Muscular funnel of the eye. Accessory organs of the eye. Accessory organs of the eye. Symptoms of eye muscle diseases

The human visual system is one of the most complex biological mechanisms in the world. Structurally, it is a combination of elements of the most diverse structures of the body, which, when working simultaneously, implement the visual function.

An important role in the process of implementing the latter is played by the oculomotor apparatus, represented by muscle fibers and those that control them. In today’s material, we’ll talk in more detail about the muscles of the eye, looking at their anatomy and possible pathologies. Interesting? Then be sure to read the material below to the end.

The muscles of the eye have a complex structure

As noted above, the human visual system is a rather complex system.

Its components are no exception and are also extremely complex. Perhaps, the oculomotor apparatus of the eyes considered today is still relatively uncomplicated. But first things first.

Consideration of the anatomy of the muscles of the ocular system should begin with the fact that they are combined into a complex sensorimotor mechanism. The latter, by its nature, immediately implements two most important visual functions:

• Firstly, it ensures the movement of the eyeballs behind the object of gaze.
• Secondly, the resulting image for each eye is combined into a single picture.

This functional purpose also determines the main feature of the oculomotor system, expressed in the close connection of muscles (motor components) and nerve fibers (sensory elements).

Working together, these nodes of the muscular mechanism allow a person to see stably and efficiently. Structurally, the eye muscles can be of two types:

1. Straight ones, which move the eyeballs along a straight axis and are attached to them only on one side.
2. Oblique, moving them more flexibly and having a double fastening with those.

Both the first and second muscles of the oculomotor system act under the control of nerves, the main ones of which are considered to be oculomotor, abducens and trochlear.

All nerve endings are responsible for the implementation of specific tasks and functions, but invariably go to the cerebral cortex, from which they are controlled.

The eye muscles, due to their diversity, can jointly organize eye movements in synchronous and asynchronous versions. In any case, the eye muscles are divided into main and auxiliary.

The main difference between the types of fibers is that the first organize the movement of the eyeballs along the main axes, while others complement the variability of their functions (for example, they are responsible for lacrimation).

Examination of the oculomotor system

The anatomy of the eye muscles is much more complex than what was discussed above. In the first paragraph of today’s article, our resource drew attention only to the basis of the summarized question, since its in-depth study within the framework of the article material is almost impossible.

In any case, the noted information will be sufficient to understand the entire essence of the human oculomotor system, so let’s begin to consider methods for examining it for pathologies.

Firstly, one important aspect should be noted - many techniques from the field of ophthalmology are used to diagnose the correct functioning of the extraocular muscles. The main tests and instrumental measures are:

• Examination of the eyeball.
• Evaluation of the process of eye tracking the movement of an object, both together with two apples and separately.
• (ultrasound).
• Computed tomography (CT).
• Magnetic resonance imaging (MRI).

To obtain the most accurate and high-quality information about the correct operation of the oculomotor mechanism, the noted diagnostic procedures are carried out in a single complex.

Some of them (examination, tracking testing) are necessary to obtain basic data on the condition of the eye muscles and identify the first signs of their pathologies. If there are unfavorable suspicions, a more global examination is required, so they resort to ultrasound, CT and MRI.

By the way, these diagnostic methods make it possible to identify the pathological condition of not only the muscle fibers themselves, but also the nerves that control them.

An examination of the oculomotor system is carried out exclusively by a professional doctor, namely.

For really high-quality, quick and effective diagnostics, it is advisable to be examined in specialized centers specializing in ophthalmology. Do not forget that only such medical institutions have the necessary equipment and specialists with the required qualifications.

Possible pathologies of the muscles of the organs of vision

There is probably no need to talk about the importance of a completely healthy state of the eye muscles.

Everyone understands that only with the correct operation of the oculomotor mechanism, the human visual system is able to realize its functions.

Any deviation in the functioning of muscle fibers or nerves manifests itself in visual impairment and the development of corresponding pathologies. Most often, the muscular system of the eyes suffers from:

• Myasthenia gravis is a weakness of muscle fibers that does not allow them to properly move the eyeballs.
• Muscle paralysis or paresis, expressed in structural damage to the muscular-nervous structure and the inability of muscle fibers to perform their functions.
• Muscle spasm, accompanied by excessive tension in the eye muscles and associated problems (for example, inflammation).
• Congenital anomalies of the oculomotor system (aplasia, hypoplasia, etc.) are pathologies that are expressed in disturbances in the functioning of the eye muscles or their nerves from the very birth of a person and are anatomical defects.

Symptoms of damage to the muscular-nervous structure of the human ocular system have a typical formation for different lesions. As a rule, signs of pathology include:

1. Diplopia is a violation of binocular vision (doubling the image of the surrounding reality received through the eyes).
2. Nystagmus is an involuntary movement of the eyes that naturally interferes with the ability to focus on a specific area.
3. Pain in the eye sockets or head, which is a consequence of constant muscle spasm or improper functioning of their nerves.

If the noted symptoms are present, the patient must be prescribed a set of examination measures described in the previous paragraph of the article. Based on the results of all types of diagnostics, treatment is organized, which can be either conservative or surgical.

Note that in the case of damage to the muscles of the ocular apparatus, direct surgery is most often used, since other methods of therapy, as a rule, are not particularly effective or are completely pointless.

The severity of the disease and methods of its treatment are determined exclusively by a professional ophthalmologist, which should not be forgotten.

The prognosis for treatment of 2/3 of the pathologies of the muscular mechanism of the eyes is favorable. However, it is important to understand that even with such a prognosis, there are risks of not fully returning vision. If we are talking about congenital anomalies of the apparatus, then the situation is even more complicated.

With these pathologies, often nothing can be done at all. Unfortunately, ophthalmology has not yet fully studied all aspects of the treatment of eye diseases of this kind.

On this note, we will conclude the story on the topic of today’s article. We hope that the material presented was useful to you and provided answers to your questions. As you can see, the anatomical structure of the eye muscles and their pathologies are not so difficult to consider. Good health to you!

Anatomy of the eye muscles - topic of the video:

The auxiliary organs of the eye are the muscles of the eyeball, the lacrimal apparatus, the conjunctiva, and the eyelids. Orbital cavity, in which the eyeball and its auxiliary organs are located, it is lined with the periosteum of the orbit, which in the area of ​​the optic canal and the superior orbital fissure fuses with the dura mater of the brain. The eyeball is enveloped by its connective tissue sheath (vagina bulbi— Tenon's capsule), which is connected to the sclera by loose connective tissue. On the posterior surface of the eyeball, the vagina is fused with the external sheath of the optic nerve; in front it approaches the fornix of the conjunctiva. The vessels, nerves and tendons of the extraocular muscles pierce the vagina of the eyeball. Between the eyeball and its vagina there is a narrow episcleral (Tenon's) space (spatium episclerale). Between the periosteum of the orbit and the vagina of the eyeball lies fatty body of the orbit (corpus adiposum orbitae). Anteriorly, the eye socket (and its contents) is partially closed orbital septum (septum orbitale), starting from the periosteum of the upper and lower edges of the orbit and attaching to the cartilages of the upper and lower eyelids. In the area of ​​the inner corner of the eye, the ocular septum connects to the medial ligament of the eyelid. Eyelids(palpebrae) protect the eyeball from the front. They are folds of skin that limit the palpebral fissure and close it when the eyelids close (Fig. 125). On the sides, the eyelids are connected by lateral and medial commissures, closing the corresponding corners of the eye. Lateral angle of the eye (angulus oculi lateralis) spicy and medial angle (angulus oculi medialis) rounded. Due to this, there is a notch in the area of ​​the medial angle - tear lake (lacus lacrimalis). The upper eyelid is limited from above eyebrow (supercilium) with short, coarse hair. The lower eyelid drops slightly when the eyes are opened under the influence of gravity. Suitable for the upper eyelid muscle that lifts the upper eyelid(m. levator palpebrae), which begins together with the rectus muscles from the common tendon ring. The muscle passes through the upper part of the orbit and attaches to upper eyelid cartilage (tarsus superior)- a plate of dense fibrous connective tissue that performs a supporting function. In the thickness of the lower eyelid there is

The extraocular muscles are innervated by the III, IV and VI pairs of cranial nerves.

Oculomotor, or III cranial nerve. The third nerve (n. osiioshoi-gish) is mixed and includes motor and parasympathetic portions (Fig. 1.6).

Looking up and outwards M. rectus superior

Looking up and inward M. obliquus inferior

Outward movement of the eye (abduction) m. rectus

Inward eye movement

(cast)

Looking down and outwards M. rectus inferior

Looking down and inward M. obliquus superior

• - Somatic motor fibers
• - Preganglionic fibers Postganglionic fibers

All rectus muscles except the lateralis;

inferior oblique muscle;

muscle that lifts the upper eyelid

Rice. 1.6.

Motor portion innervates four of the six extraocular muscles of the eye and the muscle that lifts the upper eyelid. Vegetative parasympathetic portion innervates the smooth (intrinsic) muscles of the eye.

The nuclear complex of the III cranial nerve is located in the tegmentum of the mesencephalon at the level of the superior colliculi of the quadrigemina near the midline, ventral to the aqueduct of Sylvius.

This complex includes paired somatic motor and parasympathetic nuclei. The parasympathetic nuclei include: the paired accessory nucleus (n. oculomotorius accessorius), also called the Yakubovich-Edinger-Westphal nucleus, and the unpaired central nucleus of Perlia, located in the middle between the accessory nuclei.

The nuclei of the oculomotor nerve, through the fibers of the posterior longitudinal fascicle (fasc. longitudinalis posterior), are connected with the nuclei of the trochlear and abducens nerves, the system of vestibular and auditory nuclei, the nucleus of the facial nerve and the anterior nuclei of the spinal cord. The axons of the neurons of the nuclear complex go in the ventral direction, pass through the ipsilateral red nucleus and emerge on the surface of the brain in the interpeduncular fossa fossa interpeduncularis at the border of the midbrain and the Varoliev bridge in the form of a trunk of the oculomotor nerve.

The trunk of the III nerve pierces the dura mater in front and lateral to the posterior sphenoid process (processus clinoideus posterior), runs along the lateral wall of the cavernous sinus and then enters the orbit through the fissura orbitalis superior (Fig. 1.7, 1.8).

Processus clinoideus posterior

Rice. 1.7. Places of passage of cranial nerves on the internal base of the skull

Fissura orbitalis superior

Foramen rotundum

Foramen spinosum

Porusacusticus internus

Foramen jugulare

Canalis hypoglossalis

In the orbit, the III nerve is located below the IV nerve and such branches of the I branch of the V nerve, such as the lacrimal nerve (n. lacrimalis) and the frontal nerve (n. frontalis). The nasociliary nerve (p. nasociliaris) is located between the two branches of the III nerve (Fig. 1.9, 1.10).

N. oculomotorius N. trochlearis

N. ophthalmicus N. abducens N. maxillaris

Sinus cavernosus

Sinus sphenoidalis

Rice. 1.8. Diagram of the relationship between the cavernous sinus and other anatomical structures, section in the frontal plane (according to Drake R. et al., Gray’s Anatomy, 2007)

M. rectus superior

M. rectus lateralis

M. rectus inferior

M. obliquus inferior

M. obliquus superior

M. rectus medialis

Rice. 1.9. Extrinsic muscles of the eye, anterior view of the right orbit

Entering the orbit, the oculomotor nerve divides into two branches. The superior branch (the smallest) passes medially and above the optic nerve (n. opticus) and supplies the superior rectus muscle (m. rectus superior) and the muscle that lifts the upper eyelid (i.e. levator palpebrae superioris). The lower branch, which is larger, is divided into three branches. The first of them goes under the optic nerve to the medial rectus muscle (m. rectus medialis); the other - to the inferior rectus muscle (m. rectus inferior), and the third, the longest, follows forward between the inferior and lateral rectus muscles to the inferior oblique muscle (m. obliquus inferior). From here comes a short thick connecting branch - the short root of the ciliary ganglion (radix oculomotoria parasympathetica), carrying preganglionic fibers to the lower part of the ciliary ganglion.

glia (ganglion ciliare), from which postganglionic parasympathetic fibers for m. sphincter pupillae and m. ciliaris (Fig. 1.11).

N. oculomotorius, upper branch -

N. oculomotorius, lower branch

Rice. 1.10.

NN. ciliares longi

M. obliquus superior

M. levator palpebrae superioris

M. rectus superior

Ramus superior nervi oculomotorii

A. carotis interna

Plexus caroticus catoricus

N. oculomotorius

NN. ciliares breves

Ganglion trigeminale

M. rectus inferior

Ganglion ciliare

M. obliquus inferior

Ramus inferior nervi oculomotorii

Rice. 1.11. Branches of the oculomotor nerve in the orbit, lateral view (http://www.med.yale.edu/

caim/cnerves/cn3/cn3_1.html)

The ciliary ganglion (ganglion ciliare) is located near the superior orbital fissure in the thickness of the fatty tissue at the lateral semicircle of the optic nerve.

In addition, in transit through the ciliary ganglion, without interruption, pass fibers that conduct general sensitivity (branches of the nasociliary nerve from the V nerve) and sympathetic postganglionic fibers from the internal carotid plexus.

Thus, the motor somatic part of the oculomotor nerve includes a complex of motor nuclei and axons of the neurons that make up these nuclei, which innervate the muscles of the oculomotor. levator palpebrae superioris, m. rectus superior, m. rectus medialis, m. rectus inferior, m. obliquus inferior.

The parasympathetic part of the oculomotor nerve is represented by its parasympathetic nuclei, the axons of their cells (preganglionic fibers), the ciliary ganglion and the processes of the cells of this node (postganglionic fibers), which innervate the sphincter pupillae and the ciliary muscle (m. ciliaris). In other words, each Yakubovich-Edinger-Westphal nucleus contains the bodies of preganglionic parasympathetic neurons, the axons of which go as part of the trunk of the third cranial nerve, in the orbit they pass along with its lower branch and reach the ciliary (ciliary) ganglion (see Fig. 1.11). Axons of ciliary ganglion neurons (postganglionic fibers) form short ciliary nerves (nn. ciliares breves), and the latter pass through the sclera, enter the perichoroidal space, penetrate the iris and enter the sphincter muscle in separate radial bundles, innervating it sectorally. The unpaired parasympathetic nucleus of Perlia also contains the bodies of preganglionic parasympathetic neurons; their axons switch in the ciliary ganglion, and the processes of its cells innervate the ciliary muscle. It is believed that the Perlia nucleus is directly related to ensuring the convergence of the eyes.

Parasympathetic fibers coming from the Yakubovich-Edinger-Westphal nuclei constitute the efferent part of the reflex reactions of pupil constriction (Fig. 1.12).

Normally, pupil constriction occurs: 1) in response to direct lighting (direct reaction of the pupil to light); 2) in response to illumination of the other eye (reaction to light friendly with the other pupil); 3) when focusing the gaze on a nearby object (pupil reaction to convergence and accommodation).

The afferent part of the reflex arc of the pupil's reaction to light starts from the cones and rods of the retina and is represented by fibers that go as part of the optic nerve, then cross in the chiasm and pass into the optic tracts. Without entering the external geniculate bodies, these fibers, after partial decussation, pass into the handle of the superior colliculus of the midbrain roof plate (brachium quadrigeminum) and end at the cells of the pretectal region (area pretectalis), which send their axons to the nuclei

Yakubovich-Edinger-Westphal. Afferent fibers from the macula of the retina of each eye are represented in both Yakubovich-Edinger-Westphal nuclei.

Rice. 1.12.

E.J., Stewart P.A., 1998)

The efferent pathway of innervation of the sphincter of the pupil, described above, begins from the Ya Kubovich-Edinger-Westphal nuclei (see Fig. 1.12).

The mechanisms of the pupil's response to accommodation and convergence are not well understood. It is possible that during convergence, contraction of the medial rectus muscles of the eye causes an increase in the proprioceptive impulses coming from them, which are transmitted through the trigeminal nerve system to the parasympathetic nuclei of the 111th nerve. As for accommodation, it is believed that it is stimulated by defocusing images of external objects on the retina, from where information is transmitted to the center of the eye's close position in the occipital lobe (Brodmann's 18th field). The efferent pathway of the pupillary response also ultimately includes parasympathetic fibers of the 111 pair on both sides.

The proximal part of the intracranial segment of the third nerve is supplied with blood from arterioles arising from the superior cerebellar artery.

terpi, the central branches of the posterior cerebral artery (thalamoperforating, mesencephalic paramedian and posterior villous arteries) and the posterior communicating artery. The distal part of the intracranial segment of the III nerve receives arterioles from the branches of the cavernous part of the ICA, in particular from the tentorial and inferior pituitary arteries (Fig. 1.13). The arteries give off small branches and form numerous anastomoses in the epineurium. Small vessels penetrate the perineurium and also anastomose with each other. Their terminal arterioles pass into the nerve fiber layer and form capillary plexuses along the entire length of the nerve.

A. chorioidea anterior

A. hypophysialis inferior

Rice. 1.13. Branches of the internal carotid artery (according to Gilroy A.M. et al., 2008)

The trochlear, or IV cranial, nerve (n. trochlearis) is purely motor. The nucleus of the trochlear nerve (nucl. n. trochlearis) lies in the tegmentum of the midbrain at the level of the lower colliculi of the quadrigeminal, i.e. below the level of the nuclei of the third nerve (Fig. 1.14).

The fibers of the trochlear nerve emerge on the dorsal surface of the midbrain under the lower tubercles of the quadrigeminal, cross, bend around the cerebral peduncle from the lateral side, follow under the tentorium of the cerebellum, enter the cavernous sinus, where they are located under the trunk of the III nerve (see Fig. 1.8), after exiting from which they pass into the orbit through the superior orbital fissure outward from the tendon ring of Zinn surrounding the optic nerve. The IV nerve innervates the superior oblique muscle of the opposite eye (see Fig. 1.9).

To the superior oblique muscle

Rice. 1.14. Course of trochlear nerve fibers at the level of the midbrain

The nucleus of the trochlear nerve through the fibers of the posterior longitudinal fascicle (fasc. longitudinalis posterior) is connected with the nuclei of the oculomotor and abducens nerves, the system of vestibular and auditory nuclei, and the nucleus of the facial nerve.

Blood supply. The nucleus of the IV nerve is supplied by branches of the superior cerebellar artery. The trunk of the IV nerve is supplied with blood from the subpial arteries and the posterior lateral villous branch of the posterior cerebral artery, and at the level of the superior orbital fissure - by the branches of the external carotid artery (Schwartzman R.J., 2006)

The abducens, or VI, cranial nerve (n. abducens) is purely motor. Its only motor nucleus is located in the tegmentum of the Varoliev bridge under the bottom of the IV ventricle, in the rhomboid fossa (Fig. 1.15). The abducens nucleus also contains neurons that are connected through the medial longitudinal fasciculus to the nucleus of the oculomotor nerve, which innervates the medial rectus muscle of the contralateral eye.

The axons of the cells of the nucleus of the abducens nerve emerge from the substance of the brain between the edge of the pons and the pyramid of the medulla oblongata from the bulbar-pontine groove (Fig. 1.16).

In the subarachnoid space, the VI nerve is located between the pons and the occipital bone, ascending towards the pontine cistern lateral to the basilar artery. Next, it pierces the dura mater slightly below and outward from the posterior sphenoid process (Fig. 1.17), follows in the Dorello canal, which is located under the ossified petro-sphenoid ligament of Gruber (this ligament connects the apex of the pyramid with the posterior sphenoid process -

lump of the main bone), and penetrates the cavernous sinus. In the cavernous sinus, the abducens nerve is adjacent to the III and IV cranial nerves, the first and second branches of the trigeminal nerve, as well as the ICA (see Fig. 1.8). After leaving the cavernous sinus, the abducens nerve enters the orbit through the superior orbital fissure and innervates the lateral rectus muscle of the eye, which rotates the eyeball outward.

Rice. 1.15.

Abductor

Rice. 1.1V. Position of the abducens nerve on the ventral surface of the brainstem

brain (according to Drake R. et al., Gray’s Anatomy, 2007)

Direction of the course of the VI nerve in the cranial cavity

For clear and clear vision, as well as coordinated work of the eyeball, extraocular muscles are needed. Their innervation is due to a large number of nerve contacts, which make it possible to make precise movements when examining objects that are at different distances. The work of six muscles (of which 4 are oblique and two rectus) is provided by three cranial nerves.

It is thanks to muscle fibers that we can direct our gaze up, down, left, right, or close our eyes when working at close range. Different muscle groups allow us to see clear images with a high degree of confidence. In this article we will talk in detail about the muscular structure of the visual organs. Let's consider its function, anatomy, as well as possible pathologies.

Anatomical structure

The extrinsic eye muscles are located inside the orbit and are attached to the eyeball. When they contract, the visual organ rotates, directing the gaze in the desired direction. To a greater extent, the work of the muscular system is regulated by the oculomotor nerve. All the muscles of the eye begin in the area surrounding the optic nerve foramen and the superior orbital fissure.

Depending on the characteristics of attachment and movement, the muscle fibers of the eye are divided into straight and oblique. The first group goes in the forward direction:

• internal (medial);
• external (lateral);
• top;
• lower

The external rectus muscle rotates the eye toward the temple. Thanks to the shortening of the internal straight line, it is possible to direct the gaze towards the nose. The superior and inferior rectus muscles help the eye move vertically and toward the inner corner.

The remaining two muscles (upper and lower) have an oblique course and are attached to the eyeball. They perform more complex actions. The superior oblique muscle lowers the eyeball and turns it outward, and the inferior oblique muscle lifts it and also moves it outward. Eye movements depend on the characteristics of the attachment of striated muscle fibers.

At the end of the article, we’ll talk about the nerves that innervate the muscles of the visual apparatus:

• trochlear – superior oblique;
• abducens – lateral straight;
• oculomotor – all the rest.

INTERESTING! Overstrain of the oblique muscles of the eye becomes the main cause of myopia.

The extrinsic muscular system also includes the levator palpebrae superioris and the orbicularis muscle. The orbicularis oculi muscle (radial) is a plate that closes the entrance to the orbit. It goes along the entire circumference of the eye. Its main function is to close the eyelids and protect the eye socket. It consists of three main parts:

• century - responsible for closing the eyelids;
• orbital – with involuntary spasms, it causes the eyes to close;
• lacrimal - expands the lacrimal sac and removes fluid.

If the functioning of this muscle is disrupted, blepharospasm may develop. Involuntary contractions of the eye can last from a few seconds to several minutes. Lagophthalmos is also called "hare's eye". Due to muscle fiber paralysis, the palpebral fissure does not close completely. The above pathologies are characterized by the appearance of the following symptoms: eversion and sagging of the lower eyelid, convulsive twitching, dryness, photophobia, swelling, lacrimation.

The intrinsic muscles of the eye include:

• ciliary muscle;
• muscle that constricts the pupil;
• muscle that dilates the pupil.

The muscular apparatus configures the visual organ to examine objects. With their help, the eyelids open and close. Thanks to three-dimensional and bright vision, a person fully perceives the world around him. The coordinated operation of this system is possible due to two factors:

• correct muscle structure;
• normal innervation.

The main function of the muscular system is to ensure the movement of the eyeball in a given direction. Nerve fibers are the guiding elements of the entire movement process. Contractions of the visual muscles also cause a change in the size of the pupil.

Pathologies

Only with the correct operation of the oculomotor mechanism will the visual apparatus be able to realize all its functions. Any deviation in the functioning of muscle fibers is fraught with impaired visual function and the development of dangerous pathologies.

Most often, the oculomotor mechanism suffers from the following phenomena:

• Myasthenia. Weakness of the muscle fibers does not allow them to move the eyeballs properly.
• Paresis or paralysis. Manifests itself in the form of structural damage to the neuromuscular structure.
• Spasm. Expressed in excessive muscle tension.
• Strabismus - strabismus.
• Myositis is inflammation of muscle fibers.
• Congenital anomalies (aplasia, hypoplasia).

Diseases of the muscular system cause the following unpleasant symptoms:

• Diplopia – doubling of the image.
• Nystagmus is involuntary movement of the eyeballs. In other words, the eye twitches.
• Pain in the eye sockets.
• Loss of one or another eye movement.
• Dizziness.
• Changing head position.
• Headache.

Myositis

The outer muscles of the eyeball can become inflamed at the same time. This is a rare disease that usually affects one visual organ. Most often, young or middle-aged men suffer from myositis. At risk are people whose professional activities involve prolonged sitting.

Myositis is an inflammation of the extraocular muscles

Myositis can develop due to the following reasons:

• infectious diseases;
• helminthic infestations;
• intoxication of the body;
• incorrect body position while at work;
• long-term visual stress;
• injuries;
• hypothermia;
• mental stress.

The disease is accompanied by clearly defined pain and intense muscle weakness. Increased pain occurs at night and when weather conditions change. Minor swelling and redness of the skin may also occur. Patients complain of lacrimation and photophobia.

The more muscle fibers are involved in the pathological process, the more the inflamed muscles thicken. This manifests itself as exophthalmos, or protrusion of the eyeball. With myositis, the visual organ is painful and limited in mobility. Treatment of the disease includes a whole range of therapeutic measures, including physiotherapy, physical education, massage, diet, and the use of medications.

Myasthenia gravis

The development of myasthenia gravis is based on neuromuscular wasting. The pathology most often affects young people aged twenty to forty years. Muscular weakness of the visual organs is an autoimmune disease. This means that the immune system begins to produce antibodies to its own tissues.

ATTENTION! Symptoms of myasthenia gravis increase with exercise and decrease with rest.

Myasthenia gravis is characterized by a recurrent or constantly progressive course. The ocular form is manifested by weakness of the eyelids and muscles.

The exact causes of the disease are still unknown. Scientists suggest that the leading role in the occurrence of myasthenia gravis belongs to hereditary factors. When collecting a patient's history, it often turns out that one of the blood relatives suffered from the same illness.

Among the symptoms of pathology, the following come to the fore:

• double vision;
• unclear vision of objects;
• violation of the motor and rotational function of the eye muscles;
• drooping eyelids.

To relieve discomfort, patients are advised to wear dark glasses in bright light. Special adhesive tape can be used to hold the eyelids in place. To prevent diplopia (double vision), a blindfold is used over one visual organ. It is worn alternately on one and the other eye.

Spasm of accommodation

Normally, the organs of vision adapt and see images equally clearly at close and far distances. The focus of the eye is controlled by the ciliary muscle. If there are disturbances in its functioning, a spasm of accommodation is formed - a pathology in which a person cannot clearly see objects at different distances.

The disease is also called false myopia, or tired eyes syndrome. To view distant images, the lens relaxes, and to clearly see near objects, it tenses. With a spasm of accommodation, the lens does not relax, which is why the quality of distance vision suffers.

The main reason for the development of pathology is visual overload. Fatigue develops due to a number of reasons:

• regularly reading books in poor lighting;
• no breaks when working with small parts or at the computer;
• prolonged work requiring extreme concentration of vision;
• lack of sleep.

With a spasm of accommodation, a person has trouble seeing objects in the distance

A spasm of accommodation manifests itself in the form of myopia, periodic pain in the eyes, and increased fatigue. Patients complain of a burning sensation, pain, redness, dizziness, and a feeling of dryness. As the pathology progresses, the eyes begin to get tired even in the absence of complex visual work. Visual acuity gradually decreases.

Treatment of accommodation spasm involves complex measures. In addition to conservative therapy, hardware techniques and gymnastics are used. Doctors prescribe eye drops to relax the ciliary muscle: Midriacil, Cyclomide, Atropine. To dilate the pupil, stimulate the circulation of intraocular fluid and strengthen the ciliary muscle, Irifrin drops are prescribed.

Along with such drugs, vitamin complexes and drugs to moisturize the mucous membrane of the eye are prescribed. Neck massage helps relieve spasms.

Strabismus (strabismus)

This is a visual impairment in which one or both eyes deviate from the point of fixation. Strabismus occurs in both children and adults.

Strabismus is not a simple cosmetic defect. The pathology is based on impaired binocular vision. This means that a person cannot correctly determine the location of an object in space. The disease negatively affects the quality of life.

Normally, the image of objects is recorded in the central part of the visual organs. Next, the image from each eye is transmitted to the brain. There, this data is combined, which provides full binocular vision.

With strabismus, the brain is unable to connect the information it receives from the right and left eyes. To protect a person from double vision, the nervous system simply ignores the signal from the damaged visual organ. This causes a decrease in the functional activity of the squinting eye.

The following reasons can provoke the development of pathology:

• corneal thorn;
• cataract;
• degenerative changes of the macula;
• traumatic brain injuries;
• severe fear;
• visual fatigue;
• brain diseases;
• infectious processes of ENT organs;
• retinal detachment.

Strabismus causes restrictions in the mobility of the eyeball. The patient is deprived of the opportunity to see a three-dimensional image. Objects appear double. Patients complain of dizziness. There is a characteristic tilt of the head towards the damaged organ and squinting.

Vision can be corrected using specially selected glasses or contact lenses. Prismatic devices help relieve muscle tension and restore quality of vision.

The orthopedic treatment method involves applying a special bandage to the healthy eye. This will be a good stimulation for the damaged visual organ. In more severe cases, surgery is indicated.

The photo shows another pathology of the extraocular muscles - strabismus.

Strengthening exercises

Why do my eyes hurt? The causes of pain may be associated with the development of ophthalmological diseases or problems with the muscular system. Pain when moving the eyeballs indicates overstrain of the visual muscles. Simple eye exercises will help relieve spasm.

At first glance, the very idea of ​​training muscle fibers may seem absurd, because they are already in constant dynamics. Indeed, the eye muscles work actively throughout the day, but such movements are most often of the same type.

ATTENTION! Gymnastics for the eyes is of a general strengthening nature and can be performed at any convenient time.

First, let's talk about how to strengthen the external muscles:

• Take a sitting position and keep your back straight. Look from the ceiling to the floor ten times. Then repeat the movement in the opposite direction.
• In the same position, move your eyeballs from the left side to the right and back. You will need to do ten such approaches.
• Imagine a clock face in front of you and move your eyes in a clockwise direction. Do five reps and then change direction.
• Finally, blink intensely for thirty seconds.

To train the internal muscles, you will need to make a black circle with a diameter of five millimeters in advance. It should be glued to the window, at eye level. Stand at a distance of thirty centimeters from the window. First, fix your gaze on the black circle, and then look at some medium-sized object outside the window.

The main condition is that the image must be motionless. It could be a tree, a car or some kind of structure. You should hold your gaze on nearby and distant objects for fifteen seconds. Five such cycles will be required.

Weak eye muscles can be strengthened by palming. First, rub the palms of both hands together until you get a pleasant warmth. Place your hands on your closed eyelids and sit in this position for several minutes. Try to relax completely, without thinking about anything. After this procedure, you will immediately notice clarity in your vision of objects.

The results of visual gymnastics directly depend on the correctness of the exercises and regularity. If you do exercises twice a day every day, then within two weeks you will feel an improvement in your vision.

Preventing muscle fatigue

As you know, we are what we eat. Diet is directly related to the functional activity of the visual system. One of the mandatory foods that should be in the diet of a person who cares about their eyesight should be carrots. This vegetable is a source of vitamin A, which improves visual acuity and twilight vision. Cottage cheese contains vitamin B, which ensures normal blood circulation and metabolic processes in the visual apparatus.

Blueberries are a “friend” for the eyes. This berry contains B vitamins, as well as retinol and ascorbic acid. Constant consumption of blueberries helps restore impaired metabolic processes and the activity of various eye structures.

Alternative medicine also gives many tips for relaxing the muscular system. Pour half a glass of fresh cucumber peel with one hundred grams of cool water, and also add a little salt. After fifteen minutes, the peel will give juice. It should be used in the form of compresses.

You can forget about muscle pain by following simple medical recommendations:

• Don't read lying down. Due to the unnatural arrangement of muscle fibers, they are stretched. This causes pain and deterioration of visual function.
• Provide good lighting when performing work that requires visual concentration.
• If your eyes begin to get tired quickly when working at a computer, use special glasses.
• Treat ophthalmological diseases in a timely manner. Untreated pathologies negatively affect the condition of the muscular system.

The eye muscles play a huge role in ensuring high-quality vision of objects. Disturbances in their work are fraught with the development of such serious pathologies as strabismus, myositis, spasm of accommodation, myasthenia gravis. Prevention is the best treatment. Experts advise training muscle fibers. Regularly performing simple exercises will help strengthen your muscles.

7-06-2012, 14:35

Description

Figure 2.
Location of the external eye muscles in the orbit. Muscle funnel. The optic nerve passes between the diverging muscles along the axis of the muscular funnel. 1 - tendon ring of Zinn (annulus tendineus communis Zinnii); 2 - m. obliquus superior; 3 - the place of its passage through the block; 4 - m. rectus superior; 5 - m. obliquus inferior; 6 - m. rectus lateralis; 7 - m. rectus inferior; 8 - m. rectus medialis (no Beninghoff, 1957).

By perforating Tenon's capsule at the level of the equator of the eye, the muscles are attached to the eyeball by wide tendons that intertwine into the sclera.

Superior oblique muscle begins, just like the rectus muscles of the eye, in the depths of the orbit, but outside the ring of Zinn, in the immediate vicinity of it, and is directed along the superomedial wall of the orbit, to the spina trochlearis. The muscle looks like a round cord. Passing through the block, it sharply narrows, upon exiting the block it thickens again and turns posteriorly outward. Passing between the eyeball and the superior rectus muscle, it is attached behind the equator in the superior outer quadrant.

Inferior oblique muscle originates separately from all other muscles, from the inner bony wall of the orbit, goes downward outward, encircling the eyeball between the lower wall of the orbit and the inferior rectus muscle, rises upward and attaches to the sclera behind the equator in the same outer quadrant as the upper one.

According to their function, the muscles of the eyeball are divided into three pairs of antagonists acting in directly opposite directions:

- medial and lateral rectus- turn the eye inward and outward;

- upper and lower straight- raise and lower the eyeball;

- oblique muscles- impart rotational movements to the eye.

However Only the external and internal rectus muscles are pure antagonists, they rotate the eye in a horizontal plane, regardless of the initial position of the eyeball. The remaining muscles act as pure antagonists only in the abduction position, when the orbital axis and the anatomical axis of the eye coincide. In the direct direction of gaze, when the anatomical axis of the orbit and the axis of the eye are at an angle of 25 - 27 degrees, muscle actions are more complex:

- inferior rectus muscle lowers the eyeball downwards, brings it in, tilts its vertical meridian outward.

- superior rectus muscle lifts the eyeball upward, brings it in, tilts the vertical axis of the eye inward.

- inferior oblique muscle raises the eye upward, moves it away, tilts the vertical meridian outward.

- superior oblique muscle lowers the eyeball downwards, retracts it, tilts the vertical axis of the eye inward.

In addition, the tone of the rectus oculi muscles tends to pull the eyeball posteriorly, and the two oblique muscles anteriorly.

Thus, the entire muscular system of the eye is in a very finely regulated equilibrium.

Upper and lower eyelids protect the eyeball from the front and due to their blinking movements, which promote the uniform distribution of tears, they protect it from drying out.

The eyelids regulate the amount of light entering the eyes. Reflex closure of the eyelids occurs in response to the influence of mechanical, visual or
sound stimuli. The reflex upward movement of the eye (Bell's phenomenon) when closing the eyelids protects the cornea from foreign bodies and drying out of the cornea during sleep.

The edges of the eyelids form palpebral fissure(rima palpebrarum). (Figure 3).

Figure 3. The structure of the eyelids.
Sagittal section through both eyelids, conjunctival sac and anterior eyeball.
1 - supreorbital edge of the frontal bone; 2 - orbital fat; 3 - levator musculus palpebrae superior; bundles of its tendon fibers penetrate from the left through the circular muscle of the eyelids into the skin; 4 - tendon m. rectus superior. Eyeball: 5- sclera; 6 - conjunctiva of the superior fornix - superior transitional fold; 7 - cornea; 8 - conjunctiva of the lower fornix; 9 - tendon m. rectus inferior; 10 - section of the inferior oblique muscle; 11 - lower orbital edge of the upper jaw bone; 12 - orbital fat; 13 - tarsoorbital fascia - septum orbitale; 14 - cartilage of the lower eyelid; 15 - conjunctiva of the cartilage of the lower eyelid; 16 - conjunctiva of the cartilage of the upper eyelid; 17 - cartilage of the upper eyelid; 18 - m. orbicularis palpebrarum (according to M. L. Krasnov, 1952).

The border of the upper eyelid runs along the eyebrow, the lower eyelid along the lower edge of the orbit. Both eyelids are connected at the corners of the palpebral fissure by the internal and external ligaments (l.palpebrale mediale et laterale). The width and shape of the palpebral fissure varies normally: its horizontal length in an adult is 30 mm, its height ranges from 10 to 14 mm, the edge of the lower eyelid does not reach the limbus by 0.5-1 mm, the edge of the upper eyelid covers the limbus by 2 mm. The outer edge of the palpebral fissure is sharp, the inner edge is blunted in the form of a horseshoe bend. The latter limits the space called the lacrimal lake, in which there are the lacrimal caruncle (caruncula lacrimalis) - a small pink tubercle, which has the structure of the skin with sebaceous and sweat glands, and the semilunar fold (plica semilunaris) of thickened mucous membrane, which are the rudiments of the third eyelid. The free edges of the eyelids, about 2 mm thick, fit tightly to each other. They distinguish between anterior, posterior ribs and intermarginal space. On the anterior, more rounded rib, eyelashes grow (75-150 pcs.), into the bulbs of which the excretory ducts of the sebaceous glands of Zeiss open. Between the eyelashes there are modified Moll's sweat glands. The excretory ducts of the meibomian glands open into the intermarginal space, the fatty secretion of which lubricates the edges of the eyelids, helping to seal them. At the inner corner of the eye, i.e. near the tear lake, the intermarginal space narrows and turns into lacrimal papillae(papilli lacrimales). At the top of each of them there is a lacrimal punctum - an opening leading into the lacrimal canaliculus. The diameter of the lacrimal opening with open eyelids is 0.25 - 0.5 mm. The eyelids consist of 2 plates: the outer plate is formed by skin with muscles, the inner one - by cartilage (tarsus) and the cartilage conjunctiva tightly fused with it.

The skin of the eyelids is very thin, tender, poor in fatty tissue, loosely connected to the underlying tissues. On the skin surface of the upper eyelid there is a deep orbital-palpebral upper fold, on the lower - orbitopalpebral lower fold. The first is located just below the superior orbital margin and is caused by the tone of the anterior leg of the levator muscle attached to the posterior surface of the skin. The thinness and easy displacement of the skin of the eyelids relative to the underlying tissues are good conditions for performing plastic surgery. But in this regard, the skin easily swells with local inflammation, venous stasis, a number of general diseases, hemorrhages and subcutaneous emphysema.

Eyelid mobility is ensured by two groups of antagonistic muscles: orbicularis oculi muscle and levator veli to (m. levator palpebrae superior and m. tarsalis inferior).

Circular muscle of the eyelid- m.orbicularis oculi, s. palpebrarum, in which the palpebral, orbital and lacrimal parts are distinguished. The orbicularis muscle is involved in lowering the upper eyelid and closing the palpebral fissure. The palpebral part is located within the eyelids themselves and does not extend beyond their edges. The muscle fibers of both the upper and lower eyelids are woven into a dense medial ligament. Having described a semicircle along each eyelid, they are temporally attached to the external commissure (lateral ligament) of the eyelids. Thus, two half moons on each eyelid. When the palpebral part contracts, blinking and slight closing of the eyelids occurs, as in a dream. The muscle fibers running along the edge of the eyelids between the roots of the eyelashes and the excretory ducts of the meibomian glands constitute the ciliary muscle, or Riolan muscle (m.ciliaris Riolani), the contraction of which promotes the secretion of the meibomian glands, as well as the tight fit of the edges of the eyelids to the eyeball. Orbital part: fibers start from the medial ligament and from the frontal segment of the maxilla and pass along the periphery of the palpebral part of the orbicularis muscle. The muscle has view of a wide layer extending beyond the edges of the orbit and connects to the facial muscles. Having described a full circle, the muscle is attached near its origin. When this muscle contracts, together with the contraction of the palpebral part, the eyelids are tightly closed.

Lacrimal part of the orbicularis oculi muscle(Horner's muscle) is represented by a deep portion of muscle fibers that begin somewhat posterior to the posterior crest of the lacrimal bone (crista lacrimalis posterior os lacrimale). They then pass behind the lacrimal sac and become woven into the palpebral fibers of the orbicularis muscle, coming from the anterior lacrimal crest. As a result, the lacrimal sac is surrounded by a muscle loop, which, when contracting and relaxing during blinking movements, either expands or narrows the lumen of the lacrimal sac. The absorption and movement of tear fluid along the lacrimal ducts is also facilitated by the contraction of those bundles of lacrimal muscle that cover the lacrimal canaliculi.

Participates in raising the upper eyelid and opening the palpebral fissure striated- m.levator palpebrae superior and smooth muscle- superior and inferior tarsal or Müller muscles. In the lower eyelid there is no muscle similar to the levator. The function of raising the lower eyelid is carried out by a weakly expressed muscle (m. tarsalis inferior) and the inferior rectus muscle of the eye, which gives an additional tendon to the thickness of the lower eyelid.

M. levator palpebrae superior - begins in the depths of the orbit, where at the apex it departs from the tendon ring (annulus tendineus communis) together with the rectus muscles of the eyeball, is directed under the roof of the orbit anteriorly and at the level of the supraorbital edge passes into a wide tendon, which diverge fan-shaped and divide into three departments. The anterior part of the tendon in the form of thin bundles of fibers passes through the tarso-orbital fascia and orbicularis muscle, diverges in a fan-shaped manner and merges with the subepithelial layer of the skin of the eyelids. Rear portion penetrates into the upper fornix of the conjunctiva and attaches here. Medium - the most powerful(Müller's muscle) is attached along the upper edge of the cartilage along its entire continuation. In its structure, the Müller muscle is reticulate, only part of its muscle bundles approach perpendicular to the edge of the cartilage, penetrating between the levator fibers and accompanying them in places to the upper edge of the cartilage. In this case, the levator tendon is separated by smooth muscle fibers. The other part of the fibers approaches in an oblique direction. The third forms a well-defined transverse beam, intertwined with the levator aponeurosis. Such contact with the levator aponeurosis provides not only elevation, but also prevents wrinkling of the eyelid. The lateral branches of the levator tendon fix it to the periorbita. Contraction of the muscle leads to upward simultaneous lifting of the skin, tarsal plate and conjunctival fornix. The main muscle is the muscle that lifts the upper eyelid, the auxiliary muscle underlying it is the Müller muscle, and when looking up - the frontal and superior rectus. The Müller muscle is innervated by the sympathetic nerve, and the remaining two portions are innervated by the third pair (oculomotor nerve).

When the palpebral part of the orbicularis oculi muscle contracts blinking and slight squeezing of the eyelids is carried out. Electromyographically it has been established that during voluntary blinking movements the muscle, The levator palpebrae superioris and orbicularis muscles act reciprocally: the activity of one is accompanied by the passivity of the other. If the upper eyelid slowly droops, not only does the activity of the levator muscle decrease, but the antagonist (orbicularis muscle) also remains passive. However, the general mechanism of eyelid closure is more complex due to the combined connection of the orbicular muscle with the facial muscles on the one hand and the epidermis of the facial skin on the other. As a result of these connections, when closed, the eyelids move not only up and down, but also in the horizontal direction - inward, especially the lower one, which plays an important role in the movement of tear fluid. When the eyelids close, the palpebral fissure is shortened by 2 mm. In addition, the leading role in the lacrimal drainage mechanism belongs to the deep part of the palpebral portion of the orbicularis muscle.

Eyelid ligaments

Medial and lateral ligaments serve as the main apparatus that attaches various elements of the eyelid to the bony wall of the orbit: the edges of the eyelids themselves, the orbicularis oculi muscle, the edges of the cartilages and the tarso-orbital fascia. The medial ligament has two legs: front and back. The first, in the form of a powerful collagen cord formed by the tendon of the orbicularis muscle and merging with it by collagen fibers of the medial sections of the cartilage and orbicular fascia, runs horizontally in front of the lacrimal sac from the inner corner of the eyelids to the anterior lacrimal ridge (upper jaw). The cord can be easily palpated and becomes visible when the conjunctiva is pulled downwards, due to tension in the internal ligament. His back leg branches off slightly from the corner of the eyelids in the form of a tendon, bends around the lacrimal sac from the outside and behind and attaches to the posterior lacrimal crest of the lacrimal bone. Thus, the medial ligament covers the lacrimal sac both anteriorly and posteriorly. The lateral ligament of the eyelids, compared to the internal one, is poorly developed and is only a suture with a tendon bridge between the outer parts of the circular muscle of the upper and lower eyelids. The ligament is reinforced by the collagen fibers woven into it from the outer ends of the cartilages and the tarso-orbital fascia. It also runs horizontally from the outer corner of the eyelids to the bony tubercle of the zygomatic bone - tuberculum orbitae, where it is attached 2-3 mm from the edge of the orbit.

Cartilage of the century

It is a semilunar-shaped plate with pointed edges (when performing incision in the intermarginal space, it easily separates into 2 plates). The collagen tissue that forms this plate with an admixture of elastic fibers is distinguished by its special cartilaginous density. Therefore, the name cartilage has taken root, although histologically there are no elements of cartilage here. The pointed ends of the cartilage are firmly connected to each other by an interweaving of collagen fibers. Collagen fibers running from the edges of the cartilage to the medial and lateral ligaments of the eyelids fix the cartilage to the bony walls of the orbit. The density of cartilage determines its protective “skeletal” function. Cartilage follows the convex shape of the eyeball. The length of the cartilage of the upper eyelid is 2 cm, height 1 cm, thickness 1 mm, the cartilage of the lower eyelid is smaller, its height is 5 mm. The anterior surface is bordered by loose connective tissue, the posterior surface is closely connected with the conjunctiva.

The thickness of the cartilage contains modified sebaceous glands - Meibomian(on the upper eyelid - 27-30, on the lower - about 20). They have an alveolar structure and secrete fatty secretions. The very short ducts of the alveoli flow into the long common excretory duct. The glands are parallel to each other and perpendicular to the free edge of the eyelids, occupying the entire height of the cartilage. The openings of the ducts open in front of the posterior edge of the eyelid in the form of pores. The secretion of the meibomian glands serves as a fatty lubricant, protects the edges of the eyelids from maceration, and prevents tears from overflowing over the edge of the eyelids, promoting its proper outflow.

Thus, cartilage is, as it were, direct continuation of the tarsoorbital fascia, firmly connected to the orbital edge. This septum (septum orbitae) completely separates the contents of the orbit from the tissues of the eyelids, preventing the spread of pathological processes deeper. The back surface of the eyelids is covered with the conjunctiva, which is tightly fused with the cartilage, and beyond it forms a mobile arch. Deep upper and shallower and easily accessible lower arch.

The conjunctiva is a thin, transparent mucous tissue, which in the form of a thin shell covers the entire back surface of the eyelids (tunica conjunctiva palpebrarum), forms deep vaults (fornix conjunctivae superior et inferior) and passes to the eyeball (tunica conjunctiva bulbi) ending at the limbus. In the conjunctiva of the eyelids, in turn, there is a tarsal part - tightly fused with the underlying tissue, and a mobile - orbital part, in the form of a fold transitional to the arches.

Conjunctival cartilage covered with a two-layer cylindrical epithelium and contains goblet cells at the edge of the eyelids, and the crypts of Henle at the distal end of the cartilage. Both of them secrete mucin. Under the epithelium there is reticular tissue tightly fused with cartilage. At the free edge of the eyelids the mucous membrane is smooth, but already 2-3 mm from it a roughness appears, due to the presence of papillae here.

Conjunctiva transitional fold smooth and covered with 5-6 layer transitional epithelium, also with a large number of goblet cells secreting mucin. Under the epithelium is loose connective tissue consisting of elastic fibers and containing plasma cells and lymphocytes. The conjunctiva here easily moves and forms folds that facilitate free movements of the eyeball.

On the border between the tarsal and orbital parts in the conjunctiva there are accessory lacrimal glands s, similar in structure and function to the main lacrimal gland: Wolfring - 3 at the upper edge of the upper cartilage and one more below the lower cartilage, and in the area of ​​the vaults - Krause. The number of the latter reaches 6-8 on the lower eyelid and from 15 to 40 on the upper. The blood circulation of the eyelids is carried out by two systems: the system of the internal carotid artery (branch of a.ophthalmica). a.supraorbitalis, a.lacrimalis and the system of the external carotid artery (anastomoses a.facialis and a.maxillaris, a.temporales superfacialis).

From the nasal side, they penetrate into the thickness of both eyelids from the depths of the orbit. medial palpebral arteries of the eyelid- upper and lower (a. palpebralis mediales superiores et inferiores) - terminal branches of a.supraorbitalis. The a.palpebralis lateralis extends from the lateral side of the a.lacrimalis. In the loose connective tissue layer between the musculocutaneous and tarsal-conjunctival plates of the eyelid, these medial and lateral branches of the palpebral arteries are directed towards each other, merge and form transversely located arterial arches: upper and lower (arcus tarseus sup. et inf., or arcus subtarsalis sup.et inf.). Both arterial arches run along the edges of the eyelid, the upper one is 1-2 mm from the edge of the eyelid, the lower one is 1-3 mm. At the level of the upper edge of the cartilage, a second peripheral arc or arcus tarseus sup is formed. It is not always pronounced on the lower eyelid. Between the peripheral and subtarsal arches there are vertical anastomoses with the arteries of the face. The vascularization of the lower eyelid and the surrounding area also involves branches of the infraorbital artery, arising from the maxillary artery (from the external carotid artery system). These arches nourish all the tissues of the eyelids. The veins of the eyelid follow the arteries, forming two networks: superficial and deep. There are significantly more anastomoses - with the veins of the face and the veins of the orbit. Because there are no valves in the veins, blood flows both into the venous network of the face and orbit and through the v.ophthalmica. superior, shedding blood into the cavernous sinus (hence, there is a high probability of infection entering the cranial cavity). On their way into the orbit, the veins that drain blood from the eyelid area also penetrate the orbital muscle. Its spasm in diseases of the eyeball (scrofulosis) can lead to swelling of the eyelids.

The most important anastomoses of the venous network of the eyelids- with the lacrimal vein (v.lacrimalis) and with the superficial temporal vein (v.temporalis superfacialis). Of particular importance are anastomoses with v. angularis, passing from the inner corner of the palpebral fissure and anastomosing with v. ophthalmica superior.

Lymphatic system- a network of widely branched lymphatic vessels in both the deep and subtarsal layers. Both networks anastomose widely with each other. The regional lymph node draining lymph from the upper eyelid is the preauricular one, and from the lower eyelid area is the submandibular one.

Innervation of the eyelids

The third and seventh pairs of cranial nerves take part in the motor innervation of the eyelids.

Orbicularis oculi muscle- a branch of the facial nerve (VII pair), its motor fibers ensure the closure of the eyelids. The facial nerve has a mixed composition: includes motor, sensory and secretory fibers that belong to the intermediate nerve, closely connected with the facial nerve. The motor nucleus of the nerve is located in the lower part of the pons at the bottom of the IV ventricle, bending around the nucleus of the abducens nerve localized above, forms a knee (genu n. facialis) and exits to the base of the brain in the cerebellopontine angle. Then, through the internal auditory opening, it enters the canalis facialis, in which it makes two turns to form the genu and the genu ganglion (geniculum et ganglium gen.). From the ganglion node, the great petrosal nerve (n. petrosus major) originates, carrying secretory fibers to the lacrimal gland, extending from a special lacrimal nucleus, and the facial nerve itself leaves the canal through the foramen stilomastoideum, giving off branches n at this level. auricularis posterior et r. digastricus. Then, with a single trunk, it penetrates the parotid gland and is divided into superior and inferior branches, which give off multiple branches, including to the orbicularis oculi muscle. The muscle that lifts the upper eyelid is innervated by the oculomotor nerve (III pair), only its middle part, i.e. Müller's muscle - sympathetic nerve.

Nucleus of the oculomotor nerve located at the bottom of the Sylvian aqueduct. The oculomotor nerve leaves the skull through the superior orbital fissure, joining sympathetic (from the plexus of the internal carotid artery) and sensory fibers (from the n.ophthalmicus), passes through the cavernous sinus. In the orbit, within the muscular funnel, it is divided into superior and inferior branches. The upper, thinner branch, passing between the superior rectus muscle and the levator palpebral muscle, innervates them.

Sensory nerves to the upper eyelid and skin of the forehead come from the orbital nerve (n.ophthalmicus) of the 1st branch of the trigeminal nerve, which exits through the superior orbital fissure and is divided into three main branches: n.lacrimalis, n.frontalis et n.nasociliaris. The n.frontalis plays a major role in the innervation of the skin of the eyelids., in the medial region of the upper eyelid, its branches n.supraorbitalis et n.supratrochlearis extend under the skin. The orbital nerve supplies sensitive innervation to the skin of the forehead, the anterior surface of the scalp, the upper eyelid, the inner corner of the eye, the back of the nose, the eyeball itself, the mucous membranes of the upper part of the nasal cavity, the frontal and ethmoid sinuses, and the meninges. The lower eyelid receives sensitive innervation from n.infraorbitalis, extending from the 2nd branch of the trigeminal nerve (n.maxillaris). Maxillary nerve exits the cranial cavity through the round foramen and innervates the dura mater, skin, cartilage and conjunctiva of the lower eyelid (except for the innermost and outer corners of the palpebral fissure), the lower half of the lacrimal sac and the upper half of the nasolacrimal duct, the skin of the anterior part of the temporal region, the upper part of the cheek , wings of the nose, as well as the upper lip, the upper jaw (and the teeth on it), the mucous membranes of the back of the nasal cavity and the maxillary sinus.

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