The Eyelids and Conjunctiva

The eyelids, upper and lower (Palpebra superior et inferior), are movable folds of integument situated in front of the eyeball. When closed, they cover the entrance to the orbit and the anterior surface of the eyeball. The upper lid is much more extensive and more movable than the lower one, and its free edge is more concave. The interval between the lids is termed the palpebral fissure (Rima palpebrarum). When the eye is closed, it is an oblique slit about two inches (ca. 5 cm.) in length; when open, it is biconvex in outline. The ends of the fissure are the angles or canthi, and are distinguished as internal or nasal, and external or temporal (Angulus oculi medialis, lateralis). The external angle is rounded when the eye is open, but the internal angle is narrowed to form a ᑐ-shaped bay or recess, termed the lacrimal lake (Lacus lacrimalis). In this there is a rounded, pigmented prominence known as the lacrimal caruncle (Caruncula lacrimalis); it is about the size of a small pea and is covered with modified skin, connected with that of the inner commissure, from which project a number of hairs provided with sebaceous glands. The lids unite on either side and form the commissures, internal and external (Commissura palpebrarum medialis, lateralis). The anterior surface of the lids (Facies anterior palpebrarum) is convex and presents a variable number of long tactile hairs in addition to the ordinary but very short hairs. A considerable number of tactile hairs are scattered over the lower part of the lower lid, but on the upper lid they are very scanty. The infrapalpebral depression (Sulcus infrapalpebralis) indicates somewhat indistinctly the limit of the lower lid. The upper lid is marked by two furrows when raised. The posterior surface (Facies posterior palpebrarum) is adapted to the free surface of the eyeball and is covered by the palpebral conjunctiva. The free border of the lid is smooth and usually black. It has a well defined posterior margin (Limbus palpebralis posterior), along which the ducts of the tarsal glands open. The anterior margin (Limbus palpebralis anterior) bears stiff hairs termed the cilia or eyelashes. On the upper lid the cilia are long and numerous except at its inner third, where they are very small or absent. On the lower lid the cilia are often scarcely distinguishable from the ordinary hairs; in other cases they may be clearly seen except near the external canthus, and are much finer and shorter than those of the upper lid. The edge of each lid is pierced near the internal angle by a minute, slit-like opening, the punctum lacrimalis, which is the entrance to the lacrimal duct or canaliculus.

Structure of the Eyelids.—The skin of the eyelids is thin and freely movable, except near the free edge, where it is more firmly attached. The underlying subcutaneous tissue is destitute of fat. The muscular layer consists chiefly of the elliptical bundles of the orbicularis oculi, with which are associated fibers of the corrugator supercilii in the upper lid and the malaris in the lower lid. At the inner side there is a fibrous band, the palpebral ligament, which is attached to the lacrimal tubercle and furnishes origin to some fibers of the orbicularis. At the inner commissure a bundle detached from the orbicularis passes inward behind the lacrimal sac, and is known as the pars lacrimalis or Horner’s muscle. At the outer side an indistinct palpebral raphé occurs where fibers of the orbicularis decussate. The fibrous layer is thicker and denser along the free edge of the lid, forming here the tarsus. The tarsus furnishes insertion to a layer of unstriped muscle known as the tarsal muscle (of Müller). The tarsal glands (Glandulæ tarsales) are partly embedded in the deep face of the tarsus, and are visible when the lid is everted if the conjunctiva is not too strongly pigmented. They are arranged in a linear series, close together, and with their long axes perpendicular to the free edge of each lid. In the upper lid they number forty-five to fifty; in the lower, thirty to thirty-five. Each consists of a tubular duct beset with numerous alveoli, in which a fatty substance, the palpebral sebum, is secreted. The palpebral conjunctiva lines the posterior surface of the eyelids.

The conjunctiva is the mucous membrane which lines the lids as palpebral conjunctiva (C. palpebrarum) and is reflected upon the anterior part of the eyeball as bulbar conjunctiva (C. bulbi); the line of reflection is termed the fornix conjunctivæ. The palpebral part is closely adherent to the tarsus, but is loosely attached further back. It is papillated and is covered with stratified cylindrical epithelium in which many goblet cells are present. In the fornix and its vicinity there are tubular glands (of Henle). Near the inner angle there are numerous lymph nodules. The conjunctiva of the outer part of the upper lid is pierced near the fornix by the orifices of the excretory ducts of the lacrimal gland. The bulbar conjunctiva is loosely attached to the anterior part of the sclera and is pigmented in the vicinity of the corneo-scleral junction. On the cornea it is represented by a stratified epithelium.

When the lids are in apposition, the conjunctiva (including the epithelium of the cornea) forms a complete conjunctival sac, as the capillary space between the lids and the eyeball is termed.

The third eyelid (Palpebra tertia) is situated at the inner angle of the eye (Figs. , ). It consists of a semilunar fold of the conjunctiva, known as the membrana nictitans, which covers and partly incloses a curved plate of hyaline cartilage. Its marginal part is thin and usually more or less pigmented. The cartilage has an elongated quadrilateral outline. The part of it which lies in the membrana is wide and thin. The deep part is narrower and thicker and is embedded in fat at the inner side of the eyeball. Numerous minute lymph nodules occur in the membrana nictitans, and the deep part of the cartilage is surrounded by a gland which resembles the lacrimal gland in structure (Glandula superficialis palpebæ tertiæ).

Ordinarily the third eyelid extends very little over the inner end of the cornea, but when the eyeball is strongly retracted (as in tetanus) the membrana is protruded over it so as to measure about an inch (ca. 2 to 3 cm.) in its middle. This effect results from the pressure of the eyeball and its muscles on the fat which surrounds the deep part of the cartilage.

Vessels and Nerves.—The arteries which chiefly supply the eyelids and conjunctiva are branches of the ophthalmic and facial arteries, and the blood is drained away by corresponding veins. The sensory nerves are branches of the ophthalmic and maxillary divisions of the trigeminus. The motor nerves to the orbicularis oculi, corrugator supercilii, and malaris come from the facial nerve, the levator palpebræ superioris is innervated by the oculomotor, and the unstriped muscle of the lids by the sympathetic.