Understanding Eyelid Anatomy

Coco Ruby Plastic Surgery Blog Eyelid Anatomy - Woman With Eye bag Traced

Having Eye Surgery or Blepharoplasty?

If you’re considering having Eye Surgery or if you’re just doing research, its important to understand your eyelid anatomy and eye concerns for better results. The eyelids serve as very efficient protectors for our eyes.

Ageing can cause many changes to our bodies, and our eyes are no exception. Drooping eyelids are a common result of ageing. Aside from the obvious cosmetic change that results from drooping eyelids, they can also affect an individuals eyesight and even restrict your field of vision. Fortunately, blepharoplasty can help correct this.  Below, we will talk a little more about the anatomy of eyelids and discuss some of the common glossary terms related to blepharoplasty to help you understand what they mean.

Anatomy of the upper eyelids

The eyes and eyelids are complex and formed of many muscles and different types of tissue. Below we have broken down the anatomy of the upper eyelids into 5 categories, from the most superficial to the deepest;

  • Skin and subcutaneous tissue: The upper eyelid consists of very thin skin. This can become lax and cause droopy eyelids.
  • Muscle: The orbicularis oculi muscle refers to the muscle in your upper eyelid. This muscle is responsible for opening and closing your eyes.
  • Orbital septum: A thin layer of dense connective tissue right below the muscle.
  • Conjunctiva: The conjunctiva is the mucus membrane that covers the inside of your eyelids. It’s the pink part you see when you flip your eyelid out.
  • Fat: The deepest layer consists of fat.  We refer to this as the “pre-aponeurotic fat pad”. It’s located right under the orbital septum.

Other Important Eye and Eyelid Anatomy.

NEW IMAGE for Eye Anatomy Article - 25743

  • Iris: The coloured part of your eye
  • Pupil: The black central part of your eye
  • Sclera: The white part of your eye
  • Tear ducts: Consist of small tubes that stretch from the eye into the nose. This allows tears to flow for the eye.
  • Lacrimal caruncle: Or, caruncula lacrimalis, is the small, pink, nodule that you can see in the inner corner of your eye.
  • Eye Lid: The folds of skin, both upper and lower that cover your eye when closed.
  • Palpebrae: The inner surface of the eyelids
  • Conjunctiva: The red-pink mucosal membrane covering the inner part of your eyelids (the palpebrae) and eye socket. It also forms a clear coat that covers your sclera.

Eyelid conditions that a blepharoplasty can correct (eyelid lift)

A Blepharoplasty is the most commonly performed cosmetic eye procedure. It is often done to correct droopy or baggy eyelids. Blepharoplasty may be done on; the upper eyelids and/or the lower eyelids, on one or both sides. Below are the main conditions that blepharoplasty can treat:

  • Blepharoptosis (droopy eyelids): Is the medical terminology to describe upper eyelid drooping regardless of its cause.
    • Also referred to as “hooding” of the upper eyelid, where it drops down and partially covers the eye, and is usually due to excess skin and fat in the eyelids.
    • Treatment for this condition is an upper eyelid lift (upper blepharoplasty).
  • Dermatochalasis (baggy eyelids): This is when you have puffy eyelids with excess skin, and it’s commonly associated with droopy eyelids.
  • Swollen eyelids can be a result of a medical condition or just a normal consequence of ageing.
  • As you grow older, your skin loses elasticity and becomes loose. Baggy eyelids are commonly seen in middle-aged and elderly women and men.
  • Excess skin is more noticeable in the upper eyelids, but it can affect both the upper and lower eyelids.

Other important medical conditions that affect eyelids

  • Steatoblepharon: Steatoblepharon is when the deep eyelid fat herniates through the orbital septum covering it, leading to baggy eyelids. Another name for this condition is “pre-aponeurotic fat prolapse”.
  • Double eyelid: A descriptive term that describes blepharoptosis, when the excess skin and tissue create multiple creases in the eyelids.
  • Lateral hooding: A descriptive term that describes blepharoptosis when the eyelids drop to cover the outer poles of your eyes.
  • Uneven eyelids: This is a descriptive term that describes blepharoptosis when only one eyelid is drooping causing an uneven appearance. This can be a result of strokes, facial nerve palsy (Bell’s palsy), or tics.
  • Blepharochalasis: An inflammation of the eyelids that causes temporary swelling. When it resolves, blepharochalasis leaves excess tissue and skin.
  • Thyroid orbitopathy: Growth of the tissue under the eyelids related to Grave’s disease (a disease of the thyroid gland)
  • Xanthelasma: Fat deposits on your eyelids. These lesions are seen in men and women who have high cholesterol levels or thyroid problems. Xanthelasmata can be removed by eyelid surgery, cryotherapy, laser ablation, or electrodissection.
  • A stye (hordeolum): This is a painful (usually red) pimple-like lesion that can develop on your eyelid. It happens when an eyelash hair follicle becomes infected. Styes usually go away on their own, but if they persist, they can be surgically removed.
  • Chalazion: This is a painless nodular lesion that can develop on your eyelid. It happens when an oil gland on your eyelid gets clogged and form a granuloma (nodule). Chalazions can go away on their own or with certain medications, but if they persist, they can be surgically removed.
  • Conjunctivitis: Also known as pink eye. It’s caused by a viral or bacterial infection, allergies, or eye trauma. All these can lead to the inflammation of the conjunctiva (the clear outer layer of your eye).

blepharoplasty-before-and-after-60-year-old-male-subiaco-Perth-Dr Patrick Briggs-b

What causes droopy eyelids?

Droopy upper or lower eyelids can be a normal result of ageing. However, there are several medical conditions that can also cause them:

  • Congenital ptosis: Some people are born with droopy eyelids due to a developmental problem of the eye muscles. This condition usually effects a single side.
    • If drooping is severe and interferes with the baby’s vision, it can lead to permanent damage and even blindness. This is why you should not delay a blepharoplasty.
  • Ageing: This is the most common cause of droopy eyelids.
    • The correct medical term to describe age-related eyelid ptosis is “aponeurotic ptosis”.
    • As you grow older, the tissue in your eyelids becomes weaker and due to gravity, it stretches down.
    • The condition might be unilateral or bilateral. In other words, it can effect one or both eyes.
  • Myasthenia gravis: This is a neurological condition that causes muscle weakness in the whole body, but is usually first observed in the eyes.
    • Myasthenia gravis leads to droopy eyelids and interferes with eye movement.
  • Muscle problems: Certain conditions like oculopharyngeal muscular dystrophy and progressive external ophthalmoplegia lead to weak eye and eyelid muscles, and subsequent ptosis and vision problems.
  • Nerve problems: Nerves control the muscles in your eyelids. Problems with the nervous system, like a stroke, brain tumour, or brain aneurysm can put pressure on these nerves or alter how they work.
    • This can lead to visual problems and eyelid drooping.
  • Eye problems: Eye infection, local tumours, or trauma can all lead to eyelid ptosis.

How do you know if you need a Blepharoplasty?

When your upper eyelids are drooping they can affect your peripheral vision and prevent your eyes from fully opening. Blepharoplasty removes the excess tissue and restores the normal field of vision. In addition, blepharoplasty of the upper and lower eyelids can restore a young and more alert look, you could benefit from blepharoplasty if:

  • You’re not happy with the appearance of your eyelids
  • You have puffy or drooping eyelids
  • Your droopy eyelids are affecting your vision
  • You have bags under your eyes that you believe are cosmetically unappealing.

Blepharoplasty procedure.

Coco Ruby Plastic Surgery Blog Eyelid Anatomy Surgery Before and After Illustration

The procedure is simple as a day procedure. First, your doctor will draw some markings on your eyelids to determine where they will cut. After that, they will scrub your eyelids with antiseptic and apply some drapes. Then, your surgeon will inject some local anaesthetic into the eyelid skin to make it numb. After that, a skin incision will be made, and the excess skin and possibly underlying fat or muscles will be removed. The surgeon will then close the wound with very small sutures that are barely visible. The sutures will stay in place for a few days, your surgeon will take them out at a follow up appointment. The wound will eventually become virtually invisible.

Will Medicare cover my blepharoplasty in Australia?

Most of the time, blepharoplasty is considered a cosmetic procedure and as a result it is not covered by Medicare or insurance. In some cases, however, (like if your eyelids are affecting your vision), blepharoplasty can be medical necessity and as such is eligible for a rebate.

Read about Will Medicare cover eyelid surgery?

Some common eyelid surgery glossary of Eyelid Anatomy

  • Blepharoplasty: Cosmetic surgical procedure to fix eyelid drooping
  • Blepharitis: Inflammation of the eyelid which can cause redness, swelling, and scaling on your eyelashes.
  • Ectropion: This is when the lower eyelid is rolled outward showing the inner pink surface.
  • General Anesthesia: This is when the anaesthetist gives you a combination of intravenous and inhaled drugs to put you to sleep during surgery.
  • Local Anesthesia: This is when your surgeon injects drugs directly into the surgical area to numb the region so that you won’t feel any pain.
  • Hematoma: Can be a complication of surgery. This is when blood accumulates in your wound.
  • Seroma: Can be a complication of surgery. This is when fluids accumulate in your wound.
  • Conjunctivitis: Inflammation of the conjunctiva (mucosal layer covering your eye, inner part of your eyelids, and eye socket)
  • Lacrimal glands: The glands that produce tears
  • Medial angle of the eye: The angle near your nose
  • Lateral angle of the eye: The angle at the side of your face

Our surgeons are some of the best plastic and reconstructive surgeons in Australia, and they offer blepharoplasty with outstanding results. They can help you restore the normal young, alert look in your eyes and remove any excess skin that might be disturbing your vision. If you have any questions about, Eyelid Anatomy, blepharoplasty or other eye surgery options, call us to set up an appointment and learn more about your options!

Further Reading – Medical Sources:

 

Last updated: 25/02/2021
Author profile image
Dr Richard Sackelariou - MBBS, FRACS, FRCS
Dr Richard Sackelariou, MBBS, FRACS/FRCS, is a leading Sydney Specialist Plastic, Cosmetic & Reconstructive Surgeon who sees patients in two locations: Double Bay, Sydney and Melbourne VIC (Australia). Dr Sackelariou offers extensive experience in attaining natural-looking, excellent surgical results for patients of all ages. Graduate of Sydney University, FRACS, Plastic and Reconstructive Surgery plus additional training in Cosmetic Surgery in Paris at the Clinique Turin in 1994. BIO PAGE: Click here