Anatomical areas and points used in the evaluation of this area
1 a; iris, 1b; limbus (round line separating iris and sclera), 2; sclera (white part of the eye), 3; medial canthus;(inner corner of the eye), 4; lateral canthus(outer corner of the eye), 5a; lower eyelid, 5b; free bleed of the lower eyelid, 6a; upper eyelid, 6b; free edge of the upper eyelid, 7; upper eyelid crease line, 8a; the inner part of the eyebrow, 8b; middle part of the eyebrow, 8c; outer part of the brow, tail of the brow
upper eyelid fold line
There is a natural line on the upper eyelid depending on the fold. The upper eyelid fold line is the point of attachment of the muscle that opens the eyelid to the muscle around the eye. It runs parallel to the cilia on the upper eyelid and divides the upper eyelid into 2, with a ratio of 1 on the bottom and 2 on the top. This fold line changes depending on ethnicity and age. While the patient is looking down, the upper eyelid is slightly pulled up and the distance of the fold line to the eyelashes is measured. This distance varies between 8-11 mm. The distance between the eyebrow and the upper eyelid fold line should be 1.6 cm on average.
This fold line should not exceed the inner corner of the eye on the inside and the orbital rim on the outside. When the upper eyelid crease extends outward too much or even crosses the edge of the eye, it is called “Connell’s Sign”. It is one of the signs of aging of the face and is associated with drooping of the eyebrows.
The upper eyelid fold line extends around the eyes. This is called the Connel Symptom. It is associated with the drooping of the eyebrows.
The distance between the inner corners of both eyes (intercanthal distance) varies according to the races, but the average is 30-35 mm. This distance is equal to the distance-eye width between the inner and outer corners of an eye. Also, both distances should be 1/5 of the width of the face.
The distance between the edge of the lower eyelid and the most protruding point of the cheek is 27 mm or less. When the muscles around the eyes thicken in the lower eyelid, the eyelid becomes prominent when the person smiles. The distance between the cornea of the eye and the lowest edge of the lower eyelid is 5.5 mm. The distance between the cornea and the upper eyelid margin is 4.5 mm.
The distance between the inner corner and the outer corner of the eye-eye width is 30-40 mm.
The distance between the upper and lower eyelids in the eye is 10-15 mm.
While the upper eyelid covers the iris by 2-3 mm, the lower eyelid is at the border of the lower iris.
When we combine the inner and outer corners of the eye, it is called the eye axis. This axis extends slightly upwards from the inside out. This means that the outer edge of the eye is slightly higher than the inner.
One of the most important differences between men and women is in the eye axis. In men, this axis is flatter than in women, and the outer eye corner is lower. The bone structure above the eye is more anterior and stronger.
In the first picture, the eye axis is seen in women. In the second picture, the eye axis in men is seen.
The following method is used to determine the relationship between the eyeball and the bone anatomy that forms the orbital socket surrounding the eye. When looking at the face from the front, a vertical line is drawn through the iris of the eye. The points where this line cuts the bone around the eye are marked at the top and bottom.
In the anterior evaluation of the face, a perpendicular line is drawn through the iris of the eye. The points of this line that cut the bone around the eye at the upper and lower points are determined.
Then, the profile evaluation of the face is passed and the 3 perpendicular reference lines passing through these 3 points are used.
These reference lines are;
eye corneal line; The most anterior point of the eyeball in profile is the line passing through the cornea.
The upper orbital bone line; It is located 8–10 mm in front of the corneal line.
The lower orbital bone line; This reference line can be located in front of or behind the corneal line. Being in front of it causes a younger appearance on the face. Being behind it gives an older and tired expression on the face. It is often caused by the insufficient development of the middle part of the face.
In the first picture, the lower eye bone line is in front of the corneal line and gives the patient a younger expression. In the second picture, the lower eye bone line is behind the corneal line. This gives the face a tired and older expression.
The inner part of the upper eyelid has a steeper cast than the outer part.
In the upper eyelid, the blue line shows the angulation of the inner part, and the yellow shows the angulation of the outer part. The angle of the inside is steeper than the outside.
Evaluation of the upper outer part of the eye
The upper outer part of the eye has an important value in facial aesthetics and should be evaluated carefully.
This area should appear slightly fuller than normal. This gives the person a more youthful and attractive expression. The protrusion of the upper outer part of the bone around the eye more forward and downward or the fact that the tear gland is prominent here causes this area to appear fuller. This excessive fullness gives the person a more tired expression.
The upper eyelid fold line should end at the outer corner of the eye. If it continues out of the eye, it is called “Connel’s Sign”. It is one of the eye contour changes due to aging and is caused by the drooping of the eyebrows and the pressure on the eyelids.
In the evaluation of the eyelids, the following evaluations must be made during the examination.
Dermatochalasis; It is the presence of more than normal skin on the upper eyelid. It is observed in middle-aged people. Excess skin can be measured with the eyes closed. Blepharochalosis is different from dermatochalosis. This is recurrent edema and redness of the eyelids. It is observed in young women and causes wrinkles on the eyelids at an early age.
eyelid skin elasticity; When the eyelid is pulled down, it quickly becomes old with the adequacy of its flexibility. This is called a “snap test”. When the eyelid is pulled down, it should move 7 mm away from the eye limbus. This is called the “Distraction test”.
3. Evaluation of herniation-herniation of adipose tissue above and below the eye should be performed. For this, when light pressure is applied on the eye while the eye is closed, swelling is observed in the upper and lower parts of the eye.
There may be herniation of the adipose tissue, which is known as Festoons (cheek bags, malar bags) under the lower eyelid. This should not be confused with lower eyelid bagging.
