Skip to main content
UploadLanguage (EN)Support
BusinessMobileSocial MediaMarketingTechnologyArt & PhotosCareerDesignEducationPresentations & Public SpeakingGovernment & NonprofitHealthcareInternetLawLeadership & ManagementAutomotiveEngineeringSoftwareRecruiting & HRRetailSalesServicesScienceSmall Business & EntrepreneurshipFoodEnvironmentEconomy & FinanceData & AnalyticsInvestor RelationsSportsSpiritualNews & PoliticsTravelSelf ImprovementReal EstateEntertainment & HumorHealth & MedicineDevices & HardwareLifestyle
DB
Uploaded byDr Anushruth Bhandare
PPTX, PDF187 views

Anatomy of Conjunctiva.pptx

The document summarizes the anatomy of the conjunctiva in 3 parts - palpebral, bulbar, and fornix conjunctiva. It describes the layers, glands, blood supply, nerve supply and functions of the conjunctiva. The conjunctiva lines the inner surface of the eyelids and anterior surface of the eyeball. It contains goblet cells that secrete mucus to lubricate the eye and protect it. The seminar provides details on the histology and applied anatomy of inflammatory conditions, degenerative conditions, cysts and tumors that can affect the conjunctiva.

Health & Medicine◦
Download to read offline
DEPARTMENTAL SEMINAR on Anatomy of Conjunctiva By, Dr Anushruth T Bhandare 1st Year PG Scholar SJGAMC DATE : 12-07-2022 1
Contents Introduction Parts of conjunctiva Conjunctival glands Blood supply and Lymphatic drainage Nerve supply Functions of conjunctiva Tearfilm Applied Anatomy of Conjunctiva 12-07-2022 2
INTRODUCTION Conjunctiva is a transparent mucous membrane that lines the posterior surface of the eyelids and the anterior surface of the eye ball, terminating at the corneoscleral limbus. It joins the eyeball to the eyelids  it stretches from the lid margin to the limbus and encloses a complex space called conjunctival sac 12-07-2022 3
Parts of conjunctiva Conjunctiva can be divided into 3 parts A. Palpebral Conjunctiva B. Bulbar Conjunctiva C. Conjunctival Fornix 12-07-2022 4
12-07-2022 5 PARTS OF CONJUNCTIVA A. Palpebral Conjunctiva C. Conjunctival Fornixes B. Bulbar Conjunctiva 1. Marginal 3. Orbital part 2. tarsal 2. Limbal 1. Scleral 1. Superior 2. Inferior 4. Medial 3. Lateral
12-07-2022 6
A. Palpebral conjunctiva Highly vascular Extremely thin Can be subdivided into 3 part 1. Marginal Conjunctiva 2. Tarsal Conjunctiva 3. Orbital Conjunctiva 12-07-2022 7
1. Marginal conjunctiva  Extends from lid margin to about 2mm on the back of the lid up to the sulcus sabtarsalis Consist of 5 layers 5 layered non keratinized stratified squamous epithelium Superficial layer- squamous cells Middle 3 layers- Polyhedral cells Deepest layers- Cylindrical cells` 12-07-2022 8
2. Tarsal conjunctiva Tarsal conjunctiva is thin, transparent and highly vascular In the upper lid it is Firmly adhered to tarsal plate In lower lid it is adherent only to half width of the tarsus Tarsal glands can be seen through this layer as a yellow streak Consist of 2 layers of stratified cuboidal epithelium Superficial layer- cylindrical cells Deepest layer- cuboidal cells 12-07-2022 9
12-07-2022 10
3. Orbital conjunctiva Lies loose between tarsal plate and fornix Orbital conjunctiva of upper lid is loose and lies over the muller’s muscle so folds readily Shallow grooves and elevations are called stieda’s plateaux and grooves 12-07-2022 11
b. Bulbar conjunctiva Lies in contact with eyeball Thin translucent and loosely attached by connective tissue to sclera and fascia bulbi Consist of 3 layers of stratified squamous epithelium 1. Superficial layer – Cylindrical cells 2. Middle layer – polyhedral cells 3. Deepest layer – cuboidal cells 12-07-2022 12
1. Scleral conjunctiva Covers the anterior sclera and is continuous with the corneal epithelium at the limbus It is transparent and lies loose over the underlying structures and thus can be moved easily Its separated from the anterior sclera by episcleral tissue and tenon’ capsule 12-07-2022 13
2. Limbal conjunctiva Limbal conjunctiva is a 3 mm ridge of bulbar conjunctiva around the cornea In this area tenon’s capsule and episcleral tissue are fused into a dense tissue which is strongly adherent to the underlying corneoscleral junction At the limbus the epithelium of conjunctiva becomes continuous with that of cornea 12-07-2022 14
12-07-2022 15
c. Conjunctival fornix It joins bulbar conjunctiva with palpebral conjunctiva Subdivided into 1. Superior fornix 10 mm from limbus, ducts of lacrimal gland open into the lateral part of superior fornix 2. Inferior fornix 8 mm from limbus 3. Lateral fornix 14 mm from limbus 4. Medial fornix 7 mm from limbus 12-07-2022 16
Conjunctival sac The conjunctiva while lining the structures like the posterior part of the lids and anterior part of the globe forms a sac that opens at the palpebral fissure. The conjunctival sac contains about 7µl of tear fluid but has the capacity to accommodate fluid up to 30 µl. 12-07-2022 17
Histological structures of conjunctiva Layers of conjunctiva 1. Epithelium 2. Adenoid layer 3. Fibrous layer 12-07-2022 18
1. Cells present in epithelium The conjunctival epithelium is a non-keratinized, stratified columnar epithelium that lines the inside of the eyelids and covers the sclera. The conjunctiva contains Goblet Cells that secrete mucin, which generates the moisture that covers the surface of the eye and allows the eyelids to open and close easily 12-07-2022 19
2. Adenoid layer Also called as lymphoid layer Consists of fine connective tissue reticulum in the meshes of which lie lymphocytes Most developed at fornixes Not present at birth, develops after 3-4 months of life. 12-07-2022 20
3. Fibrous layer Consist of meshwork of collagenous and elastic fibres This layer is thicker than the adenoid layer, except in the region of tarsal conjunctiva Blends with the underlying tenon’s capsule in the region of bulbar conjunctiva Contains blood vessels and nerves suppling conjunctiva 12-07-2022 21
12-07-2022 22 CONJUNCTIVAL GLAND 1. Mucin Secretory Gland a. Goblet Cells b. Henle’s Glands c. Glands of Manz 2. Accessory Lacrimal Glands a. Glands of Krause b. Glands of Wolfring
A. Goblet cells Unicellular, round and oval cells present abundantly in conjunctival of all regions except marginal and limbal conjunctiva Formed in the deepest layers of epithelium and then are pushed upwards They are destroyed after discharging their content, the mucin 12-07-2022 23
a. Goblet cells Numerous of cells present on the nasal side, particularly in bulbar conjunctiva and inferior fornix Density of cells is high in children and young adults 12-07-2022 24
b. Henle’s glands Tubular structures with lumina of 15-30µm which contains a few goblet cells Present in the folds of mucous membrane present in the palpebral conjunctiva between tarsal plate and fornixes 12-07-2022 25
c. Glands of manz Found in limbal conjunctiva Arranged in ring, near the cornea Secrete mucus essential for wetting the cornea and conjunctiva 12-07-2022 26
Functions of mucin Provide a hydrophilic layer that allows for even distribution of the tear film Provide lubrication and protects the epithelial cells of cornea and conjunctiva Ensures tearfilm stability by reducing the surface tension 12-07-2022 27
a. Glands of Krause Lie in deep sub-conjunctival tissue of the upper and lower fornixes Upper fornix- 42 in number Lower fornix- 6-8 in number In the upper fornix they lie between the palpebral part of the lacrimal gland and tarsal plate 12-07-2022 28
b. Glands of wolfring Also called as glands of ciaccio, larger than Glands of Krause Situated in the upper border of the tarsus midway between the end of the tarsal glands Upper lid- 2-5 in number Lower lid- 1-3 in numbers 12-07-2022 29
12-07-2022 30
The plica semilunaris Pinkish crescentic fold of the conjunctiva, present in the medial canthus Lateral free border is concave which becomes less prominent on abduction but forms a cul-de-sac about 2mm in depth when eyeball is adducted Vestigial in humans 12-07-2022 31
The plica semilunaris Epithelium of this part of conjunctiva consist of 8-10 layers of cells with many goblet cells Substantia propria is composed of oose connective tissue containing numerous blood vessels, lobule of fat, a few non striated muscle fibres and melaphores 12-07-2022 32
12-07-2022 33
The caruncle It is small (5mm×3mm), soft, ovoid, pinkish mass situated in inner canthus, just medial to plica semilunaris It is a piece of modified skin and so is covered with stratified squamous epithelium and contains sweat glands, sebaceous glands and hair follicles Blood supply through superior medial palpebral artery Nerve supply is from inferior trochlear nerve 12-07-2022 34
12-07-2022 35
Blood supply and lymph drainage Artery supply by Peripheral arterial arcade Marginal arterial arcade Venous drainage Venous plexus of eyelids Pericorneal plexus Lymphatic drainage Lateral side- preauricular lymph nodes Medial side- submandibular lymph nodes 12-07-2022 36
Nerve supply Circumcorneal zone- branches from long ciliary nerves which supply the cornea Rest of the conjunctiva- branches from lacrimal, infratrochlear, supratrochlear, supraorbital and frontal nerves 12-07-2022 37
Functions of conjunctiva Production of tears (mucin by the goblet cells and aqueous by the accessory lacrimal glands) Supply of oxygen directly to the cornea when the eyes are open Wash off debris Maintain a smooth ocular surface 12-07-2022 38
Functions of conjunctiva Protection of the eye by defence mechanism which include Non-Specific measures i. presence of an intact epithelial barrier ii. Lacrimation iii. Provision f rich blood supply and mucin clumping Specific immunological mechanisms i. Outpouring of mast cells ii. Leucocytes iii. Presence of an active mucosal-associated lymphoid tissue iv. Secretory IgA 12-07-2022 39
Tear film Conjunctival surface is lubricated by the tear film It is triple-layered 1. Innermost mucinous layer- lines conjunctival cells and corneal epithelium, secreted by the goblet cells, crypts of Henle, and by glands of Manz. 2. Middle aqueous layer- secreted by glands of Krause and glands of wolfring 3. Outermost superficial lipid layer- secreted by meibomian glands , this layer limits the evaporation of tears 12-07-2022 40
Applied anatomy of conjunctiva 12-07-2022 41
Applied anatomy of conjunctiva 1. Inflammatory conditions of Conjunctiva 2. Degenerative conditions of Conjunctiva 3. Symptomatic conditions of Conjunctiva 4. Cysts and Tumors of Conjunctiva 12-07-2022 42
1. Inflammatory conditions of Conjunctiva Infective conjunctivitis i. Bacterial conjunctivitis ii. Chlamydial conjunctivitis iii. Viral conjunctivitis iv. Granulomatous 12-07-2022 43
1. Inflammatory conditions of Conjunctiva Allergic conjunctivitis- inflammation due to allergic or hypersensitivity reactions may be immediate (humoral) or delayed (cellular) Simple Allergic conjunctivitis Vernal keratoconjunctivitis Atopic keratoconjunctivitis Giant papillary conjunctivitis Phlyctenular keratoconjunctivitis (PKC) Dermatoconjunctivitis (ADC) 12-07-2022 44
Simple Allergic conjunctivitis It is a mild, nonspecific allergic conjunctivitis characterized by itching, hyperaemia and mild papillary response. Basically, it is an acute or subacute urticarial reaction. 12-07-2022 45
Vernal keratoconjunctivitis VKC is a recurrent, bilateral, interstitial, self-limiting, allergic inflammation of the conjunctiva having a periodic seasonal incidence. 12-07-2022 46
Atopic keratoconjunctivitis It can be thought of as an adult equivalent of vernal keratoconjunctivitis and is often associated with topic dermatitis. Most of the patients are young adults, with male predominance 12-07-2022 47
Giant papillary conjunctivitis GPC is the inflammation of conjunctiva with formation of very large sized papillae. 12-07-2022 48
PHLYCTENULARKERATOCONJUNCTIVITIS Phlyctenular keratoconjunctivitis is a characteristic nodular affection occurring as an allergic response of the conjunctival and corneal epithelium to some endogenous allergens to which they have become sensitized 12-07-2022 49
CONTACTDERMATOCONJUNCTIVITIS It is an allergic disorder, involving conjunctiva and skin of lids along with surrounding area of face 12-07-2022 50
1. Inflammation conditions of Conjunctiva Cicatricial conjunctivitis- its is a chronic conjunctivitis with conjunctival fibrosis Toxic conjunctivitis- it is a type of chronic follicular conjunctivitis that occurs as a response to toxic cellular debris desquamated into the conjunctival sac 12-07-2022 51
2. Degenerative conditions Pinguecula Pterygium Concretions Amyloid degenerations 12-07-2022 52
Pinguecula It is an extremely common degenerative condition of conjunctiva. characterized by formation of a yellowish white patch on the bulbar conjunctiva near the limbus 12-07-2022 53
Pterygium It is a wing shaped folds of conjunctiva encroaching upon the cornea from either ide within the interpalpebral fissure 12-07-2022 54
Concretions These are formed due to accumulation of inspissated mucus and dead epithelial cell debris into the conjunctival depressions called loops of Henle 12-07-2022 55
Amyloid degeneration of conjunctiva The deposition of yellowish, well-demarcated, irregular amyloid material in the conjunctiva with superior fornix and tarsal conjunctiva being more commonly involved areas. 12-07-2022 56
Symptomatic conditions of Conjunctiva A. Hyperaemia B. Haemorrhages/Ecchymosis C. Chemosis D. Xerosis E. Conjunctival discharge F. Follicles G. Papillae H. Pseudomembranous 12-07-2022 57
a. Hyperaemia Hyperaemia of conjunctiva means congestion of the conjunctival vessels Conjunctival hyperemia is caused by a pathological vasodilatory response of the microvasculature in response to inflammation due to a myriad of infectious and non-infectious etiologies May be transitory, acute, recurrent or chronic Transitory Hyperaemia- due to temporary irritation such as by small F/B in conjunctival sac 12-07-2022 58
a. Hyperaemia Acute/Recurrent Hyperaemia- concretions in palpebral conjunctiva inspissated calcareous secretions in meibomian glands In-growing eye lashes Chronic Hyperaemia- caused by condition such as Dusty Ill-ventilated rooms Exposure to heat or dryness Allergic conditions such as hay fever 12-07-2022 59
b. Haemorrhages A bright red patch appearing in the white of the eye beneath the clear lining of the eye (conjunctiva) May occur in viral conjunctivitis- when they are often multiple, small and discrete such as “Petechial bleeding” Severe bacterial conjunctivitis when they are lager and diffuse 12-07-2022 60
c. Chemosis (conjunctival oedema) Chemosis of conjunctiva is due to exudation from abnormal permeable capillaries retained within the mucous membrane which becomes swollen and gelatinous Translucent swelling of conjunctiva when severe may protrude through the eyelids Acute chemosis- Hypersensitive response to allergens' such as pollen grains Severe infective conjunctivitis 12-07-2022 61
c. Chemosis (conjunctival oedema) Subacute/Chronic chemosis- Local- thyroid eye disease, chronic allergic conjunctivitis trauma Increased systemic vascular permeability- vasculitis, allergic conditions Increased venous pressure- superior venacava syndrome, right-sided heart failure Decreased plasma oncotic pressure- nephrotic syndrome 12-07-2022 62
d. Xerosis Refers to symptomatic condition in which conjunctiva becomes dry and lusterless. 12-07-2022 63
e. Conjunctival discharge Refers to the production of excessive secretion in conjunctival disorders Depending upon nature of the disease various types of discharge can be seen Watery/Mucoid discharge- viral and allergic conjunctivitis Mucopurulent discharge- bacterial conjunctivitis 12-07-2022 64
f. Follicles Appears as yellowish-white round elevations more prominent in the fornixes 1-2mm in diameter Occurs due to localized aggregations of lymphocytes in subepithelial adenoid layer Unless an acute inflammation is present , the conjunctiva over them remains normal 12-07-2022 65
g. papillae Papillae are a hyperplasia of normal vascular system with glomerulus-like bunches of capillaries growing into the epithelium in inflammatory conditions Papillae can develop only in the palpebral conjunctiva and in the limbal bulbar conjunctiva where it is attached to deeper fibrous layers 12-07-2022 66
h. Pseudomembranous A pseudomembrane is formed when inflammatory exudate rich in fibrin coagulates on the conjunctiva Pseudomembranous consist of coagulated exudate adherent to the inflamed conjunctival epithelium. They can be peeled away leaving the underlying epithelium intact. 12-07-2022 67
4. Cysts and tumours Cysts of conjunctiva-common cystic lesions are Congenital cystic lesions lymphatic cysts Retention cyst Epithelial cyst Aqueous cyst etc. Tumors of conjunctiva- classified into 2 types Non-pigmented tumours- congenital, benign, premalignant, malignant Pigmented tumours- benign, precancerous melanosis, malignant 12-07-2022 68
Common Symptoms of conjunctival disorders Redness Stickiness Foreign body sensation/ Grittiness Lacrimation 12-07-2022 69
Common Symptoms of conjunctival disorders Photophobia Burning sensation Dryness of eyes Blurring of vision which may be due to excessive formation of tear film over cornea 12-07-2022 70
Conclusion Let us have a glans 12-07-2022 71
12-07-2022 72