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18-10-2015 1
 Lacrimal apparatus
 Main gland
 Accessory glands
 Blood supply and Nerve supply
 Lacrimal Passages
 Puncta
 Canaliculi
 Sac
 Nasolacrimal duct
 Tear film
 Functions of tear film
 Lacrimal pump mechanism18-10-2015 2
 The lacrimal apparatus comprises
 Main lacrimal gland
 Accessory lacrimal glands
 Lacrimal passages, which include :
▪ Puncta
▪ Canaliculi
▪ Lacrimal Sac
▪ Nasolacrimal Duct (NLD)
18-10-2015 3
 Orbital Part:
 About the size and shape of a small almond
 Situated in the lacrimal fossa on the frontal bone,
at the outer part of the orbital plate
 The superior surface is convex and lies in contact
with the bone
 The inferior surface is concave and lies on the
levator palpebrae superioris (LPS )muscle
 10-12 ducts pass downward from the gland and
open into the lateral part if the superior fornix
18-10-2015 4
 Palpebral Part :
 It is small and consists only of 1-2 lobules
 It is situated in the course of the ducts of the
orbital part
 Posteriorly it is continuous with the orbital part
18-10-2015 5
 Glands of Krause :
 They are microscopic groups of acini that lie beneath
the palpebral conjunctiva between the fornix and the
edge of the tarsus
 There are about 42 in the upper fornix and 6-8 in the
lower fornix
 The ducts of numerous acini unite to form a larger
duct that open into the fornix
 Glands of Wolfring :
 These are present near the upper border of the
superior tarsal plate and along the lower border of the
inferior tarsus
18-10-2015 6
Structure : All glands are made up of serous acini and
ducts, connective tissue and puncta
18-10-2015 7
 Blood Supply : Main gland is supplied by
lacrimal artery, a branch of ophthalmic artery
 Nerve Supply:
 Sensory supply : Lacrimal nerve
 Sympathetic supply : Carotid plexus of cervical
sympathetic chain
 Secretomotor fibres
18-10-2015 8
18-10-2015 9
 Two small rounded or oval openings, on the
upper and lower lids, about 6 and 6.5 mm
respectively, temporal to the inner canthus
 Each punctum is situation on a slight
elevation called lacrimal papilla
 Normally, puncta dip into lacus lacrimalis
18-10-2015 10
 Each canaliculus has two parts : vertical (1-
2mm) and horizontal (6-8mm) which lie at
right angles to each other
 Horizontal canaliculi open either separately
or join together and open into the lacrimal
sac
 Fold of mucosa at this point forms theValve
of Rosenmuller which prevents reflux of tears
18-10-2015 11
 Lies in lacrimal fossa which is formed by
lacrimal bone and frontal process of maxilla
 When sac is distended, it measures 12-15mm
vertically and 5-6mm horizontally
 Fundus extends slightly beyond medial
palpebral ligament and sac itself is
surrounded by fibres of the orbicularis muscle
18-10-2015 12
 Extends from neck of sac to inferior meatus of
the nose
 It is about 15-18mm long, and lies in a bony
canal formed by maxilla and inferior turbinate
 Direction is downwards, backwards and laterally
 Surface marking : Line joining inner canthus to
ala of nose
 Mucous lining forms an imperfectValve of
Hasner at the lower end of the duct and prevents
reflux from the nose
18-10-2015 13
 Structure of fluid covering the cornea :
 Mucus Layer
 Aqueous layer
 Lipid or Oily Layer
18-10-2015 14
 Keeps cornea and conjunctiva moist
 Provides oxygen to conjunctival epithelium
 Washes away debris and noxious irritants
 Prevents infection due to presence of
antibacterial substances
 Facilitates movement of lids over the globe
18-10-2015 15
18-10-2015 16
 Dry eye or Keratoconjunctivitis Sicca (KCS)
due to lacrimal gland deficiencies or
obstructions
 Hyperlacrimation due to tumors or cysts of
the lacrimal gland, or the effect of strong
parasympathomimetic drugs
 Epiphora due to pump failure or obstructions
 Dacryocytitis due to blockage or infection
 In atonia of the sac tears aren’t drained
through lacrimal passages, in spite of
anatomical patency, leading to epiphora
18-10-2015 17
 Parsons’ Diseases of the Eye; 21st Edition; Editors
: Ramanjit Sihota, RadhikaTandon; Elsevier
 A K Khurana : Comprehensive
Ophthalmology; Fifth Edition; New Age International
Publishers
18-10-2015 18
18-10-2015 19

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Anatomy of lacrimal apparatus

  • 2.  Lacrimal apparatus  Main gland  Accessory glands  Blood supply and Nerve supply  Lacrimal Passages  Puncta  Canaliculi  Sac  Nasolacrimal duct  Tear film  Functions of tear film  Lacrimal pump mechanism18-10-2015 2
  • 3.  The lacrimal apparatus comprises  Main lacrimal gland  Accessory lacrimal glands  Lacrimal passages, which include : ▪ Puncta ▪ Canaliculi ▪ Lacrimal Sac ▪ Nasolacrimal Duct (NLD) 18-10-2015 3
  • 4.  Orbital Part:  About the size and shape of a small almond  Situated in the lacrimal fossa on the frontal bone, at the outer part of the orbital plate  The superior surface is convex and lies in contact with the bone  The inferior surface is concave and lies on the levator palpebrae superioris (LPS )muscle  10-12 ducts pass downward from the gland and open into the lateral part if the superior fornix 18-10-2015 4
  • 5.  Palpebral Part :  It is small and consists only of 1-2 lobules  It is situated in the course of the ducts of the orbital part  Posteriorly it is continuous with the orbital part 18-10-2015 5
  • 6.  Glands of Krause :  They are microscopic groups of acini that lie beneath the palpebral conjunctiva between the fornix and the edge of the tarsus  There are about 42 in the upper fornix and 6-8 in the lower fornix  The ducts of numerous acini unite to form a larger duct that open into the fornix  Glands of Wolfring :  These are present near the upper border of the superior tarsal plate and along the lower border of the inferior tarsus 18-10-2015 6
  • 7. Structure : All glands are made up of serous acini and ducts, connective tissue and puncta 18-10-2015 7
  • 8.  Blood Supply : Main gland is supplied by lacrimal artery, a branch of ophthalmic artery  Nerve Supply:  Sensory supply : Lacrimal nerve  Sympathetic supply : Carotid plexus of cervical sympathetic chain  Secretomotor fibres 18-10-2015 8
  • 10.  Two small rounded or oval openings, on the upper and lower lids, about 6 and 6.5 mm respectively, temporal to the inner canthus  Each punctum is situation on a slight elevation called lacrimal papilla  Normally, puncta dip into lacus lacrimalis 18-10-2015 10
  • 11.  Each canaliculus has two parts : vertical (1- 2mm) and horizontal (6-8mm) which lie at right angles to each other  Horizontal canaliculi open either separately or join together and open into the lacrimal sac  Fold of mucosa at this point forms theValve of Rosenmuller which prevents reflux of tears 18-10-2015 11
  • 12.  Lies in lacrimal fossa which is formed by lacrimal bone and frontal process of maxilla  When sac is distended, it measures 12-15mm vertically and 5-6mm horizontally  Fundus extends slightly beyond medial palpebral ligament and sac itself is surrounded by fibres of the orbicularis muscle 18-10-2015 12
  • 13.  Extends from neck of sac to inferior meatus of the nose  It is about 15-18mm long, and lies in a bony canal formed by maxilla and inferior turbinate  Direction is downwards, backwards and laterally  Surface marking : Line joining inner canthus to ala of nose  Mucous lining forms an imperfectValve of Hasner at the lower end of the duct and prevents reflux from the nose 18-10-2015 13
  • 14.  Structure of fluid covering the cornea :  Mucus Layer  Aqueous layer  Lipid or Oily Layer 18-10-2015 14
  • 15.  Keeps cornea and conjunctiva moist  Provides oxygen to conjunctival epithelium  Washes away debris and noxious irritants  Prevents infection due to presence of antibacterial substances  Facilitates movement of lids over the globe 18-10-2015 15
  • 17.  Dry eye or Keratoconjunctivitis Sicca (KCS) due to lacrimal gland deficiencies or obstructions  Hyperlacrimation due to tumors or cysts of the lacrimal gland, or the effect of strong parasympathomimetic drugs  Epiphora due to pump failure or obstructions  Dacryocytitis due to blockage or infection  In atonia of the sac tears aren’t drained through lacrimal passages, in spite of anatomical patency, leading to epiphora 18-10-2015 17
  • 18.  Parsons’ Diseases of the Eye; 21st Edition; Editors : Ramanjit Sihota, RadhikaTandon; Elsevier  A K Khurana : Comprehensive Ophthalmology; Fifth Edition; New Age International Publishers 18-10-2015 18