Relationship between Whit nail's ligament and the position of the superior eyelid Anatomical study in man

Abstract

Purpose Whitnall's ligament is one of the main landmarks in ptosis surgery. However, its relationship with the levator muscle is still unclear. In order to define its anatomical position precisely the authors have performed a study on 18 cadaver orbits.

Material and methods Macroscopic anatomy of the upper eyelid was examined using surgical observation and three fresh cadaver dissections. Microscopic anatomy was examined using 13 fresh cadaver dissections after a subperiosteal exenteration with histologic sections of the upper eyelid.

Results The distance between the origin of the levator aponeurosis and the superior border of the tarsus varied between 5.4 and 8.2 mm. The aponeurotic fibers blending with the septum are located between 2.4 and 5.3 mm from the superior border of the tarsus. The thickness of Whitnall's ligament averages between 0.1 and 1 mm.

Conclusion The unit levator muscle, levator aponeurosis, Whitnall's ligament plays a primary role in the statics and the physiologic movements of the upper eyelid.

Key Words:

• Eyelid anatomy
• Whitnall's ligament
• levator palpebrae superioris
• levator aponeurosis
• ptosis surgery.