Brief on general conjunctival anatomy and physiology with some clinical implications

1. Conjunctiva
-Anatomy and Physiology
— Dr Aman dalal

2. —> Thin mucus membrane lining surface of eye and eyelids
— Palpebral
— Bulbar
—> Fornix : the junction of Palpebral and Bulbar

3. palpebral -
Firmly adherent to tarsus
palpebral -
Firmly adherent to tarsal plate
Commences at ant margin of Lid edge
2 layers of epithelium
Epithelium thickens from fornices to Limbus

4. Bulbar -
—> Freely movable conjunctiva over sclera
Scleral conj is separated from sclera
by tenon’s capsule and episcleral
vessels
At Limbal conjunctiva, the conj. ,tenons
and episcleral tissue are fused
and is Strongly adherent

5. Histology -
✰ Epithelium
✰ Adenoid layer- develops by 2-3 months of infancy
✰ (Deep) Dense fibrous layer —lodges conjunctival vessels
and nerves
Epithelium histology of conjunctiva varies based on location
Near margins. — Stratified non keratinised
Rest palpebral conj — thinner non keratinised epi.
Bulbar — stratified columnar epi.

6. Adenoid layer contains lymphoid tissue — follicle formation
in response to stimuli

7. Marginal conj : by marginal arcade of eyelid
Forniceal conj : by peripheral arcade of eyelid
Other supplies —
Posterior conjunctival artery ( a branch of peripheral arcade)
Anterior conjunctival artery ( branch of anterior ciliary for
limbus)
Capillary arcades (extend 1 mm into cornea)

8. Lymphatics

10. Branches of Ophthalmic division
&
Maxillary division of FIFTH cranial nerve

12. Glands in Conjunctiva
Mucin : goblet cells, henle’s glands, glands of manz
Accessory Lacrimal : glands of krausse & wolfring
✰marginal and limbal conjunctiva lack Goblet cells
✰Tear film — 1. Innermost mucinous layer ( goblet, crypts of
henle, glands of manz)
2. Middle aqueous ( by lacrimal and accessory
glands of krausse)
3. Outermost lipid layer( by meibomian)

14. Applied anatomy
Conjunctivitis
Pterygium
Pinguecula
Subconj hemorrhage
Chemosis
Conjunctival inflamm reactions —
Follicles: yellow-white, round elevations, 1-2 mm diameter.
Lymphocyte aggregations in adenoid layer, overlying conj
remains normal

15. Papillae: hyperplasia of normal vascular system, with bunch
of capillaries growing into epithelium.
Slit lamp necessary for clinical differentiation.

16. Subconj hemorrhage/ echymosis :
Due to Small vessel rupture
Etio- straining, vomit, heavy wt lifting, systolic Htn
Local ocular trauma, scurvy, bleeding diasthesis
Resolves in 1-3 weeks

18. Chemosis : edema of conjunctiva due to permeable
capillaries
Swollen & gelatinous appearance mostly
in loosely attached regions - bulbar conj & fornices
Etio - obstructed blood circulation/ lymphatics
inflammation, panophthalmitis, acute glaucoma
nephritis, severe anemia.