www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Part A of the second class on lids deals with the palpebral fissure, eyelid retractors (levator aponeurosis and Muller’s muscle) and protractors (orbicularis oculi). It discusses the lid to globe apposition, factors responsible for vertical and horizontal tautness of the lids, including the canthal ligaments and tarsus. Horizontal lid laxity leading to entropion and ectropion is explained. A brief outline of management of involutional ectropion and entropion is given.
7. Levatoraponeurosis Wide insertion into various layers of the lid Medial horn – posterior lacrimal crest Lateral horn – lateral orbital tubercle Anterior portion – skin Posterior portion – anterior tarsus Superior tarsal muscle – conjunctiva and tarsus
8. Muller’s muscle (superior tarsal muscle) Posterior part of levator 2 mm lift to the upper lid Insertion to tarsus and conjunctiva Sympathetic supply Horner’s syndrome – mild ptosis
11. Lower eyelid retractors Capsulopalpebral fascia analogous to levatoraponeurosis From inferior rectus terminal fibres Encircles inferior oblique Inserts to inferior conjunctival fornix and inferior tarsal border Inferior tarsal muscle Poorly developed Posterior to capsulopalpebralfascia