Eyelid Muscle Function and Anatomy Levator, Muller's, and Frontalis Muscles and Ptosis (droopy upper eyelid).

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Function:

The upper eyelid function is to protect the eye yet get out of the way for vision. Certain muscles lift the eyelid up so that you can see through the pupil.

• Levator Muscle
• Muller's Muscle
• Frontalis Muscle

Gravity, eyelid tone, and the Orbicularis Occuli Muscles close the eye.

Levator Muscle Anatomy
The levator muscle starts back above the eyeball, courses over the top, descends in the eyelid, and attaches to the eyelid margin. Its function is to lift the eyelid out of the line of vision. It can be weakened by disease, congenitally weak, ripped by trauma, or separated by age. If it is working the eyelid (with the brow blocked - see below), the upper eyelid:

• rests just under the iris (colored part of the eye)
• moves more than 16 mm.
• can close all of the way (when the levator is relaxed)

Muller's Muscle Anatomy
This is a short muscle controlled by the sympathetic nerves of your body. It generally is contracted while you are awake so that it lifts the eyelid. When tired or asleep, it is relaxed letting the eyelid sag and droop. The eyelids can now close with minimal orbicularis tone.

Frontalis Muscle Anatomy
Is the brow's muscle. It lifts the eyebrow out of the way and is a muscle of facial animation. It starts on the top of the head and attaches to the eyebrow skin. There is one for each brow. It works with facial expression. It can lift the eyelid in a secondary fashion and can compensate for eyelid muscles to a certain degree. With the aging face, the brow can descend with gravity. This pair of muscles may have to work "overtime" to keep the redundant skin and tissues off the eyelid. Correction of this process is covered in Brow Lift sections of Dr. Bermant's web site. You can see examples of the aged sagging skin problems on Paul Revere and President Adams. Notice the prominent extra folds of skin showing the compensation happening. Below you can see examples of the frontalis muscle compensation in ptosis.

Obicularis Occuli Muscle Anatomy
These muscles circle the eyes. They are located just under the skin. There are several subgroups in this muscle that act to close the eyelids. They have a resting tone and can close the eyes to various degrees. The obicularis occuli muscles are important muscles of facial expression.The aging and sagging of these muscles are addressed during blepharoplasty eyelid rejuvination surgery.

Congenital Eyelid Ptosis in a 26 year old black male.
(Drooping of upper eyelid)

These images before surgery here demonstrate the typical problems and compensation of the patient who can not get the ptotic eyelids out of the way.

The eyelid is lifted up for the eye to see with the levator muscle. This muscle attaches to the eyelid and courses above the eyeball. The eyebrow (frontalis muscle) can assist to open the lid. You can tell when the patient is using his brow to help open his eyelids - the brow wrinkles. Notice the brow differences before and after surgery. The patient can still use the brow to help, he just does not need the help except for a little on upward gaze.

Look at the black pupils. This is where the eye sees through. On the before surgery pictures, the patient can barely lift the lids to expose half of the pupil for vision on direct ahead gaze.

Photograph Before Surgery	Photograph Before Surgery

Looking up obstructs the pupils - this patient could not see looking up before surgery. Although the lid muscles may appear to be "lazy", they just do not work very well. The frontalis is working overtime.

Picture blocking right brow and eyelid function before surgery. Notice the left brow elevation in the patient's attempt to open the right eyelid.	Picture showing left eyelid function with brow blocked before surgery

The hand on the forehead is stabilizing, or holding the brow. This eliminates the contribution from the frontalis muscles for opening the eyelids. Notice how the lids do not open as well. The ruler is used to measure how much the eyelid can move between looking up and looking down.

Looking down, the brow is relaxed even before the secondary surgery. The frontalis, levator and Muller's muscles must be able to relax enough for the lid to close completely. Notice the patient is not compressing his obicularis muscles for this action.

Image Before Surgery Looking Down

See other photographs of this patient before and after surgery.

Other topics of interest:

Ptosis of the eyelid (dropping of the upper eyelid).
Ptosis classification
Muscle function and dysfunction in drooping eyelid problems.
Measuring eyelid function in eyelid ptosis.
Congenital eyelid ptosis reconstructive surgery options.
Recurrent congenital eyelid ptosis in a 26 year old black male.
Ptosis associated with paralyzed eyebrow muscle.
Ptosis associated with Blepharophimosis (congenital eyelid deformity).
Blepharoplasty (Cosmetic surgery of the eyes)
Ectropion (Drooping of the lower eyelid) Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts. Reconstruction of the lower eyelid

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Ptosis of the eyelid (drooping of the upper eyelid)

• Simple congenital
• Acquired Myogenic (muscle related)
• Ptosis associated with Blepharophimosis (congenital eyelid deformity)
• Ptosis associated with paralyzed eyebrow muscle

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Ectropion (Drooping of the lower eyelid)

Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

Reconstruction of the lower eyelid

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This page last updated on: March 31, 2009

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