of the time the child sleeps and has his eyes closed. You need to carefully monitor the baby's facial expression. Sometimes the disease may manifest as frequent blinking of the affected eye during feeding.

At an older age, ptosis in children can be suspected by the following signs:

• While reading or writing, the child tries to throw back his head. This is due to the limitation of visual fields when the upper eyelid droops.
• Uncontrolled muscle contraction on the affected side. Sometimes this is mistaken for a nervous tic.
• Complaints about rapid fatigue after visual work.

Cases of congenital ptosis may be accompanied by epicanthus(overhanging folds of skin over the eyelid), damage to the cornea and paralysis of the oculomotor muscles. If ptosis in a child is not eliminated, it will lead to development and decreased vision.

Diagnostics

A routine examination is sufficient to diagnose this disease. To determine its degree, it is necessary to calculate the MRD indicator - the distance between the center of the pupil and the edge of the upper eyelid. If the eyelid crosses the middle of the pupil, then the MRD is 0, if higher, then from +1 to +5, if lower, from -1 to -5.

A comprehensive examination includes the following studies:

• Determination of visual acuity;
• Determination of visual fields;
• Ophthalmoscopy with examination of the fundus;
• Examination of the cornea;
• Study of tear fluid production;
• Biomicroscopy of the eyes with assessment of the tear film.

It is very important that while determining the extent of the disease, the patient is relaxed and does not frown. Otherwise, the result will be unreliable.

Children are examined especially carefully, since ptosis is often combined with eye amblyopia. Be sure to check visual acuity using Orlova's tables.

Treatment of ptosis

Elimination of ptosis of the upper eyelid can only be done after determining the root cause

Treatment of ptosis of the upper eyelid is possible only after determining the root cause. If it is neurogenic or traumatic in nature, its treatment necessarily includes physical therapy: UHF, galvanization, electrophoresis, paraffin therapy.

Operation

As for cases of congenital ptosis of the upper eyelid, it is necessary to resort to surgical intervention. It is aimed at shortening the muscle that lifts the eyelid.

Main stages of the operation:

The operation is also indicated if the upper eyelid still remains drooping after treatment of the underlying disease.

After the intervention, an aseptic (sterile) bandage is applied to the eye and antibacterial drugs are prescribed wide range actions. This is necessary to prevent wound infection.

Medicine

Drooping of the upper eyelid can be treated with conservative methods. To restore the functionality of the extraocular muscles, use following methods therapy:

If the upper eyelid droops after a botulinum injection, then it is necessary to instill eye drops with alphagan, ipratropium, lopidine, and phenylephrine. Such drugs promote contraction of the extraocular muscles and, as a result, the eyelid rises.

You can speed up the lifting of the eyelid after Botox with the help of medical masks and creams for the skin around the eyelids. Professionals also recommend massaging your eyelids daily and visiting a steam sauna.

Exercises

A special gymnastic complex helps strengthen and tighten the extraocular muscles. This is especially true for involutional ptosis, which occurs as a result of natural aging.

Gymnastics for the eyes with ptosis of the upper eyelid:

Only with regular performance of a set of exercises for ptosis of the upper eyelid will you notice the effect.

Folk remedies

Treatment of ptosis of the upper eyelid, especially on initial stage, perhaps at home. Folk remedies are safe, and there are practically no side effects.

Folk recipes to combat ptosis of the upper eyelid:

With regular use folk remedies not only strengthen muscle tissue, but also smooth out small wrinkles.

Amazing results can be achieved with complex application masks and massage. Massage technique:

1. Treat your hands with an antibacterial agent;
2. Remove makeup from the skin around the eyes;
3. Treat your eyelids with massage oil;
4. Perform light stroking movements on the upper eyelid in the direction from the inner corner of the eye to the outer. When treating the lower eyelid, move in the opposite direction;
5. After warming up, lightly tap the skin around the eyes for 60 seconds;
6. Then continuously press on the skin of the upper eyelid. Do not touch your eyeballs when doing this;
7. Cover your eyes with cotton pads soaked in chamomile infusion.

Photo of ptosis of the upper eyelid

Date: 04/26/2016

Comments: 0

Comments: 0

Many people are familiar with the feeling when the upper eyelid twitches. Why is this happening? What is the body trying to say by giving such signs, and what can be done to prevent the eyelid from twitching? After all, as you know, human body- a delicate instrument, and various problems in it can manifest themselves in completely unexpected ways.

Upper eyelid twitches: features

This is a manifestation of hyperkinesis; it occurs when there is a malfunction in the brain centers responsible for motor activity. Overexcited neurons send an unauthorized impulse to the brain, causing obsessive movement. More often the upper eyelid reacts to this, since it contains more nerve endings than the lower eyelid. This attack can affect both the eyelid of the left eye and the right.

Sometimes a slight twitching of the upper eyelid may go unnoticed, but it also happens that at first it starts twitch eyelid right eye, but the person does not pay attention to it for a long time. Then the same phenomenon affects the left eyelid. Next, the eyebrow and the corner of the eye rise. Subsequently, the tic progresses, and everything begins to descend involuntarily.

A twitching eyelid makes it difficult to concentrate, irritates, and is often accompanied by mood swings, lethargy, absent-mindedness, fast fatiguability, continuous tension, emotional imbalance.

There are primary and secondary hyperkinesis. The cause of secondary hyperkinesis lies in serious brain disorders.

With a simple tic, the eyelid does not twitch for long; one-time manifestations are possible. When complex, the movements are repeated and prolonged: at first their duration does not exceed a few minutes, but later does not stop for hours.

Return to contents

What are the causes of the disease

There are several factors that provoke the occurrence of tics, and the main one is nervous and emotional exhaustion.

It can occur from constant intense mental activity, frequent lack of sleep, moving and flying, lack of rest, regular stressful situations that arise at work or in the family. The reasons may be the following:

The above reasons are usually provoked by the person himself, causing twitching eyelid syndrome.

Sometimes there is also the presence of helminths, the presence of which a person does not even suspect. The onset of tic is due to the presence cervical osteochondrosis, when specific nerves associated with the muscle of the upper eyelid are pinched. Sometimes it's a harbinger serious illnesses: cerebral atherosclerosis, Parkinson's disease, meningitis, intracranial pressure.

Return to contents

What can be done for prevention

If your eye twitches repeatedly, you simply cannot ignore it. At the initial stage, you should analyze your condition and determine what caused this signal. You need to think carefully, radically change yourself and change your preferences and rhythm of life.

1. The very first thing it is advisable to do is eliminate coffee and alcoholic drinks from your diet.
2. If a person works a lot and hard and rarely rests, then maybe it makes sense to take a short vacation and go, for example, to the sea. If this is not possible, then you can visit the spa several times: physical relaxation procedures provide an opportunity to relax not only the body - the mental state also normalizes.
3. Drinking a full course of light sedatives: tincture of valerian, motherwort, peony is sometimes enough to not remember about tic. Chamomile and mint teas. Infusions of geranium leaves, plantain with honey and lemon.
4. Compresses on the eyelids made from infusions of the same herbs have a calming effect.
5. Get a good night's sleep and adjust your daily routine, balancing vigorous activity and good sleep. It should last at least 7 - 9 hours, it depends on the needs of the body.

If communication with a computer is related to the main activity of a person, then it is recommended to give your eyes rest every hour, literally 10, or even 5 minutes is enough so that twitching eyelids no longer bother you.

If you are overcome with problems at home and at work, then at least a one-time visit to a psychologist will help you choose the right line of behavior in order to react intelligently and with restraint to a psycho-irritating factor.

The specialist will tell and demonstrate exercises that promote relaxation.

And of course, we must not forget about physical education, working out in the gym, swimming in the pool.

Camping, Fresh air, walks in the park, in the forest - all this should be present in order to avoid overexertion and the development of serious illnesses.

Return to contents

Taking them in tablets or pills helps to avoid a deficiency of vitamins and microelements.

At the initial stage, you can slightly exceed the dose indicated on the package, and then use them according to the instructions. But nutritional correction is most important. Consumption of fish, peas, chocolate, banana, sesame seeds, dill, spinach, broccoli, cocoa, onions, and almonds will help compensate for the lack of magnesium and potassium.

Vitamin B, essential for proper functioning nervous system, found in eggs, black bread, beef liver, yeast, beans, wheat sprouts. Sometimes the doctor recommends injections of a vitamin complex intramuscularly.

At allergic reactions it is better to use antihistamine tablets, since the drops dry out the mucous membrane of the eye and provoke further development eye tic.

If you follow all the above recommendations, the eyelid will stop twitching, the body will rest, gain strength, and the present will seem more joyful and happy. But if there is no result and the symptoms continue to appear, then you should urgently go to a neurologist. The specialist will be able to determine the origin of the disease and prescribe appropriate therapy.

If the origins are hidden in the spine, then the doctor usually eliminates the problem with the help medications and massage. But you shouldn’t rely only on pills. Required physiotherapy, static poses should be avoided and physical activity should be increased.

Doctors often recommend acupuncture, breathing exercises. A visit to the ophthalmologist will eliminate eye inflammation. Drops for dry mucous membranes or anti-inflammatory ointments prescribed by a doctor will eliminate the disease.

4644 0

The eyelids are movable structures that protect the eyeball from the front. There are upper (palpebra superior) and lower (palpebra inferior) eyelids. Thanks to the mobility of the eyelids, namely due to their blinking, the tear fluid is evenly distributed over the front surface of the eye, moisturizing the cornea and conjunctiva. The connection of the upper and lower eyelids occurs through the medial commissure (commissura medialis palpebrarum) and the lateral commissure (commissura lateralis palpebrarum), which begin respectively in the outer (angulus oculi lateralis) and inner corner of the eye (angulus oculi medialis).

In the inner corner, at a distance of approximately 5 mm before the junction of the eyelids, a recess is formed - the lacrimal lake (lacus lacrimalis). At its bottom there is a rounded pink tubercle - the lacrimal caruncle (caruncula lacrimalis), to which is adjacent the semilunar fold of the conjunctiva (plica semilunaris conjunctivae). The almond-shaped space between the open eyelids is called the palpebral fissure (rima palpebrarum). Its horizontal length in an adult is 30 mm, and its height in the center is from 10 to 14 mm. When the eyelids are closed, the palpebral fissure completely disappears.

In the eyelids, two plates are conventionally distinguished - the outer (musculocutaneous) and the inner (conjunctival-cartilaginous). The skin of the eyelids contains sebaceous sweat glands. The subcutaneous tissue of the eyelids is devoid of fat, so swelling and hemorrhages easily spread in it, it easily folds, forming upper and lower folds that coincide with the corresponding edges of the cartilage. The cartilages of the eyelids (tarsus superior et inferior) look like a slightly convex plate about 20 mm long, up to 12 mm high and about 1 mm thick. The height of the cartilage on the lower eyelid is 5-6 mm; on the upper eyelid the cartilage is more pronounced. Cartilage consists of dense connective tissue and does not have its own cartilage cells. From the top and bottom wall the eye sockets are connected by ligaments of the eyelids (lig. palpebrale mediale et laterale).

The orbital part of the cartilage is connected to the edges of the orbit through dense fascia (septum orbitale). The cartilages contain elongated alveolar glands (glandulae tarsales), about 20 of them in the lower eyelid and 25 in the upper. The glands are located in parallel rows, their excretory ducts open near the posterior free edge of the eyelids. The lipid secretion of the glands lubricates the intercostal space of the eyelids, forming outer layer precorneal tear film, which prevents tears from rolling down through the lower edge of the eyelid.

The connective tissue membrane (conjunctiva) covering the back surface of the eyelids is tightly fused with cartilage. When the conjunctiva passes from the eyelids to the eyeball, it forms movable vaults - upper and lower. The edges of the eyelids, forming the palpebral fissure, are limited in front by the anterior rib, and behind by the posterior rib. The narrow strip between them, up to 2 mm wide, is called the intercostal (intermarginal) space; here are located the roots of the eyelashes in 2-3 rows, sebaceous glands (Zeiss glands), modified sweat glands (Moll glands), openings of the excretory ducts of the meibomian glands. At the inner corner of the eye, the intermarginal space narrows and passes into the lacrimal papilla (papilla lacrimalis), at the top of which there is an opening - the lacrimal punctum (punctum lacrimale); it is immersed in the lacrimal lake and opens into the lacrimal canaliculus (canaliculus lacimalis).

Eyelid muscles

Under the skin of the eyelids, ensuring their mobility, there are two groups of muscles - antagonists in the direction of action: the circular muscle of the eye (m. orbicularis oculi) and the muscle that lifts the upper eyelid (m. levator palpebrae superioris).

Orbicularis oculi muscle consists of the following parts: orbital (pars orbitalis), palpebral, or age-old (pars palpebralis), and lacrimal (pars lacrimalis). The orbital part is a circular belt, the fibers of which are attached to the medial ligament of the eyelids (lig. parpebrale mediale) and the frontal process of the maxilla. When this part contracts, the eyelids close tightly. The fibers of the palpebral part begin from the medial ligament of the eyelids and, forming an arc, reach the outer corner of the eye, attaching to the lateral ligament of the eyelids. When this muscle group contracts, the eyelids close and blink.

The lacrimal part is a group of muscle fibers that start from the posterior lacrimal crest of the lacrimal bone (os lacrimalis), then pass behind the lacrimal sac (saccus lacrimalis), intertwining with the fibers of the palpebral part. The muscle fibers enclose the lacrimal sac in a loop, as a result of which, when the muscle contracts, the lumen of the lacrimal sac either expands or narrows. Thanks to this, the process of absorption and movement of tear fluid along the lacrimal ducts occurs.

There are muscle fibers of the orbicularis oculi muscle, which are located between the roots of the eyelashes around the duct of the meibomian glands (m. ciliaris Riolani). Contraction of the fibers promotes the secretion of the mentioned glands and a tight fit of the edge of the eyelids to the eyeball. The circular muscle is innervated by the zygomatic (rr. zygomatici) and temporal (rr. temporales) branches of the facial nerve.

Levator superioris muscle, begins near the optic canal (canalis opticus), goes under top part orbit and ends in three muscle plates. The superficial plate, forming a wide aponeurosis, perforates the tarso-orbital fascia and ends above the skin of the eyelid. The middle one consists of a thin layer of smooth fibers (m. tarsalis superior, m. Mulleri), intertwined with top edge cartilage, innervated by sympathetic nerve fibers. A deep plate in the form of a wide tendon reaches the upper fornix of the conjunctiva and is attached there. The superficial and deep plates are innervated by the oculomotor nerve.

The lower eyelid is retracted muscle of the lower eyelid cartilage(m. tarsalis inferior) and fascial processes of the inferior rectus muscle (m. rectus inferior).

Blood supply

The blood supply to the eyelids is carried out through the branches of the ophthalmic artery (a. ophthalmica), which is part of the internal carotid artery system, as well as anastomoses from the facial and maxillary artery(aa. facialis et maxiaJlaris) from the external carotid artery system. These arteries branch and form arterial arches: two on the upper eyelid, one on the lower. The arteries correspond to veins, through which the outflow of venous blood occurs mainly towards the angular vein (v. angularis), vein of the lacrimal gland (v. lacrnnalis) and temporal superficial vein(v. temporalis superfirialis). The structural features of these veins include the absence of valves and the presence of a large number of anastomoses. It is clear that such features can cause the development of severe intracranial complications, for example, with the development of purulent processes on the face.

Lymphatic system

The lymphatic network is well developed on the eyelids; There are two levels, which are located on the anterior and posterior surfaces of the cartilage. Lymphatic vessels upper eyelids flow into preauricular The lymph nodes, lower eyelid - into the submandibular lymph nodes.

Innervation

The branches of the facial nerve (n. facialis) and three branches of the trigeminal nerve (n. trigeminus), as well as the great auricular nerve (n. auricularis majos) provide sensitive innervation to the skin of the face. The skin and conjunctiva of the eyelid are innervated by two main branches of the maxillary nerve (n. maxillaris) - the infraorbital (n. infraorbitalis) and zygomatic (n. zygomaticus) nerve.

Eyelid research methods

To study the condition of the eyelids, the following research methods are used:

1. External examination of the eyelids, palpation.

2. Inspection with side (focal) lighting.

3. Inspection of the mucous membrane of the eyelids when everting the upper and lower eyelids.

4. Biomicroscopy.

Diseases of the eyelids

Among the total number of patients with inflammatory diseases 23.3% of eyes are patients with inflammation of the eyelids. The pathology of the auxiliary and protective apparatus of the eyes is of great socio-economic importance, as it is one of the most common reasons temporary disability and can lead to significant complications from the organ of vision.

Zhaboyedov G.D., Skripnik R.L., Baran T.V.