ANATOMI DAN

FISIOLOGI PALPEBRA
 Anatomi
Terdiri atas :
• Skin :
– Paling tipis
– Jaringan longgar
– Tdk ada lemak subkutan
• Otot Protraktor (M.orbicularis oculi)
• Septum orbita, lemak orbita
• Otot Retraktor (M. Levator)
• Tarsus
• Konjungtiva
• Silia
• Glandula (Zeis, Moll, Meibom)
• Otot :
– M. Orbikularis okuli :
• Circular
• Fungsi : membuka/menutup
• inervasi : N VII
– M. Levator palpebra :
• Melekat pd batas atas tarsus &
pertengahan kulit
• Inervasi : N III
– M. Muller’s :
• Otot polos
• Insersi : tepi atas tarsus
Fungsi Palpebra

• Pelindung mekanik bola mata.

• Menghasilkan komponen lipid untuk
air mata.
• Membantu membasahi kornea.
 Batas-Batas Palpebra
• Batas superior
daerah alis dan rima orbita
superior.
• Batas inferior
dari rima orbita inferior sampai ke
kulit nasojugal
dan lipatan malar.
• Lebar
horizontal fisura :30 mm vertikal
:8-10 mm.
 Lipatan Palpebra Superior
• (Lid crease) :
terbentuk dari perlekatan
serabut aponeurosis levator
di lapisan subkutan.
• Lokasi:
7-11 mm di atas margo
palpebra.
 Margo Palpebra (1/2)

• Panjang 25-30 mm dan

lebar 2 mm.
• Papila lakrimal:
6 mm lateral dari sudut kantus
medial
• Gray Line  Pertemuan antara
– epitel berlapis gepeng
berkeratin di anterior,
– epitel berlapis gepeng tak
berkeratin dan epitel berlapis
silindris di posterior.
 7 Lapisan Palpebra

1. Kulit & jaringan

subkutan.
2. Otot protraktor.
3. Septum orbita.
4. Lemak orbita.
5. Otot retraktor.
6. Tarsus.
7. Konjungtiva.
Vaskularisasi Arteri

• Dari a.karotis interna melalui

a.oftalmika dan a.infraorbita.
• A.karotis eksterna melalui
a.fasialis dan a.temporalis
superfisialis.
• Membentuk sirkulasi kolateral
yang besar.
Vaskularisasi Vena
• Terdiri dari arkade palpebra
superior dan arkade palpebra
inferior.
• Vena palpebra superior dan
inferior menuju v.angularis di
kantus medial.
• Vena angularis membentuk
anastomosis dengan sinus
kavernosus.
Sistim Limfatik

• Menuju nodus limfatikus

preaurikular dan submandibular.
• Menerima drainase dari sistem
superfisial dan profunda.
• Pleksus superfisial : menerima
aliran limfa dari kulit dan otot
orbikularis.
• Pleksus profunda : dari tarsus
dan konjungtiva.
Eye Lids
Diseases
 Eyelid Diseases
• Infection
– Hordeolum
• Suppurative acute infection at eyelids gland
caused by Staphylococcus
– Hordeolum internum : at meibom gland
 – Hordeolum eksternum : at zeis,mole gland

• Therapy :
– Systemic & local antibiotics
– Incision :
• mostly common on hordeolum externum
• Skin incision : margo
• Conjuctival incision : margo
• Complication : eyelids abscess
• Chalazion
– Chronic lipogranulomatous
inflammation of the meibom gland
– red-purple painless nodule at the
conjunctiva
– Therapy : incision
• Eyelids abscess
– originates from hordeolum or severe
eyebrow infections
– Therapy :
• Local and systemic antibiotics
• incision skin line
• Blepharitis
– bilateral
– chronic infection margin of the eye lid
– Squamous blepharitis (seborrhea) :
• signs : itching, burning, squamous seborrhoic at
the lash
• Th/ : cleaning with wet cotton, corticosteroid
ointment
• Herpes Zoster Ophtalmica
– E/ : herpes zoster viral
– clinical signs : very pain and burning (caused by
disturbances of the first branch of nervus V)
– Th/ : analgetic, antiviral (acyclovir), antibiotic
(to prevent from secondary infection) and local
corticosteroid
• ALERGY
– Clinical signs : eye lids edema
– Type :
• anaphylactic and atopy (urticaria and
angioneurotic edema)
• contact allergy (cosmetic)
– Th/ :
• eliminate etiological agent
• local and systemic steroid ( depend on
the E/)
 Tumor
– Benign :
• naevus
•verucca
• xanthelasma :
–yellowing plaque, irregular esp..
at medial
–Th/ : excision (for cosmetic
reason)
• milium :
– small and white papil (lenticular)
– caused by retention of sebacea gland
• Haemangiom (vascular tumor)
–Cavernous haemangiom :
• consists of the big branch of vein at
subcutan
• blueing
• change at vaso dilatation  bigger if
crying (Valsava test +)
– Capilary haemangiom :
• superficial
• consist of widing capillary
• red
– Th/ :
• cryocoagulation (if big and disturbing)
• steroid injection
• Neurofibromatosis (von
Recklinghausen disease)
• usually occur at temporal
– Malignant
• Basal Cell Ca at geriatric
• the most common eye lid malignancy (90-95%) on
lower eye lid (near medial cantus)
• clinical signs : ulcerative node, irregular,
pigmentation, metastation rare
• Th/ : excision and radio th/
– Nodular basal cell Ca
• firm, raised, pearly nodule
• central ulceration
– Morpheaform
• firm, slightly elevated
• characteristically : ulceration
– Squamous Cell Ca (Epithelioma)
• at geriatric
• esp. at superior palpebra
• metastation to preauricular nodes through lymphatic
system
• Th/ : wide excision
– Malignant Melanoma
• associated with conjuntival melanoma
• Th/ : radical operation --> excenteration
– Sebaceous Cell Ca
• at gland. Meibom
• recurrent Chalazion
• multifocal
• metastation : rare
• Th/ : wide excision
Eye Lid Malposition
• Entropion
– turning in of the eye lid margin  the
lashes touch the cornea (Trichiasis) 
corneal irritation  corneal ulcer
– unilateral or bilateral
• Congenital entropion
– Senile Entropion
• Th/ : blepharoplasty (reconstruction)

– Acute spastic
• ocular inflamation
• ocular irritation
– Cicatricial entropion
• caused by cicatrix/shortening of the
tarsus
• E/ :
– trauma thermal, chemical burns and eye lid
injury
– infections : trachoma, herpes zoster
• Th/
– eye lid reconstruction
– trachoma --> Sie Boen Lian technique (SBL)
• Ectropion
– turning out of the eye lid margin 
conjunctiva is not well covering  thick,
red, chronic conjunctivitis
– Congenital ectropion
– Senile ectropion :
• caused by tissue relaxation loss of eye lid tone 
evertion of margin
• often seen in the lower eye lid
– Paralytic ectropion :
• caused by N.VII palsy  poor blinking &
lagophthalmos
– Cicatrical ectropion

• Th/ : blepharoplasty/reconstruction
• Mechanical
– caused by :
• bulky tumor of the eye lid
• fluid accumulation
• Simblepharon
– attachment of the eye lid to the eye
ball (usually with cornea)
– Th/ : simblepharectomy
• Lagophthalmos
– the eyelids aperture can not close
perfectly
– E/ : paralyze of N.VII, cicatrix,
proptosis, tumor
– complication : xerosis (dry eye)
• Ptosis
– the upper eye lid can not open perfectly
– unilateral/bilateral
– congenital ptosis
– acquired ptosis
• senile
• myogenic
• neurogenic (paralyze of N.III)
• trauma
• mechanic (tumor)
– Th/ :
• fasanela servat
– if some and the function of levator still good
• levator shortening
– skin approach or
conjunctival approach
 LACRIMAL SYSTEM
• Secretory apparatus
– Lacrimal gland :
• located in superolateral quadrant of the orbit
• exocrine gland
– Accesoryexocrine glands :
• Krause & Wolfring
• location in the superior fornix and above the
superior border of the tarsus
• Excretion section
– draining the tears into the nasal cavity
• Tear
– slightly alkaline
– containing NaCl, such a lyzozym enzyme
that bacteriostatic
– Normal : tear dampened the eye ball -->
apart are evaporated and most of the
tear flows is actively pump by the action
of the orbicularis muscles/blinking
– measure with Schirmer Test

5mm 25 mm
Normal 10 - 15 mm dalam 5’
 Congenital abnormalities of
the nasolacrimal system

• Nasolacrimal duct obstruction

– complete absence or the puncta
– lacrimal cutaneus fistula
– nasolacrimal obstruction of the distal
end (the valve of Hasner) ---> very
often
• Punctum anomaly
– no punctum
– punctum evertion
• loose palpebra -----> facial paralysis
• cicatrix -----> old age
– Th/ : reconstruction
 Nasolacrimal Infection
• Acute dacrioadenitis
– signs :
• red painfull swelling with redness of the
outer of the upper eye lid , pseudo ptosis
(sometime)
– E/ :
• adult : gonorrhoica
• children : with another disease -->
parotitis
• Chronic dacrioadenitis
– slightly edema
– not pain
– often at TB, leukemia, trachoma
– Th/ : depend on the etiological agent
• Chronic dacriosistitis
– more common
– attributed to the nasolacrimal obstruction
– children and adult
– symptom :
• epiphora
• swelling at the site of the sac (distended sac)
• on pressure over the sac --> muco-pus or pus
regurgitates trough the puncta
– Th/ :
• topical and systemic antibiotic
• if obstruction --> dacriosistorinostomi
• Lacrimal sac tumor
– benign
• squamous papiloma
– malignant
• epidermoid Ca
– Th/
• operation (cystectomy)
• radiation