A plastic surgery guide to lower eyelid anatomy with images and comprehensive annotations.
Overview of Upper Eyelid
The Eyelid is a bilammellar structure. Its anatomy is complex & best remembered by the “Rule of 2’s”:
- 2 Eyelids: Upper Eyelid and Lower Eyelid
- 2 compartments for each Eyelid: Anterior and Posterior Lamellae separated by an Orbital Septum.
- 2 contents for each compartment: Skin and Muscle, Tarsus and Conjunctiva.
Anterior Lamella Anatomy
The Anterior Lamella is composed of Skin and Orbicularis Oculi muscle.
- Thinnest on the human body
- Loosely adherent to underlying orbicularis oculi muscle
The orbicularis oculi muscle is divided into 3 parts, organised concentrically around the palpebral fissure.
- Pre-Septal covers the orbital septum
- Pre-Tarsal covers the Tarsal Plate. Role in blinking and tear flow.
- Orbital is the outermost part of the muscle. Role in voluntary eye closure.
The orbicularis oculi muscle is innervated by the zygomatic branch of the facial nerve.
Posterior Lamella Anatomy
The Posterior Lamella is composed of Tarsal Plate and Conjunctiva.
Lower Tarsal Plate
The Tarsal Plate is approximately 25mm long, 1 mm thick and 5mm tall. Simply speaking, it provides structural support to the upper eyelid. It is anchored to the periosteum of the lateral orbit via the lateral canthal tendon.
Tissue that lines the inside of the eyelids and covers the sclera (the white of the eye).
Orbital Septum Anatomy
The Orbital Septum separates the anterior and posterior lamellae.
This fibrous membrane of connective tissue inserts onto the tarsal plate, where it fuses with the capsulopalpebral fascia (equivalent to upper eyelids levator aponeurosis).
It contains 3 pre-aponeurotic (nasal, central and lateral) fat pads:
- Each fat pad is separated by fibrous septa
- Inferior oblique muscle lies between nasal and central fat pads (important to remember in lower lid blepharoplasty.
Eyelid Reconstruction. Chang, Edward I. M.D.; Esmaeli, Bita M.D.; Butler, Charles E. M.D.Plastic and Reconstructive Surgery: November 2017 – Volume 140 – Issue 5 – p 724e-735edoi: 10.1097/PRS.0000000000003820