ANATOMY OF CONJUNCTIVA

-K.MOHAN RAM

Conjunctiva

Thin, transparent, mucous membrane lining the posterior aspect of eye lid & anterior aspect of eye ball

Latin : conjoin – to join ( it joins the eye ball to the eye lid )

Conjunctiva

Palpebral Conjunctiva

Marginal Tarsal Orbital

Bulbar Conjunctiva

Scleral Limbal

Conjunctival Fornix

PartsOf

Conjunctiva

Palpebral Conjunctiva

Marginal

Tarsal

Orbital

Extends from the lid margin ( opening of tarsal gland ) to the sulcus subtarsalis

Sulcus subtarsalis ◦ Marks the inferior edge of the tarsal plate◦ Shallow groove situated 2mm from lid margin

Lacrimal puncta open in the marginal zone

Marginal Conjunctiva

Firmly adherent to the tarsal plate

Thin+transparent+highly vascular structure

Meibomian glands appear as yellow streaks through the tarsal conjunctiva

Tarsal Conjunctiva

Extends from the upper border of the tarsal plate to the fornix

Loosely attached to the superior tarsal muscle [Müller’s muscle] and so folds readily

Shallow grooves and elevations are called Stieda’s plateaux and grooves

Orbital Conjunctiva

Bulbar Conjunctiva

Scleral

Limbal

Thin, transparent & loosely attached to underlying sclera

Permits the visualization of Conjunctival and episcleral vessels

Separated from the sclera by episcleral vessels and Tenon’s capsule

Scleral Conjunctiva

3mm ridge around the cornea

Conjunctiva, Tenon’s capsule and episcleral tissue are fused together

Strongly adherent to sclero-corneal junction

Limbal Conjunctiva

Joins the bulbar and palpebral conjunctiva

Ducts of the lacrimal gland open into the lateral part of superior fornix

Conjunctival Fornix

HISTOLOGY OF

CONJUNCTIVA

Epithelium

Adenoid Layer

Fibrous Layer

Substantia Propria

Layers Of Conjunctiva

Conjunctiva Number of layers Cells in the layers

Marginal5 layered non-keratinised

stratified squamous epithelium

Superficial layer: Squamous cells

Middle three layers: Polyhedral cells

Deepest layer: Cylindrical cells

Tarsal and Orbital 2 layers of Stratified cuboidal epithelium

Superficial layer: Cylindrical cells

Deepest layer: cuboidal cells

Fornix and Scleral 3 layers of Stratified, squamous epithelium

Superficial layer: Cylindrical cells

Middle layer: polyhedral cells

Deepest layer: Cuboidal cells

Limbal 10 layers of stratified squamous epithelium

Superficial layer: squamous cells

Middle layer: polygonal cells

Basal- cubical

Goblet Cells Melanocytes Langerhan’s Cells CALT MALT

Cells Present In Epithelium

Also called Lymphoid layer

Consists of fine connective tissue reticulum in the meshwork of which lies the lymphocytes

Not present at birth , develops after 2-3 months of life

Adenoid Layer

Has Collagenous fibres + Elastic fibres

Thicker than adenoid layer except in the Tarsal Conjunctiva

Lodges the Conjunctival vessels and nerves

Fibrous Layer

Mucin Glands

Goblet Cells

Henle’s Glands

Glands of Manz

Conjunctival Glands

Unicellular round or oval mucous glands

Absent in the Marginal & Limbal conjunctiva

These cells are destroyed after discharging the contents

Goblet Cells

Goblet Cell Density

Numerous on nasal side

High in children and young adults

Not true glands

Tubular structure which contains a few goblet cells

Present in the folds of mucous membrane present in palpebral conjunctiva between tarsal plate & fornices

Resembles the Crypts of Lieberkuhn in large intestine

Henle’s Gland

Located in the scleral conjunctiva

Arranged in a ring around the cornea, near the scleral junction

Glands of Manz

Mucin Glands

Provide a hydrophilic layer that allows for even distribution of the tear film

Ensures tear film stability by reducing the surface tension

Provides lubrication and protects the epithelial cells of cornea and conjunctiva

Functions Of Mucin

Lie in deep sub - conjunctival tissue of the upper and lower fornices

42 in number in upper fornix and 6 to 8 in lower fornix

In upper fornix they lie between the palpebral part of the lacrimal gland and tarsal plate.

Glands of Krause

Also called Glands of Ciaccio, larger than Glands of Krause

Situated in the upper border of the tarsus midway between the end of the tarsal glands

2 to 5 in the upper lid and 1-3 in the lower lid

Glands of Wolfring

Accessory Lacrimal Glands

Blood Supply , Lymphatics

& Innervation

Of the Conjunctiva

Blood Supply

Marginal Tarsal Arcade

Peripheral Tarsal Arcade

Anterior Ciliary Arteries

Arterial Supply

Venous Drainage

Lymphatic Drainage

Nerve Supply

Applied Anatomy

Conjunctivitis

Conjunctivochalasis

Pinguecula

Pterygium

Rougine

Subconjunctival

hemorrhage