Gross and microscopic study of insertion of levator palpebrae superioris and its anatomical correlation in superior palpebral crease formation and its clinical relevance

BackgroundTo study insertion of LPS and correlate anatomically the formation of superior palpebral crease and its clinical relevance in section of Indian population.MethodsTwenty-five human eyelids from cadavers ranging from 15–80 years were studied by dissection and histology.ResultsThe levator aponeurosis traverses through interfascicular space of orbicularis oculi with twenty four inserting into subcutaneous tissue. Low septo aponeurotic sling or preaponeurotic fat was not observed. Lower one third tarsal insertion seen in twenty four specimens. Fibres become denser as it reaches the connective tissue anterior to tarsal plate. The crease was at different levels in relation to the tarsal insertion.ConclusionThe aponeurosis insertion is either to the skin, the subcutaneous tissue or into the interfascicular space of the orbicularis. The present study reaffirms the insertion of LPS to the subcutaneous tissue of the eyelid with an extension reaching lower one third of the tarsal plate. The tissues in the anterior tarsal plate are closely packed but to act as a single complex to form a dynamic crease has not been confirmed in the study. No gross or histological difference was observed in the skin of the eyelid in the vicinity of the crease. The pattern of insertion of LPS aponeurosis plays a direct role in the formation of superior palpebral crease an important role in surgeries for Ptosis. The eyelids studied were of Indian origin with crease, and further comparative studies needs to be done for the precise anatomical explanation of single fold eyelids.