elaborate discussion on the anatomy and physiology of the conjunctiva

1. ANATOMY AND PHYSIOLOGY OF
THE CONJUNCTIVA
Presented By
Arundhati Hatikakoty
Bachelor of Optometry 3rd year
Roll no- 302

2. Introduction
Conjoin = to join
So the name conjuctiva has
been given to this mucous
membrane owing to the fact
that it joins the eyeball to
the lids
It is a translucent mucous
membrane which lines the
posterior surface of the
eyelids and anterior aspect
of the eyeball

3. The normal conjuctiva is
o Pink
o Smooth
o Thin
o Transparent
There are normally
large deep blood vesells
that run vertically

4. Functions of conjunctiva
The conjunctiva helps lubricate the eye by
producing mucus and tears, although a
smaller volume of tears than the lacrimal
gland
It also contributes to immune surveillance and
helps to prevent the entrance of microbes into
the eye

5. Parts of the conjunctiva

6. Parts of the conjunctiva
Conjunctiva
Palpebral
Marginal
Tarsal
Orbital
Bulbar
Scleral Limbal
Fornix
Superior
Inferior
Lateral
Medial

7. Palpebral conjunctiva:
o It is richly vascular, extremely thin and strongly
bounded to the tarsal plate

8. o It lines the lids and is subdivided into
marginal
tarsal
orbital

9. Marginal-
o Extends from the lid margin to about 2mm back of
the lid upto the sulcus subtarsalis
o Actually a transitional zone between skin and the
conjunctiva proper
o Lacrimal puncta open in the marginal zone

10. Tarsal-
o Thin, transparent and highly vascular
o Firmly adherent to the whole tarsal plate in the
upper lid and only to half width of the tarsus in
the lower lid
o The tarsal glands are seen through it as yellow
streaks

11. Orbital-
o It lies loose between the tarsal plate and the
fornix
o Orbital margin of the upper eyelid is loose and lies
over the muller’s muscle

12. Bulbar conjunctiva-
o It is transparent and lies
loose over the
underlying structures
and thus can be moved
easily
o It is separated from the
anterior sclera by
episcleral tissue and
tenon’s capsule

13. o The average thickness is 33 microns
o It is also known as ocular conjunctiva
o It is further of two types
Limbal
Scleral

14. Limbal-
o A 3mm ridge of bulbar conjunctiva around the
cornea is called limbal conjunctiva
o Strongly adherent to sclero-corneal junction
Scleral-
o Covers the eyeball above the anterior sclera and
hence known as scleral conjunctiva
o Thin, transparent & loosely attached to underlying
sclera
o Separated from the sclera by episcleral vessels and
Tenon’s capsule

15. Conjunctival fornix:
o It is thin, transparent , continuous circular cul-de-
sac
o It is broken only on the medial side by caruncle
and the plica semilunaris
o It joins the bulbar conjunctiva with the palpebral
conjunctiva

16. Superior
Lateral
Medial
inferior
 It is further of four types

17. Superior
o Located at the level of superior orbital margin
o Extends from slightly upper border of the tarsal
plate to a distance about 10mm from the upper
limbus
o Here we can find the glands of Krause and
Mullers’s muscle in the subconjunctival tissue

18. Inferior fornix
o Extends from slightly below the lower border of
the lower tarsal plate to a distance about 8mm
from the lower limbus
o Located near the inferior orbital margin
o Helps in maintaining the recess of the inferior
fornix during movements of the lower lid

19. Lateral
o Small in size like a cul de sac
o Extends to just behind the equator of the eyeball
o It is 14mm from the lateral limbus and about 5mm
from the lateral canthus
Medial
o It is a shallow cul de sac in which lie the caruncle
and plica seminlunaris dipped in pool of tears
called as tear lake

20. HISTOLOGY OF THE
CONJUNCTIVA

21. Structure of conjunctiva
Histologically cornea consists of 3 layers
Conjunctiva
Epithelium
Adenoid layer
Fibrous layer

22. Epithelium
a. The layers of epithelial cells in the conjunctiva
vary from region to region and its different parts
are
oMarginal conjunctiva-
o Have 5 layers non keratinised stratified squamous type of
epithelium
o Superficial layer- squamous cell
o Intermediate 3 layers- polyhedral cells
o Deepest layer- goblet cells
oTarsal conjunctiva-
o Has 2 layer epithelium in the upper eyelid
o Superficial layer- cylindrical cells
o Deep layers- cubical cells
o Lower tarsal conjunctiva is made of 3-4 layers of cells like the
cubical, polygonal, elongated wedge shaped and cone shaped
cells

23. The Epithelium
The Adenoid
Layer
The Fibrous
Layer
The Epithelium

24. o Fornix and bulbar conjunctiva
o 3 layered epithelium
o Superficial layer- cylindrical ells
o Middle layer- polyhedral cells
o Deep layer- cuboidal cells
o Limbal conjunctiva
o 8-10 layers of stratified squamous epithelium
o Most superficial 1-2 layers- squamous cells
o Intermediate several layers- polygonal cells
o Basal layer- cylindrical or cubical cells

25. Cells Present In The Epithelium
a. Goblet cells-
o Present between the epithelial cells in all regions
of conjunctiva
b. Melanocytes-
o Found in conjunctiva at limbus, fornix, crancule
and at the site of entry of anterior ciliary vessels
c. Langerhans cells-
o Present in all parts of conjunctiva
d. Conjunctival associated lymphoid tissue ( CALT)-
o Consists of T and B lymphocytes

26. d. Mucosal associated lymphoid tissue(MALT)
o MALT of the gut and bronchi are also found in the
conjunctiva

27. Adenoid layer
o Also called as lymphoid
layer
o Consists of fine
connective tissue
reticulum in the meshes
of which lie the
lymphocytes
o Most developed in the
fornices and ends at the
subtarsal fold
o Develops after 2-3
months of life
The Adenoid Layer

28.  Fibrous layer
o Consists of a meshwork of collagenous and elastic
fibres
o Thicker than the adenoid layer
o Except in the tarsal conjunctiva where it is very
thin
o This layer consist vessels and nerves of the
conjunctiva
o The adenoid layer and the fibrous layer are
collectively called as substantia propia

29. The Epithelium
The Adenoid
Layer
The Fibrous
Layer
The fibrous layer

30. Conjunctival glands
Mucin
secretory
glans
• Goblet cells
• Crypts of henle
• Glands of manz
Acessory
lacrimal
glands
• Glands of krause
• Glands of
wolfring

32.  Goblet cells
o Round or oval in shape with
an eccentric flat nucleus
o Unicellular mucous cells
located abundantly within
the epithelium of all regions
of conjunctiva
o These cells are formed from
the deepest cells of the
conjunctiva
o Once discharging their
content- the mucin they are
destroyed
o Density is more in children
than adults
o More in the bulbar
conjunctiva and inferior
fornix

33. Henle’s glands
o Not true glands but folds of mucous membrane
present in the palpebral conjunctiva
o These are tubular structures with lumina of 15-30
µm
Glands of manz
o Found in limbal conjunctiva in animals

34. Glands of krause
o Microscopic glands that lie in the sub conjuctival
tissue of the fornices
o These are about 40-42 in the upper fornix and
about 6-8 in the lower fornix
Glands of wolfring
o Also called as the glands of Ciaccio
o These are microscopic glands present along the
upper border of superior tarsus and lower border
of inferior tarsus

35. Blood supply
Arteries supplying the conjunctiva are derived
from 3 sources. They are:
1. Marginal arcade of the eyelid
2. Peripheral arterial arcade of the eyelid
3. Anterior ciliary artery
 The palpebral conjunctiva and the fornices
are supplied by branches from the marginal
and peripheral arcades of the artery

36.  Bulbar conjunctiva is
supplied by posterior
conjunctival arteries
and anterior
conjunctival arteries

37. Venous drainage
The veins from
conjunctiva drain into
the venous plexus of
eyelids which in turn
drain into the superior
and inferior ophthalmic
veins.
A cicumcorneal zone of
limbus drain into the
anterior cilliary veins

38. Lymphatic drainage
Lymphatics from the
lateral side drain into
the periauricular lymph
nodes
The lymphatics from
the medial side drain
the submandibular
lymph nodes

39. Nerve supply
A circumcorneal zone of the conjunctiva is supplied
from the long ciliary nerves
Rest of the conjunctiva is supplied by the branches
from the lacrimal, infratrochlear, supratrochlear,
supraorbital and the frontal nevers

41. Anatomy

42. References-
o AK Khurana, Anatomy and physiology of the eye 2nd
edition, page no- 306-372
o AK Khurana, Comprehensive ophthalmology 4th
edition, page no- 51-54
o AI Lens, Ocular Anatomy and Physiology, page 50-53
o A. M. R. Agur, Grant's Atlas of Anatomy, page 650
o https://en.wikipedia.org/wiki/Conjunctiva#Function
o https://www.slideshare.net/pranaykumarshinde/conj
unctiva-anatomy-and-physiology?qid=5cf7b98a-e6f5-
4369-bccd-0b1168d7d77e&v=&b=&from_search=6

43. THANK YOU