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Conjunctiva and
sclera
Outline
• Conjunctiva
• sclera
Conjunctiva
• Introduction
• Surface anatomy
• Conjunctival layers
• Blood supply and drainage and nerve
supply
What is conjunctiva?
• Vascularized mucous membrane that
covers the anterior surface of the globe
(bulbar and forniceal co...
Combats infection
1. Highly vascular
2. The different cell types can initiate and
participate in defensive inflammatory
re...
Surface anatomy
• The conjunctiva lines the posterior surface
of the upper and lower lids and the
anterior surface of the ...
Arrow pointing to the region of the superior fornix
Region of the inferior fornix (arrow)
Medical region of the eye showing the
caruncle (C) and plica semilunaris (P)
Region of the lateral fornix (arrow)
14 mm fr...
Palpebral conjunctiva
Palpebral conjunctiva
• Starts from posterior end of the eyelid
margin at the mucocutaneous junction
• Marked adherent to ...
Follicular reaction
•identical to lymphoid follicles
•viral and chlamydial infections as
well as toxic conjunctivitis due ...
Bulbar conjunctiva
Bulbar conjunctiva
• limbus to the forniceal area.
• thin and translucent.
• loosely adherent to the sclera to allow the e...
Conjunctival glands
42
6-8
2-5
2
Conjunctival layers
• The stratified epithelial layer
• The substantia propria layer
Conjunctival epithelium
• 2 to 4 layers-upper tarsal portion
• 6 to 8 layers-corneoscleral junction,
• 8 to 10 layers-conj...
Conjunctival epithelium
• Columnar in the fornix
• Cuboidal on the bulbar and tarsal
conjunctiva
Types of cells
• Type I cells are the goblet cells
• Type II cells are defined by the numerous
60- to 300-nm electron-dens...
Goblet cells
Goblet cells
• middle and superficial layers of the
epithelium
• 25 by 25 μm
• 2.2 μL of mucus daily
Function of goblet cell mucus
• Preserve stability of tear film
• Local immunity
• Cleansing mechanism of the eye
• Traps ...
Substantia propria
• Connective tissue layer
• Anti-infectious potential
• Numerous mast cells (6000/mm3),
lymphocytes, pl...
Substantia propria
Superficial lymphoid layer
•Not present at birth
•Lymphocytes aggregrated into
nodules
Deeper fibrous l...
Blood supply
Internal carotid artery ophthalmic artery
The palpebral branches of the
nasal and lacrimal arteries of
the li...
Venous drainage
• numerous than the arteries
• tarsal conjunctiva and the bulbar
conjunctiva is directed to the palpebral
...
Lymphatic drainage
• a superficial plexus and a deeper
plexus
• Ultimately as in the lids drains to the
pre auricular and ...
Nerve supply
Caruncle
• small, flesh-like body that lies to the medial
side of the plica semilunaris
• stratified squamous epithelium s...
Plica semilunaris
• Fold of conjunctiva lying lateral to the
caruncle
• cul-de-sac of approximately 2 mm in depth
is forme...
Sclera
• Introduction
• Development
• Gross anatomy
• Layers
• Blood supply,drainage and nerve supply
Sclera
Introduction
• dense connective tissue that accounts for five
sixths of the outer coat of the eyeball
• sklera mannix- har...
Prenatal development
• neural crest-mesodermal origin
• anterior to posterior and from inside to
outside
5th
week double-l...
Postnatal development and age
related characterstics
• Postnatal- relatively thin, bluish,
distensible, small, and translu...
Gross anatomy
five sixths of the eyeball with a
radius of curvature of 12 mm
Optic nerve
Equator=0.4-0.5mm
Behind insertions
Insertions=0.6mm
Thickness of sclera
Clinical applications
• The traumatic scleral rupture
• Strabismus surgery.
Tenons capsule
• fascial sheath of the eyeball
• extends anteriorly from the
limbus backward, envelopes the
globe and fuse...
Sclera foramina
• anterior for the cornea
• posterior for the optic nerve
Anterior scleral foramen
• Sclera merges with the cornea at the anterior
scleral foramen forming the corneoscleral
junctio...
Posterior scleral foramen
• The exit of the optic nerve
• Lamina cribrosa-After piercing the lamina cribrosa, the axons of...
Layers of sclera
• Episclera
• Scleral stroma
• Lamina fusca
Episclera
• Superficial aspect of sclera
• bundles of collagen circumferentially
arranged
• rich blood supply anteriorly
•...
Scleral stroma
• bundles of collagen intermingled with
fibroblasts, melanocytes, elastic fibers,
proteoglycans, and glycop...
Lamina fusca
• Brown color due to melanocytes
• grooves for the passage of ciliary vessels
and nerves (emissary canals)
• ...
Melanosis oculi
Blood supply
• Episclera-anterior and posterior ciliary
arteries
• Scleral stroma-relatively avasculature
structure
Venous drainage
• Episcleral collecting veins
• Vortex veins
Anterior ciliary veins
Nerve supply
• Rich in nerve supply
• Anterior sclera- long posterior ciliary
nerves
• Posterior sclera- short posterior c...
Thank you
References
1. Fundamentals and principles of Ophthalmology,section
2,2014-2015, American Academy of Ophthalmology
2. Exter...
Conjunctiva
Conjunctiva
Conjunctiva
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Conjunctiva

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Conjunctiva

  1. 1. Conjunctiva and sclera
  2. 2. Outline • Conjunctiva • sclera
  3. 3. Conjunctiva • Introduction • Surface anatomy • Conjunctival layers • Blood supply and drainage and nerve supply
  4. 4. What is conjunctiva? • Vascularized mucous membrane that covers the anterior surface of the globe (bulbar and forniceal conjunctiva) and the posterior surface of the upper and lower eyelids (palpebral conjunctiva).
  5. 5. Combats infection 1. Highly vascular 2. The different cell types can initiate and participate in defensive inflammatory reaction 3. Immunocompetent cells that contribute a rich supply of immunoglobulins 4. The surface anatomy (microvilli) and biochemistry (enzymatic activity) enable that tissue to engulf and neutralize foreign particles, such as viruses
  6. 6. Surface anatomy • The conjunctiva lines the posterior surface of the upper and lower lids and the anterior surface of the globe • Forms superior fornix(8-10mm from limbus) and inferior fornix(8 mm from limbus) • Caruncle and the plica semilunaris
  7. 7. Arrow pointing to the region of the superior fornix Region of the inferior fornix (arrow)
  8. 8. Medical region of the eye showing the caruncle (C) and plica semilunaris (P) Region of the lateral fornix (arrow) 14 mm from the limbus
  9. 9. Palpebral conjunctiva
  10. 10. Palpebral conjunctiva • Starts from posterior end of the eyelid margin at the mucocutaneous junction • Marked adherent to tarsal plate of lids • Freely movable in fornices (forniceal conjunctiva)
  11. 11. Follicular reaction •identical to lymphoid follicles •viral and chlamydial infections as well as toxic conjunctivitis due to application of certain topical medications Papillary reaction •chronic inflammatory cells such as lymphocytes and plasma cells •presence of blood vessels at their center •,Allergic conjunctivitis, Bacterial conjunctivitis,Contact lens wears,Superior limbic keratoconjunctivitis.
  12. 12. Bulbar conjunctiva
  13. 13. Bulbar conjunctiva • limbus to the forniceal area. • thin and translucent. • loosely adherent to the sclera to allow the eye free movement in all directions. • Approximately 3 mm from the limbus, the bulbar conjunctiva, Tenon's capsule, and sclera become firmly attached, and the conjunctiva cannot be easily picked up. This attachment is routinely encountered during the dissection of a limbal-based conjunctival flap in ocular surgery.
  14. 14. Conjunctival glands 42 6-8 2-5 2
  15. 15. Conjunctival layers • The stratified epithelial layer • The substantia propria layer
  16. 16. Conjunctival epithelium • 2 to 4 layers-upper tarsal portion • 6 to 8 layers-corneoscleral junction, • 8 to 10 layers-conjunctival margins
  17. 17. Conjunctival epithelium • Columnar in the fornix • Cuboidal on the bulbar and tarsal conjunctiva
  18. 18. Types of cells • Type I cells are the goblet cells • Type II cells are defined by the numerous 60- to 300-nm electron-dense granules • Type III cells are recognizable by their well developed Golgi complex • type IV cells are characterized by rough endoplasmic reticulum • Type V cells are identified by the high content of mitochondria
  19. 19. Goblet cells
  20. 20. Goblet cells • middle and superficial layers of the epithelium • 25 by 25 μm • 2.2 μL of mucus daily
  21. 21. Function of goblet cell mucus • Preserve stability of tear film • Local immunity • Cleansing mechanism of the eye • Traps cell debris, foreign bodies, and bacteria • inflammatory response
  22. 22. Substantia propria • Connective tissue layer • Anti-infectious potential • Numerous mast cells (6000/mm3), lymphocytes, plasma cells, and neutrophils are normally present in this layer.
  23. 23. Substantia propria Superficial lymphoid layer •Not present at birth •Lymphocytes aggregrated into nodules Deeper fibrous layer •thick, collagenous, elastic tissue and contains the vessels and nerves of the conjunctiva in addition to Krause's glands Senile elastotic degeneration
  24. 24. Blood supply Internal carotid artery ophthalmic artery The palpebral branches of the nasal and lacrimal arteries of the lid Anterior ciliary artery.
  25. 25. Venous drainage • numerous than the arteries • tarsal conjunctiva and the bulbar conjunctiva is directed to the palpebral veins • superior and inferior ophthalmic veins
  26. 26. Lymphatic drainage • a superficial plexus and a deeper plexus • Ultimately as in the lids drains to the pre auricular and sub-mandibular lymph glands.
  27. 27. Nerve supply
  28. 28. Caruncle • small, flesh-like body that lies to the medial side of the plica semilunaris • stratified squamous epithelium similar to skin, but does not undergo keratinization • Hair,sebaceous and sweat glands, goblet cells and accessory lacrimal glands similar to Krause's glands. • Blood supply-superior palpebral arteries • Nerve supply-infratrochlear nerve • Lymphatic drainage-sub maxillary lymph nodes
  29. 29. Plica semilunaris • Fold of conjunctiva lying lateral to the caruncle • cul-de-sac of approximately 2 mm in depth is formed when the globe is adducted • nonexistent when the globe is abducted • nictitating membrane in lower vertebrates
  30. 30. Sclera • Introduction • Development • Gross anatomy • Layers • Blood supply,drainage and nerve supply
  31. 31. Sclera
  32. 32. Introduction • dense connective tissue that accounts for five sixths of the outer coat of the eyeball • sklera mannix- hard membrane 1.protects intraocular components from trauma, light, and mechanical displacement 2.withstands the considerable expansive force generated by the intraocular pressure maintaining the shape of the globe 3.provides attachment sites for the extraocular muscles.
  33. 33. Prenatal development • neural crest-mesodermal origin • anterior to posterior and from inside to outside 5th week double-layered optic cup or neuroectoderm 6th week Differentiation into sclera and choroid anterior to equator 8th week Backward to the equator 12th week Posterior pole 4th month Scleral spur 5th month Lamina cibrosa
  34. 34. Postnatal development and age related characterstics • Postnatal- relatively thin, bluish, distensible, small, and translucent • Childhood and puberty-thicker, whiter, less distensible, larger, and more opaque • Adult- poorly distensible,opaque or translucent depending on water content • Elderly- less distensible,yellowish color and senile scleral plaques.
  35. 35. Gross anatomy five sixths of the eyeball with a radius of curvature of 12 mm
  36. 36. Optic nerve Equator=0.4-0.5mm Behind insertions Insertions=0.6mm Thickness of sclera
  37. 37. Clinical applications • The traumatic scleral rupture • Strabismus surgery.
  38. 38. Tenons capsule • fascial sheath of the eyeball • extends anteriorly from the limbus backward, envelopes the globe and fuses with the optic nerve dural sheath and with the sclera around the exit of the optic nerve • supports the eyeball within the orbit • permits the eyeball movement produced by the extraocular muscles
  39. 39. Sclera foramina • anterior for the cornea • posterior for the optic nerve
  40. 40. Anterior scleral foramen • Sclera merges with the cornea at the anterior scleral foramen forming the corneoscleral junction or limbus Fig: longitudinal section through the region of the corneoscleral junction showing the peripheral cornea, the sclera, the conjunctiva, and Tenon's capsule, canal of Schlemm, the trabecular meshwork, and the iris
  41. 41. Posterior scleral foramen • The exit of the optic nerve • Lamina cribrosa-After piercing the lamina cribrosa, the axons of the optic nerve become myelinated. One of the small perforations is larger than the rest and permits the passage of the central retinal artery and vein.
  42. 42. Layers of sclera • Episclera • Scleral stroma • Lamina fusca
  43. 43. Episclera • Superficial aspect of sclera • bundles of collagen circumferentially arranged • rich blood supply anteriorly • thickest anterior to the rectus muscle insertions and becomes progressively thinner toward the back of the eye.
  44. 44. Scleral stroma • bundles of collagen intermingled with fibroblasts, melanocytes, elastic fibers, proteoglycans, and glycoproteins • variability in collagen fiber diameter, interlacing in bundles of collagen, and relative deficiency in water-binding substances accounts for the scleral dull- white color.
  45. 45. Lamina fusca • Brown color due to melanocytes • grooves for the passage of ciliary vessels and nerves (emissary canals) • attached to the choroid by fine collagen fibers
  46. 46. Melanosis oculi
  47. 47. Blood supply • Episclera-anterior and posterior ciliary arteries • Scleral stroma-relatively avasculature structure
  48. 48. Venous drainage • Episcleral collecting veins • Vortex veins Anterior ciliary veins
  49. 49. Nerve supply • Rich in nerve supply • Anterior sclera- long posterior ciliary nerves • Posterior sclera- short posterior ciliary nerves • Pain- inflammation, stretching due to oedema and movement of eye
  50. 50. Thank you
  51. 51. References 1. Fundamentals and principles of Ophthalmology,section 2,2014-2015, American Academy of Ophthalmology 2. External Disease and Cornea, Section 8, 2014-2015, American Academy of Ophthalmology 3. Duane's Foundations of Clinical Ophthalmology, Foundation volume 1 4. Jack J Kanski, Brad Bowling, Clinical Ophthalmology, seventh edition 2011 5. M.J. Roper- Hall, Stallard’s Eye Surgery, Seventh Edition, 1989 6. Parsons’ Diseases of the Eye, Twentieth Edition 2007 7. Internet

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