Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The tarsal glands are embedded in the posterior surface of each tarsal plate, the fibrous “skeleton” of the upper eyelid. The orbital septum is a sheet of connective tissue separating the superficial facial fascia and the contents of the orbit. The tarsal glands drain by orifices lying posteriorly to the eyelashes and secrete an oily substance onto the margin of the eyelids that prevents the overflow of tears (lacrimal fluid). The lacrimal gland lies in the lacrimal fossa of the frontal bone. The lacrimal sac lies posterior to the medial palpebral ligament, which is attached to the anterior lacrimal crest that forms the anterior border of the lacrimal groove (Plate 3.32). The lacrimal sac receives lacrimal fluid from the medial angle of the eye through the lacrimal canaliculi. When lacrimal fluid accumulates in excess and cannot be removed from the medial corner of the eye via the lacrimal canaliculi, it overflows the eyelids (visible crying or shedding of tears). Tears also drain into the nasal cavity via the lacrimal sac, resulting in a runny nose.
Bacteriology of Ophthalmic Infections
K. Balamurugan, U. Prithika in Pocket Guide to Bacterial Infections, 2019
Partition of the soft tissues of eyelid and orbit by orbital septum creates preseptal and postseptal space. Infections at the preseptal space which is anterior to the orbital septum is defined as the preseptal or periorbital cellulitis (Nageswaran et al., 2006). In orbital cellulitis, the infection is restricted to the posterior of orbital septum (Mawn et al., 2000). Trauma, sinusitis, and bacteremia are the major routes of orbital infections. Clinical manifestations of periorbital cellulitis include erythema, induration, tenderness, chemosis, proptosis, limited ocular motility, optic neuritis, hypesthesia, sensory distribution, and so on. Infection of the periorbital cellulitis is restricted to the preseptal eyelid tissue. H. influenza, beta hemolytic Streptococcus spp., S. aureus, S. epidermidis, and S. pyogenes are major etiological agents. Other rare causative agents are P. aeruginosa, N. gonorrhoeae, Treponema pallidum, and Mycobacterium tuberculosis among others (Ambati et al., 2000; Carlisle and Fredrick, 2006).
Cosmetic Facial Interventions
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in Scott-Brown's Essential Otorhinolaryngology, 2022
Important surgical references for upper eyelid blepharoplasty include (Figure 49.1):Any eyelid ptosis or brow ptosis should be addressed.A minimum distance of 7–8 mm should be left between lid margin and the upper eyelid skin crease and approximately 22–25 mm of skin between the inferior aspect of the eyebrow and the eyelid margin.The upper eyelid skin crease represents the most superior point of attachment between the skin and the levator aponeurosis. This position is just inferior to the insertion of the orbital septum onto the levator aponeurosis. The skin crease lies at a higher level in females, approximately 7–8 mm from the lash line, compared with 5–6 mm in males. It is important not to raise the skin crease in males to avoid a ‘feminisation’ of the eyelid appearance.
Efficacy of vertical lid split versus lateral canthotomy and cantholysis in the management of orbital compartment syndrome
Published in Orbit, 2021
Julia Elpers, Christopher Areephanthu, Peter J. Timoney, William R. Nunery, H.B. Harold Lee, Roxana Fu
Blindness following orbital trauma is rare, however when vision loss does occur, it is most often due to orbital compartment syndrome.1–3 The orbital contents are bound posteriorly by four bony walls and anteriorly by the orbital septum, which fuses with the periosteum and eyelids. These rigid confinements limit the compliance of the space, and any increase in volume, as occurs with edema, neoplasm, infection, anesthetic injection and retrobulbar hemorrhage, will increase orbital pressure. In OCS, the orbital pressure rises above perfusion pressure of the posterior ciliary arteries leading to optic nerve ischemia, and the central retinal artery may also become occluded. Studies have shown irreversible damage occurs between 60 and 120 minutes with sustained high orbital pressure.4,5
Deep lateral rim-sparing orbital wall decompression in spontaneous globe subluxation associated with shallow orbits and eyelids laxity
Published in Orbit, 2020
Álvaro Bengoa-González, Bianca-Maria Laslӑu, Agustín Martín-Clavijo, Enrique Mencía-Gutiérrez, Elena Salvador, María-Dolores Lago-Llinás
In patients with small bony orbit configuration and eyelid laxity, an increase in intraorbital pressure, or eyelid manipulation may induce globe subluxation. To date, two articles reported the association between SGS, shallow orbits and eyelid laxity.2,4 Ezra et al. argued a possible relationship between shallow orbits, excessively lax orbital septum and the development of SGS.2 Orbital septum is an inelastic fibrous sheet that functions like a diaphragm to retain the contents within the orbits. The increased laxity of the orbital septum and lateral and median canthal tendons allow a greater movement of the orbital contents, especially when a decreased depth of orbit exists and could be the causative factors for the development of SGS in our series. This painful and alarming event requires long-term treatment to prevent new episodes.
Post-traumatic enophthalmos secondary to orbital fat atrophy: a volumetric analysis
Published in Orbit, 2020
Liza M. Cohen, Larissa A. Habib, Michael K. Yoon
CT images were exported in DICOM format and analyzed using OsiriX imaging software (v.9.0.2, Pixmeo, Switzerland). Total orbital volume and orbital fat volume for the fractured and normal contralateral orbits were measured via semiautomated segmentation with three-dimensional volume rendering assisted region-of-interest (ROI) computation in the axial plane (Figure 1). The “Closed Polygon” tool was used to manually create an ROI every three slices, encompassing all the orbital contents including prolapsed tissue for the total orbital volume measurements and only fat for orbital fat volume measurements. After the group of ROIs were selected, the “missing” ROIs were generated. These were checked for errors in segmentation, and corrections were made by manual adjustment using the “Repulsor” tool to adjust the borders of an ROI. Then, the volume of the ROI was computed. Bone window was used for total orbital volume measurements, and soft tissue window was used for orbital fat volume measurements. Intraconal and extraconal fat volumes were quantified separately by measuring volumes of ROIs for contiguous regions of fat and computing the sum. Approximation of the orbital septum was defined as the anterior orbital boundary. Posterior regions lacking a bony boundary (i.e. superior/inferior orbital fissures, orbital apex) were traced with a straight line. Enophthalmos was measured radiographically in relation to the lateral orbital rim and orbital apex, which has been shown to have a strong positive correlation with clinically measured enophthalmos using a Hertel exophthalmometer (r = 0.97).3
Related Knowledge Centers
- Anatomy
- Eyelid
- Levator Palpebrae Superioris Muscle
- Scalp
- Biological Membrane
- Orbit
- Tarsus
- Medial Palpebral Ligament
- Posterior Lacrimal Crest
- Face