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Interlower and postlower eyelid retractor fat pads: a cadaveric microscopic study
  1. Jacqueline T Mupas-Uy1,
  2. Yasuhiro Takahashi1,
  3. Takashi Nakano2,
  4. Munekazu Naito2,
  5. Hiroshi Ikeda3,
  6. Hidetaka Miyazaki4,
  7. Hirohiko Kakizaki1,
  8. Raman Malhotra5
  1. 1 Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
  2. 2 Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
  3. 3 Department of Pathology, Aichi Medical University, Nagakute, Aichi, Japan
  4. 4 Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama, Japan
  5. 5 Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
  1. Correspondence to Dr Yasuhiro Takahashi, Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi 480-1195, Japan; yasuhiro_tak{at}


Background To report the histological microscopic anatomy of the interlower and postlower eyelid retractor (LER) fat pads.

Methods In this experimental microscopic study, 31 exenterated orbits from 31 Japanese cadavers (19 right and 12 left; 15 male and 16 female; mean age of death, 81.0±8.8 years; range, 52–97 years) fixed in 10% buffered formalin were used. Masson trichrome was used to stain sagittal full sections of exenterated tissues. Microscopic examination of the lower eyelids was carried out.

Results The exenterated orbits demonstrated the presence of the histological existence of inter-LER fat pad (80.6%) and post-LER fat pad (22.6%) in the lower eyelids. The inter-LER fat pad was thick and located between the anterior and posterior layers of the LER, where the blood vessels passed through in 18 specimens (72.0%). The post-LER pad was thin, subtle and located between the posterior layer of the LER and conjunctiva.

Conclusion This study reports a novel finding of the inter-LER and post-LER fat pads. Awareness of these fat layers provides surgeons with additional anatomical detail of lower eyelid anatomy.

  • anatomy
  • eye lids

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  • Contributors All authors qualify for authorship based on contributions to the conception and design (YT, RM), acquisition of data (YT, TN, MN, HI and RM), literature search (JTM-U, YT), and analyses and interpretation of data (all authors). All authors contributed to drafting the article and revising it critically for important intellectual content and final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Before death, the donors submitted written approval for the donation of their body, and its use for clinical studies. The format of the approval was consistent with Japanese law involving “Act on Body Donation for Medical and Dental Education.” All cadavers were donated and registered with the cadaveric service of Aichi Medical University. The methods used for securing human tissues were humane and complied with the tenets of the Declaration of Helsinki. This study was approved by the Institutional Review Board (IRB) of Aichi Medical University (No. 2016-M021). At the request of the IRB, we published an outline of the study, available for public viewing on the Aichi Medical University website. This public posting also gave the donors’ family the opportunity to decline participation, although no one did so.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper.

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