Lower Eyelid

In addition to an understanding of the anatomy described in Chapter 2 for the lower eyelid approach, the transconjunctival approach requires understanding of a few additional matters.

Lower Lid Retractors. During full downward gaze, the lower lid descends approximately 2 mm in conjunction with movement of the globe itself. The inferior rectus muscle, which rotates the globe downward, simultaneously uses its fascial extension to retract the lower eyelid. This extension, which arises from the inferior rectus, contains sympathetic-innervated muscle fibers and is commonly called the capsulopalpebral fascia (Fig. 3-2). This fascia is incised during the transconjunctival approach to the orbit, but seems to be inconsequential from a clinical standpoint.

Figure 3 2 Sagital section through orbit and globe. C=palpebral conjunctiva; IO=inferior oblique muscle; IR=inferior rectus muscle; LLR=lower lid retractors; OO=orbicularis oculi muscle; OS=orbital septum; P=periosteum/periorbita; TP=tarsal plate.

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