Yuzuriha S, Matsuo K, Kushima H
Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Br J Plast Surg. 2000 Sep;53(6):466-72. doi: 10.1054/bjps.2000.3387.
The typical Mongoloid eye differs from the Occidental one in puffiness of the upper eyelid and narrowness of the palpebral fissure. We surmised that an anatomical structure might exist in the preaponeurotic fat space, which determines the features of the Mongoloid eye. The upper eyelids of 720 Japanese patients and eight Japanese cadavers were macroscopically investigated, and sagittal slices of the central upper eyelid of one patient and nine cadavers were microscopically analysed. Another, lower-positioned transverse ligament different from the higher-positioned Whitnall's one was identified just above the fusional line between the orbital septum and the levator aponeurosis in almost every upper eyelid. A robust ligamentous structure was observed in 331 patients (46%) with puffier eyelids and a narrower palpebral fissure, a diaphanous retinaculum in 381 patients (53%) and no transverse ligamentous tissue in eight patients (1%). Histological evaluation demonstrated that this ligament was composed of tight bundles of collagen fibres containing few elastic fibres. Examination of the preaponeurotic fat space indicated that the superficial expansion of the levator aponeurosis turned up around this transverse ligament to become the orbital septum. When the levator muscle contracts, the deep expansion of the levator aponeurosis retracts the tarsus, the middle expansion retracts the pretarsal orbicularis oculi muscle and skin, and the superficial expansion retracts the preaponeurotic fat against this ligament. This structure thus determines the low position of the preaponeurotic fat and restricts the vertical width of the palpebral fissure, causing the features of the Mongoloid eye.
典型的蒙古人种眼睛与西方人种眼睛的区别在于上睑臃肿和睑裂狭窄。我们推测在眶隔前脂肪间隙可能存在一种解剖结构，它决定了蒙古人种眼睛的特征。对720例日本患者和8具日本尸体的上睑进行了宏观研究，并对1例患者和9具尸体的中央上睑矢状切片进行了微观分析。在几乎每只上睑的眶隔与提上睑肌腱膜融合线的上方，都发现了一条与位置较高的惠特纳尔韧带不同的、位置较低的横向韧带。在331例（46%）上睑较臃肿且睑裂较窄的患者中观察到一种坚韧的韧带结构，在381例（53%）患者中观察到一种薄的支持带，8例（1%）患者未发现横向韧带组织。组织学评估表明，这条韧带由紧密的胶原纤维束组成，含少量弹性纤维。对眶隔前脂肪间隙的检查表明，提上睑肌腱膜的浅层扩展围绕这条横向韧带向上翻转形成眶隔。当提上睑肌收缩时，提上睑肌腱膜的深层扩展使睑板后缩，中层扩展使睑板前眼轮匝肌和皮肤后缩，浅层扩展使眶隔前脂肪紧贴这条韧带后缩。因此，这种结构决定了眶隔前脂肪的低位，并限制了睑裂的垂直宽度，从而形成了蒙古人种眼睛的特征。
