Kakizaki Hirohiko, Zhao Jinsong, Nakano Takashi, Asamoto Ken, Zako Masahiro, Iwaki Masayoshi, Miyaishi Osamu
Department of Ophthalmology, Aichi Medical University, Nagakute, Japan.
Ophthalmology. 2006 Dec;113(12):2346-50. doi: 10.1016/j.ophtha.2006.06.017. Epub 2006 Sep 25.
To examine whether the lower eyelid retractor consists of a single layer or multiple layers.
Retrospective clinical case series and dissectional study.
Fifty-one lower eyelid retractors (31 right, 20 left) of 44 patients (ages, 63-95 years) during entropion surgeries and 10 lower eyelids (5 right, 5 left) of 5 Oriental cadavers (73-91 years old at death) were observed macroscopically. Specimens from 20 postmortem lower eyelids of 12 Orientals (11 right, 9 left; 66-96 years old at death) were used for microscopic observations.
Macroscopically, we bluntly or, in parts, sharply dissected lower eyelid retractors into 2 layers during entropion surgeries. Cadaveric lower eyelids also were used to investigate relationships between the lower eyelid retractor and the Lockwood ligament. Cadaveric lower eyelids with sagittal full-thickness sections of the central part were examined microscopically using Masson trichrome staining.
Anatomical findings in the lower eyelid retractor.
Lower eyelid retractors easily were detached into 2 layers. Macroscopically, the anterior layer was defined as a coarse tissue continuing from the Lockwood ligament, which joined with the lower orbital septum, and constituted the lower conjoined fascia. The posterior layer appeared to be a dense fibrous sheet with a lustrous surface. Microscopically, the lower eyelid retractor consisted of a definite double layer. The anterior layer, a coarse fibrous tissue, consisted of the suborbicularis fascial layer, orbital septum, and superficial part of the capsulopalpebral fascia, which continued to the anterior lamellae of the lower eyelids. The posterior layer consisted of dense fibers of the capsulopalpebral fascia with smooth muscle continuing to the tarsus.
The lower eyelid retractor consists of a definite double layer. The posterior dense layer containing smooth muscle is the main tractional component of the lower eyelid retractor.
研究下睑缩肌是单层还是多层结构。
回顾性临床病例系列及解剖学研究。
对44例（年龄63 - 95岁）患者在行睑内翻手术时的51条下睑缩肌（31条右侧，20条左侧）以及5具东方人尸体（死亡时年龄73 - 91岁）的10只下睑（5只右侧，5只左侧）进行大体观察。取自12例东方人（11例右侧，9例左侧；死亡时年龄66 - 96岁）尸体的20只下睑标本用于显微镜观察。
在睑内翻手术中，我们用钝性或部分锐性分离的方法将下睑缩肌分为两层。尸体下睑也用于研究下睑缩肌与Lockwood韧带之间的关系。对中央部分矢状全层切片的尸体下睑进行Masson三色染色后显微镜观察。
下睑缩肌的解剖学发现。
下睑缩肌很容易分离为两层。大体上，前层被定义为从Lockwood韧带延续而来的粗糙组织，它与眶下隔膜相连，并构成下睑联合筋膜。后层似乎是一个表面有光泽的致密纤维片。显微镜下，下睑缩肌由明确的双层结构组成。前层为粗糙的纤维组织，由眼轮匝肌下筋膜层、眶隔膜和睑板睑筋膜的浅层部分组成，该层延续至下睑的前层。后层由睑板睑筋膜的致密纤维和平滑肌组成，延续至睑板。
下睑缩肌由明确的双层结构组成。含有平滑肌的后致密层是下睑缩肌的主要牵引成分。
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