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 amazing muscles should be studied in detail. The eyelids cover the outer part of the eyes and protect from external factors. Main functions:

• protection against the ingress of small particles and foreign objects;
• uniform distribution of 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.

The detailed structure of the eyelids 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 the 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 of the top edge connects to the tissue that supports the eyeballs. In medicine it is called the ligament of Withnell. Features a strong connection. They can be separated only 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 no less important functions. Abnormal development can 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. It can manifest itself in varying degrees of damage 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.

Ptosis (drooping) of the upper eyelid is an uncontrolled disruption of the muscles that raise and lower the 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 host 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 of the upper edge of the iris. 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 the cervical region and is capable of expanding the palpebral fissure by only 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 visual function is just developing. Ptosis in a child leads to impaired development of binocular vision.

All these complications are also typical for adults, but when they occur in an infant, they contribute to the incorrect training of the brain to compare 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 the nerve centers. Congenital ptosis is characterized by bilateral damage to the upper eyelid of the right and left eyes simultaneously.

Watch an interesting video about the congenital form of the disease and treatment methods:

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:

1. Aponeurotic blepharoptosis – excessive stretching or relaxation of muscles, loss of tone.
2. 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.
3. Mechanical blepharoptosis is post-traumatic muscle damage, tumor growth, and scarring.
4. Age-related – the natural physiological processes of aging of the body provoke weakening and stretching of muscles and ligaments.
5. 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;
• a 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:

1. First degree – from +2 to +5 mm.
2. Second degree – from +2 to -2 mm.
3. 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;
• fatigue;
• 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 and prescribing adequate treatment. Drooping of the eyelid in the early stages is hardly noticeable, but it is an extremely important sign of the onset of the development of serious diseases such as a brain tumor. Therefore, it is important for an 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 conduct additional examinations to exclude all possible causes of the disease.

Stages of diagnosing blepharoptosis:

1. Visual inspection, measurement of the degree of ptosis.
2. Measurement of acuity, visual field, intraocular pressure, fundus examination.
3. Biomicroscopy of the eye.
4. Measurement of muscle tone, fold symmetry and blinking.
5. Ultrasound of the eye, electromyography.
6. Radiography.
7. MRI of the head.
8. Checking for binocular vision.
9. 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 of 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 go 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 a drug derived from botulinum bacteria that 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 performed under local anesthesia on an outpatient basis. The 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 resolves.

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. In non-surgical treatment, medications, massage, alternative medicine, and physiotherapeutic procedures are used.

Methods for treating drooping eyelids using folk remedies:

• a mask of raw chicken eggs with sesame oil is 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 are used orally, mainly B vitamins, neuroprotectors, drugs that stimulate growth, as well as the regeneration of nerve tissue, enhancing the nutrition of 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.

Origin: tendon ring around the optic canal

Attachment – ​​cartilage of the upper eyelid

Function: raises the upper eyelid

VISUAL ANALYZER. VISUAL PATHWAY

Location of 1 neurons: Rods and cones, located in the retina, are converted neurons. Convert the energy of light quanta into a nerve impulse;

The course of axons of 1 neurons: inside the retina, to bipolar neurons;

Location of 2 neurons: Bipolar neurons, located in the retina, send axons to ganglion neurons;

The course of axons of 2 neurons: run in the retina and end at synapses on ganglion neurons

Location of 3 neurons: In the retina. The axons of ganglion neurons, leaving the eyeball, form the optic nerve;

The course of axons of 3 neurons: Optic nerve (through the optic canal it enters the middle cranial fossa), Optic chiasm (Axons coming from the medial retinal fields cross at the chiasm and go into the optic tract of the opposite side; axons coming from the lateral retinal fields go into the optic tract of their side) , optic tract, further:

Lateral geniculate body (Ends with synapses on neurons of the nucleus of the lateral geniculate body);

Superior colliculus (ends with synapses on neurons of the nucleus of the superior colliculus)

The course of the axons of 4 neurons:

A) From the nucleus of the lateral geniculate body:

The posterior leg of the internal capsule (forms the optic radiation), the occipital lobe of the telencephalon hemisphere, where they end in the cortical nucleus of the visual analyzer (the wedge, the calcarine sulcus, the lingual gyrus);

B) From the nucleus of the superior colliculus:

To the nuclei of the oculomotor nerve (III pair of cranial nerves), which control the movements of the muscles of the eyeball, accommodation and pupil diameter;

Through the posterior longitudinal fasciculus to the nuclei of the IV and VI pairs of cranial nerves and motor neurons of the cervical spinal cord

INNERVATION OF THE GAZE

This is a mechanism for controlling the synchronous rotation of the eyeballs and head towards the object of observation. The center of gaze innervation is located in the premotor zone of the left hemisphere. The conducting path from the center is directed to the bridge to the nuclei of the abducens nerves. From there, synchronizing commands through the posterior longitudinal fasciculus enter the midbrain to the nuclei of the oculomotor and trochlear nerves, as well as to the motor neurons of the cervical spinal cord.

TEST QUESTIONS

1. Specify the membranes of the eyeball

2. Indicate the parts of the light-refracting apparatus of the eyeball

3. Specify the parts of the tunica albuginea

4. Specify the parts of the choroid

5. Describe the structure of the ciliary body

6. What is the mechanism of accommodation?

7. Describe the structure of the iris

8. Describe the structure of the lens

9. Describe the structure of the anterior and posterior chambers of the eyeball

10. Indicate the place of formation and the route of outflow of aqueous humor

11. Describe the structure of the retina

12. Muscles of the eyeball: their location, origin, attachment, function;

13. Lacrimal apparatus: its parts, their structure. The path of outflow of tear fluid.

14. Conjunctiva, its structure and function.

15. Eyelids, their structure and function.

16. Visual pathway: its links, subcortical centers, cortical nucleus

This also includes the muscle that lifts the upper eyelid (m. levator palpebrae superioris).

Start : a thin narrow tendon fixed to the lesser wing of the sphenoid bone above the common tendon ring of Zinn and superiorly outside the optic foramen.

Attachment : orbital septum 2-3 mm above the edge of the cartilage (8-10 mm from the edge of the eyelid).

Blood supply : superior (lateral) muscular artery (branch of the ophthalmic artery), supraorbital artery, posterior ethmoidal artery, peripheral arterial arch of the upper eyelid.

Innervation : bilateral through the superior branch of the oculomotor nerve (n. III). Upper branch n. III enters the levator from below at the border of its posterior and middle thirds - 12–13 mm from the apex of the orbit.

Anatomy details : abdominal length - 40 mm, aponeurosis - 20–40 mm.

Three servings of muscle:

• The middle muscle portion, consisting here of a thin layer of smooth fibers (rostio media; m. tarsalis superior s. m. H. Mulleri), is woven into the upper edge of the cartilage; this portion is innervated by the cervical sympathetic nerve, while the remaining mass of striated levator fibers receives innervation from the oculomotor nerve.
• The anterior portion of the levator ending, turning into a wide aponeurosis, is directed to the tarso-orbital fascia; slightly below the superior orbital-palpebral groove it penetrates in separate bundles through this fascia, reaches the anterior surface of the cartilage and spreads all the way to the skin of the eyelid.
• Finally, the third, posterior, portion of the levator (also tendon) is directed to the upper fornix of the conjunctiva.

Such a triple ending of the muscle that lifts the upper eyelid, during its contraction, provides the possibility of joint movement of the upper eyelid as a whole through the cartilage (middle portion), the skin of the upper eyelid (anterior portion) and the upper conjunctival fornix (posterior portion of the muscle).

With normal levator tone, the upper eyelid occupies such a position that its edge covers the cornea by about 2 mm. Dysfunction of the elevator is expressed by the main symptom - drooping of the upper eyelid (ptosis) and, in addition, smoothness of the superior orbital-palpebral groove.

In the lower eyelid, there is no formalized muscle similar to the levator, i.e., the “descender” of the eyelid. Nevertheless, the lower eyelid is pulled back when the eye turns downward by fascial processes that penetrate into the thickness of the eyelid and into the lower transitional fold of the conjunctiva from the sheath of the inferior rectus muscle of the eyeball. These cords, to which smooth muscle fibers may be mixed, are then given by some authors the name m. tarsalis inferior.

The course of the muscle is located lateral to the superior oblique and over the superior rectus muscle. In the anterior part of the upper part of the orbit, the levator is surrounded by a thin layer of fatty tissue, and here it is accompanied by the superior orbital artery, frontal and trochlear nerves, separating it from the roof of the orbit.

The superior rectus and levator of the upper eyelid are easily separated, despite their close proximity, except for their medial part, where they are connected by a fascial membrane. Both muscles originate from the same area of ​​mesoderm. Both muscles are innervated by the superior branch of the oculomotor nerve. The nerve penetrates the muscles from the lower side at a distance of 12-13 mm from the apex of the orbit. Usually the nerve trunk approaches the levator from the outside of the superior rectus muscle, but it can also pierce it.

Directly behind the superior edge of the orbit, a section of dense fibrous tissue (the superior transverse ligament of Withnell, which supports the eyeball) is attached superiorly to the levator. The connection between them is quite strong, especially in the outer and inner parts. In this regard, their separation is possible only in the central areas. On the medial side, the Withnell ligament ends near the trochlea, while it passes in the form of fibrous cords under the superior oblique muscle of the eye behind, mixing with the fascia covering the supraorbital recess. On the outside, the ligament of Withnell connects to the fibrous capsule of the lacrimal gland and the periosteum of the frontal bone.

Withnell suggests that the main function of this ligament is to limit posterior displacement (tension) of the muscle. The author put forward this assumption due to the fact that its localization and distribution are similar to the limiting ligaments of the external muscles of the eye. The tension of the ligament provides support for the upper eyelid. If the ligament is destroyed, the levator of the upper eyelid sharply thickens and ptosis occurs on the inside.

The distance from the transverse ligament of Withnell to the lower edge of the cartilaginous plate is 14-20 mm, and from the levator aponeurosis to the circular and skin insert is 7 mm.

In addition to the palpebral insertion, the levator aponeurosis forms a wide fibrous cord that attaches to the edge of the orbit immediately behind the internal and external ligaments of the eyelids. They are called the inner "horn" and the outer "horn". Since they are quite rigid, during levator resection it is possible to maintain the upper eyelid in the desired position by fixing the “horn” with an instrument.

The outer “horn” is a fairly powerful bundle of fibrous tissue that partially divides the inner part of the lacrimal gland into two parts. It is located below, attached in the area of ​​the outer tubercle of the orbit to the outer ligament of the eyelid. Failure to take this anatomical feature into account when removing a lacrimal gland tumor can lead to ptosis of the lateral part of the upper eyelid. The internal "horn", on the contrary, becomes thinner, turns into a thin film that passes over the tendon of the superior oblique muscle towards the internal ligament of the eyelid and the posterior lacrimal crest.

The fibers of the levator tendon are woven into the connective tissue of the cartilaginous plate of the upper eyelid approximately at the level of its upper third. When the muscle contracts, the eyelid rises and at the same time the preaponeurotic space is shortened and the postaponeurotic space is lengthened.

The key to good results when performing facial gymnastics and massages is accurate knowledge of facial anatomy.

The fight against aging for a woman usually begins with the skin around the eyes, since this is where the first age-related problems appear: the skin loses its freshness, swelling and fine wrinkles appear.

And no wonder: in the eye area the layer of epidermis is very thin - only half a millimeter. In addition, around the eyes there are almost no sebaceous glands, a “soft pad” of subcutaneous fatty tissue and very little muscle that maintains its elasticity. Collagen fibers (the “reinforcement” of the skin) are arranged here in the form of a mesh, so the skin of the eyelids is easily stretchable. And due to the looseness of the subcutaneous tissue, it is also prone to swelling. In addition, she is constantly in motion: her eyes blink, squint, and “smile.” As a result, the skin around the eyes is particularly stressed.
Therefore, let's start understanding the structure of the face from this area.

Anatomy of the area around the eyes

The eyelids and periorbital region are a single complex consisting of many anatomical structures that undergo changes during surgical manipulation

The skin of the eyelids is the thinnest on the body. The thickness of the eyelid skin is less than a millimeter.

Unlike other anatomical areas where fatty tissue lies under the skin, just under the skin of the eyelids lies the flat orbicularis oculi muscle, which is conventionally divided into three parts: internal, median and external.
The inner part of the orbicularis oculi muscle is located above the cartilaginous plates of the upper and lower eyelids, the middle part is above the intraorbital fat, the outer part is located above the bones of the orbit and is woven above into the muscles of the forehead, and below into the superficial musculofascial system of the face (SMAS).
The orbicularis oculi muscle protects the eyeball, performs blinking, and functions as a “tear pump.”

The musculoskeletal system of the eyelids performs a supporting function and is represented by thin strips of cartilage - tarsal plates, lateral canthal tendons and numerous additional ligaments.
The superior tarsal plate is located on the lower edge of the upper eyelid under the orbicularis oculi muscle, and is usually 30 mm in length and 10 mm in width, it is firmly connected to the inner part of the orbicularis oculi muscle, the aponeurosis of the levator palpebrae superioris muscle, Müller's muscle and the conjunctiva. The inferior tarsal plate is located on the upper edge of the lower eyelid, usually 28 mm in length and 4 mm in width, and is attached to the orbicularis muscle, capsulopalpebral fascia and conjunctiva. The lateral canthal tendons are located under the orbicularis oculi muscle and are firmly connected to it. They connect the tarsal plates to the bony edges of the orbit.

Under the orbicularis muscle also lies the orbital septum - a thin but very strong membrane; one edge is woven into the periosteum of the bones surrounding the eyeball, and the other edge is woven into the skin of the eyelids. The orbital septum retains the intraorbital fat within the orbit.

Under the orbital septum there is intraorbital fat, which acts as a shock absorber and surrounds the eyeball on all sides.
Portions of the upper and lower intraorbital fat are divided into internal, central and external. Next to the upper outer portion is the lacrimal gland.

The muscle that lifts the upper eyelid opens the eye and is located in the upper eyelid under the cushion of fat. This muscle is attached to the superior tarsal cartilage.
The skin of the upper eyelid is usually attached to the levator palpebrae superioris muscle. At the site of attachment of the skin to this muscle, when the eye is open, a fold forms on the upper eyelid.
This supraorbital fold varies greatly from person to person. In people from Asia, for example, it is weakly expressed or not at all; in Europeans, it is well expressed.

1 - Müller muscle, 2 - Levator muscle of the upper eyelid 3 - Superior rectus muscle 4 - Inferior rectus muscle 5 - Inferior oblique muscle 6 - Orbital bones 7 - Edge of the eye socket 8 - SOOF - infraorbital fat 9 - Orbital ligament 10 - Orbital septum 11 - Intraorbital fat 12 - Capsulopalpebral fascia	13 - Inferior pretarsal muscle 14 - Lower tarsal plate 15 - Superior pretarsal muscle 16 - Upper tarsal plate 17 - Conjunctiva 18 - Links 19 - Muscle that lifts the upper eyelid 20 - Orbital septum 21 - Intraorbital fat 22 - Eyebrow 23 - Eyebrow fat 24 - Bones of the orbit

Behind these structures is the eyeball itself, which is supplied and innervated through the posterior part of the orbit.
The muscles that move the eye are attached at one end to the eyeball and lie on its surface, and at the other end they are attached to the bones of the orbit.
The nerves that control the muscles are small branches of the facial nerve and enter the orbicularis oculi muscle on all sides from its outer edges.

The anatomical structures of the lower eyelid and midface are closely related, and changes in the anatomy of the midface affect the appearance of the lower eyelid. In addition to portions of periorbital fat, two additional layers of fatty tissue exist in the midface.

Beneath the outer part of the orbicularis oculi muscle lies the infraorbital fat (SOOF). The greatest thickness of SOOF is on the outside and sides.
The SOOF is deep to the superficial musculoaponeurotic system of the face (SMAS) and envelops the zygomatic major and minor muscles.
In addition to SOOF, malar fat is an accumulation of fat in the form of a triangle or so-called. "painting" fat is located under the skin, above the SMAS.

Aging of the midface is often accompanied by sagging of the malar fatty tissue, which results in noticeable zygomatic or so-called “painting” bags on the face.

The main supporting structure of the midface is the orbitozygomatic ligament, which runs from the bones almost along the edge of the orbit to the skin. It contributes to the formation of the zygomatic “painting” bag and the eyelid-cheek separation visible with age.

Ideal eye proportions

As a rule, a good aesthetic result is obtained only when the proportions of the eye and eyelids are in accordance with the proportions of the face. Outside, the eyelids and paraorbital region are represented by many anatomical structures.

The palpebral fissure is formed by the edge of the upper and lower eyelids. If you measure the eye, it usually measures 30-31 mm horizontally and 8-10 mm vertically.

The outer canthus is usually located 2 mm above the inner canthus in men and 4 mm in women, forming an inclination angle of 10-15 degrees, i.e. the palpebral fissure is slightly inclined from outside to inside and from top to bottom.
However, the position of the outer corner of the eye may change due to age and may be influenced by heredity, race, and gender.

The edge of the upper eyelid usually covers the iris by approximately 1.5 mm, and the lower eyelid begins just below the lower edge of the iris.

The normal position (protrusion) of the eyeball relative to the bony walls of the orbit is noted in 65% of the population, and it ranges from 15 to 17 mm.
Deep-set eyes have a protrusion of less than 15 mm, and protruding eyes have a protrusion of more than 18 mm.

The size of the iris is approximately the same in all people, but the shape of the scleral triangles (the white triangles between the iris and the corners of the eye) may vary.
Typically, the nasal scleral triangle is smaller than the lateral one and has a more obtuse angle.
With increasing eyelid laxity and age, these triangles lose shape, especially the lateral scleral triangle.

The horizontal fold in the upper eyelid is formed by the aponeurosis of the levator palpebrae superioris muscle, which is woven into the skin, passing through the orbicularis oculi muscle.
Excess skin and muscle hangs over the crease, which is a fixed line. Both the upper folds of the eyelids and the amount of skin overhanging them vary between people of different races and are influenced by gender and age.

The fold of the upper eyelid in Europeans is approximately 7 mm above the edge of the eyelid along a line drawn through the center of the pupil in men and 10 mm above the edge of the eyelid in women. In the lower eyelids, there are similar folds that are located 2-3 mm below the edge of the eyelids. Typically, lower eyelid folds are more noticeable at a young age and less noticeable as you age. In Asians, the fold of the upper eyelid is either lower - no more than 3-4 mm above the edge of the eyelid or is absent.

Differences between the female and male eyes also appear in several other points: the inclination of the palpebral fissure (from the outside in and from top to bottom) in men is less pronounced than in women, the bone structures above the eye are more full and the eyebrow itself is usually wider, located lower and less curved.

Age-related changes in the upper and lower eyelids

The main features of young eyelids are a smooth contour extending from the eyebrow to the upper eyelid and from the lower eyelid to the cheek and midface. The eyelid-cheek division is located at the edge of the orbit and is usually 5-12 mm below the edge of the lower eyelid, the skin is taut and the tissues are full. From the inner canthus to the outer canthus, the horizontal axis of the eye has an upward slope.

In contrast, with age, the eyes appear hollow, with a clear boundary between the eyebrow and upper eyelid, lower eyelid and cheek. In most people, the palpebral fissure becomes smaller and/or rounded with age due to the downward displacement of both the upper and lower eyelids. The eyelid-cheek division is located significantly below the edge of the orbit, 15-18 mm from the edge of the lower eyelid, and the slope from the inner canthus to the outer canthus becomes downward. Which gives the eyes a sadder look.

A youthful upper eyelid usually has minimal excess skin. Dermatochalasis, or excess skin, is a cardinal feature of the aging upper eyelid.

Constant contraction of the muscles surrounding the eyes, the creep of sagging forehead tissues and loss of elastic properties of the skin lead to the formation of the so-called. "crow's feet" - fan-shaped wrinkles located at the outer corner of the eye and fine wrinkles under the lower eyelid.

The youthful lower eyelid has a smooth, continuous transition zone between the eyelid and cheek without bulging orbital fat, indentation, or pigmentation.
With age, progressive skeletonization of the orbit occurs (the relief of the bones around the eye becomes more visible), as the subcutaneous fat covering the orbital frame atrophies and migrates downward. This downward displacement of fat results in loss of cheek convexity.
Also, pigmentation (darkening of the skin) or the so-called may appear on the lower eyelid. "circles under the eyes" with or without infraorbital depressions.
Eyelid bags or herniations can be caused by orbital weakening of the orbital septum, which stretches and causes orbital fat to protrude.

♦ Increase in length (height) of the lower eyelid

The nasolacrimal groove and zygomatic groove, which appear with age, can give the eye area an unaesthetic appearance. Atrophy of intraorbital fat associated with aging can make the eyes appear sunken and skeletal.
Many wrinkles around the eye may reflect loss of skin elasticity.

Aging of the eyelids. Causes and manifestations

The main causes of age-related changes in the eyelid area are stretching and weakening of the ligaments, muscles and skin of the face under the influence of gravitational forces - attraction. The elasticity of the facial ligaments weakens, they lengthen, but remain firmly fixed to the bones and skin.
Consequently, in the most mobile areas with minimal fixation of the ligaments to the skin, gravity pulls the tissue downward with the formation of protrusions. They are filled with deep fatty tissues, such as “fatty hernias” of the lower or upper eyelid.
Where the ligaments hold the skin and muscles more firmly, depressions or grooves appear - relief folds.

In the area of ​​the upper eyelids, these changes may look like overhang of skin and fatty tissue in the area of ​​the outer corners of the eye (outer “bags” - Fig. 1) and inner corners of the eye (inner “bags” - Fig. 2), overhang of only the skin over the entire eyelid gap or only from the outside (dermatochalasis - Fig. 3), drooping of the entire upper eyelid (ptosis - Fig. 4).

In the area of ​​the lower eyelids, these changes may look like drooping of the lower eyelid (exposure of the sclera - Fig. 5), an increase in the lower portion of the muscle surrounding the eyes (hypertrophy of the orbicularis oculi - Fig. 6), the appearance of “bags” under the eyes when intraorbital fat is no longer retained inside the orbit by the orbicularis oculi muscle and the orbital septum, losing their tone (“fatty hernias” - Fig. 7, Fig. 8).

♦ Classification of age-related changes in the eyelids

Age-related changes in the lower eyelid area develop over time and can be classified into the following four types:

	Type I- Changes are limited to the area of ​​the lower eyelids; weakening of the muscle tone surrounding the eye and bulging of orbital fat may be observed.
	Type II- Changes extend beyond the boundaries of the lower eyelids; weakening of the tone of the muscles surrounding the eyes, weakening of skin tone and the appearance of excess skin, slight drooping of the cheek tissue and the appearance of eyelid-cheek separation may be observed.
	III type- Changes affect all tissues bordering the eyelids, lowering of the tissues of the cheeks and zygomatic region, increasing the separation of the eyelid-cheek, skeletonization of the orbit - the bones of the orbit become visible, the nasolabial folds deepen.
	IV type- Further lowering of the eyelid-cheek separation, deepening of the nasolacrimal grooves, the appearance of the so-called. "malar" or zygomatic "bags", drooping of the outer corners of the eye and exposure of the sclera.

This classification helps solve problems characteristic of each type of age-related changes in the eyelid area.

The classification demonstrates that the aging of the lower eyelid area and the middle zone of the face is integrally related to each other, and rejuvenation of one area without the other, in some cases, can lead to insufficient or unsatisfactory results.
It is important to note that one of the cornerstones of these changes is the real and obvious loss of tissue volume in the eyelids and cheeks, and only its restoration can sometimes improve the situation.