Topographic anatomy of the eyelids, and the effects of sex and age

Abstract

Aims-To describe the eVects of sex and age on eyeball, eyelid, and eyebrow position. Methods-A cross sectional cohort study was performed in which both eyes of 320 normal subjects aged between 10 and 89 years were included. Of each 10 year age cohort, there were 20 men and 20 women. Frontal, as well as lateral, slides were taken of both eyes. On projected slides, a reference line through the medial canthi and vertical lines through the pupil centre and the lateral canthus were constructed. Using these lines, we measured the size of the horizontal eyelid fissure, the distance from the reference line to the pupil centre and to the lateral canthus, the distance between the pupil centre and the upper and lower eyelid margin, and the distance between the upper eyelid margin and the skin fold and eyebrow. On lateral slides, the distance between the lateral canthus and the anterior corneal surface was measured. Results-Between the ages of approximately 12 and 25 years, the horizontal eyelid fissure lengthened 3 mm, while the position of other eyelid structures remained virtually unchanged. Between the average ages of 35 and 85 years, the horizontal eyelid fissure gradually shortened again by about 2.5 mm. Meanwhile, the distance between the lateral canthal angle and the anterior corneal surface decreased almost 1.5 mm. Aging caused an increase of the distance between the pupil centre and the lower eyelid of about 1 mm in men, and 0.5 mm in women. Aging also caused a higher skin crease and raised eyebrows in men and women, but it did not aVect the position of the pupil centre and the lateral canthus. Men showed an 0.7 mm larger horizontal eyelid fissure than women. In women, however, the eyebrows were situated about 2.5 mm higher than in men. Conclusion-Aging mainly aVects the size of the horizontal eyelid fissure, which lengthens by about 10% between the ages of 12 and 25, and shortens by almost the same amount between middle age and old age. Aging causes sagging of the lower eyelid, especially in men, and a higher skin fold and eyebrow position in both sexes. Aging does not aVect the position of the eyeball proper, or of the lateral canthus. (Br J Ophthalmol 1999;83:347-352) Aging may cause laxity of eyelid tissues and atrophy of the orbital fat. These changes contribute to the aetiology of several eyelid disorders such as ectropion, entropion, dermatochalasis, and aponeurogenic blepharoptosis.

Avaliação da posição do supercílio por medidas angulares

“…Mulheres possuem o supercílio cerca de 2,5 mm mais alto que os homens (10) . Porém, este dado não se confirma estatisticamente nas avaliações por medidas angulares, apesar da tendência de valores maiores de ângulo 1 e menores de ângulo 2 no sexo feminino.…”

Análise bidimensional computadorizada da fenda palpebral

“…O valor médio obtido no presente trabalho de 26,82 mm (sd = 0,785), é inteiramente concordante com esses valores da literatura. Deve-se lembrar que a quantificação da morfometria da fenda realizada na clínica leva em conta apenas o valor horizontal da fenda palpebral, ou seja, não considera o fato de o canto externo estar, em grande número de sujeitos, acima do interno 3,[14][15] . Os valores da altura do ângulo externo e angulação da fenda medidos no presente trabalho (figuras 4C e 4D e tabela 1) indicam que, ao se obedecer a obliqüidade da fenda, a diferença no cálculo da largura é negligenciável, uma vez que as duas medidas são relacionadas pelo cosseno do ângulo da fenda que é, em média, cerca de 5 graus (cosseno 5 o = 0,99).…”

Entropion in children with isolated peripheral facial nerve paresis

“…2 This may be due to a laxity of the forehead and eyebrows that develops with age. 12 Impairment of facial nerve innervation of the cheek muscles almost certainly contributed to the mild cheek atrophy observed in five of the patients.…”

“…The mechanism of lower eyelid changes observed in this study was not clear, although the presence of tight medial and lateral canthal tendons in children might combine with a loss in the balance between the orbicularis oculi and lower eyelid retractors in patients with FNP to contribute to the development of lower eyelid entropion and lid retraction. 3,12 Alternatively, maldevelopment or repair of the peripheral facial nerve injury might lead to subclinical hyperactivity of previously paralyzed periocular muscles.…”