Diagnosis, Management, and Surgery by Adam J. Cohen, Michael Mercandetti & Brian G. Brazzo. The dry eye , a practical approach by Sudi Patel & Kenny J Blades. Jack J Kanski’s clinical ophthalmology Clinical Anatomy of the Eye by Richard S. Snell & Michael A. Lemp.
3. It is concerned with the tear formation & transport. Lacrimal passage includes : Lacrimal gland Conjunctival sac Lacrimal puncta Lacrimal canaliculi Lacrimal sac Nasolacrimal duct
4. The following components of the lacrimal apparatus are discussed : Embryology Osteology Secretory system Excretory system Physiology
5. Ectodermal origin Solid epithelial buds(first 2 months) Supero
2. Wolff's Anatomy of the Eye and Orbit.
Adler's Physiology of the Eye .
The Lacrimal System
Diagnosis, Management, and Surgery by Adam J.
Cohen, Michael Mercandetti & Brian G. Brazzo.
The dry eye , a practical approach by Sudi Patel
& Kenny J Blades.
Jack J Kanski’s clinical ophthalmology
Clinical Anatomy of the Eye by Richard S. Snell
& Michael A. Lemp.
3.
4. It is concerned with the tear formation &
transport.
Lacrimal passage includes :
Lacrimal
gland
Conjunctival
sac
Lacrimal
puncta
Lacrimal
canaliculi
Lacrimal
sac
Nasolacrimal
duct
5.
6. The following components of the lacrimal
apparatus are discussed :
Embryology
Osteology
Secretory system
Excretory system
Physiology
8. Lacrimal sac and nasolacrimal duct : ectoderm
of the naso-optic furrow or nasolacrimal furrow
The ectoderm of the furrow buries and forms a
solid cord .
Canalization : begins at 4 months and may
continue after birth.
9.
10. The lacrimal sac fossa is a depression in the
inferomedial orbital rim,
Maxillary and lacrimal bones.
Bordered by the anterior lacrimal crest
(maxillary bone) & posterior lacrimal crest
(lacrimal bone).
The fossa is approximately 16-mm high, 4- to 9-
mm wide, and 2-mm deep.
11.
12. The medial orbital wall : Frontal process of
maxilla, lacrimal , ethmoid , lesser wing of
sphenoid bone.
The frontoethmoidal suture is important in
lacrimal surgery
It marks the roof of the ethmoid sinus. Bony
dissection superior to this suture may expose
the dura of the cranial cavity.
13. The nasolacrimal canal originates at base of
lacrimal fossa.
Formed by the maxillary bone laterally and the
lacrimal and inferior turbinate bones medially.
The width of superior opening is 4–6 mm.
The duct courses posteriorly and laterally in
the bone for 12 mm to drain into the inferior
meatus of the nasal cavity.
14. It includes lacrimal gland, accessory glands
Lacrimal gland is above & anterolateral to globe.
Secretes tears into superior fornix.
Tears moisten & lubricates the : cornea
, conjunctiva.
It contributes 43D of 50D of refractive power of
eye .
15. It consists of
Large Orbital Part
Smaller Palpebral Part
Lateral expansion of levator separates the parts
16. Paired almond-shaped glands.
It is present in a fossa on the anterolateral area
of orbit
It has 2 surfaces, 2 borders, 2 extremities
Superior surface
Frontal bone
Inferior surface
Levator palpebrae superioris & lateral rectus
17. Anterior border
Septum orbitale
Posterior border
Contact with orbital fat , level with posterior
pole.
Lateral extremity
Rest on lateral rectus
Medial extremity
On levator
18. 1/3rd size of orbital part
Superior fornix , seen on lid eversion.
It is situated upon the course of ducts
Related to levator superiorly, inferiorly to
superior fornix
Posteriorly it continues with orbital part.
19. Are small, compound, branched, tubular glands
Located in the middle of lid (Wolfring glands)
or superior & inferior fornices (Krause glands).
Ectopic portions of lacrimal gland tissue.
20. It is with connective tissue coat and excretory
duct.
The excretory duct splits & form intralobular
ducts, connected to secretory glandular
epithelia.
Secretory epithelia have elongated tubules.
True acini are absent.
21.
22.
23. Tubuloacinar with short, branched tubules
Acini are pyramidal secretory cells with apex
towards a central lumen .
Myoepithelial cells., contractile & aid the
secretion
24. In acinus, secretory cells are joined by
junctional complexes
Apical microvilli extend into the lumen
Nucleus and rough endoplasmic reticulum are
basal in the cells.
Abundant secretory granules, at apex .
25.
26. The ducts have two or three cell layers and
microvilli at luminal surface.
Plasma cells of the interstitial space are an
important source of immunoglobulins secrete
IgA(and fewer lgG, lgM, IgE)
27.
28. Artery supply : Lacrimal artery , branch of
ophthalmic artery.
Venous drainages : Ophthalmic Vein.
Lymphatic drainage : Joins that of conjunctiva &
drain into the preauricular lymph nodes.
29. Sensory nerve supply : lacrimal nerve
, branch of ophthalmic division of Vth nerve
Sympathetic nerve supply : carotid plexus
Secretomotor fibers : superior salivary
nucleus
30.
31.
32. A small, round or oval orifice on the
elevation, the papilla lacrimalis.
At medial end of lid margin at the junction of its
ciliated and non-ciliated parts.
Upper punctum medial to lower, from the
medial canthus being 6 and 6.5 mm.
The upper punctum opens inferoposteriorly, the
lower superoposteriorly.
33.
34. First vertical and then horizontal
Vertical part is 2 mm & turns medially at right-angle
to become horizontal 8 mm
At angle - dilatation or ampulla.
The canaliculi pierce the fascia (i.e. the periorbita
covering the lacrimal sac) separately,
Uniting to enter lacrimal sac.
Stratified squamous epithelium supported by
elastic tissue.
35. Lacrimal fossa, formed by lacrimal bone and
frontal process of maxilla .
The sac, closed above and open below, is
continuous with the nasolacrimal duct.
The sac is enclosed by a periorbita, splits &form
the lacrimal fascia .
36. Relations
Medial : periorbita and bone, arc of ethmoid
sinuses.
Lateral : skin, orbicularis oculi, and lacrimal
fascia.
Anterior: medial palpebral ligament and
angular vein.
Posterior : lacrimal fascia and muscle
37. The nasolacrimal duct, continuation of lacrimal
sac to the inferior meatus.
15 mm.
It lies in a canal formed by the maxilla, lacrimal
bone and lacrimal process of inferior concha.
It descends posterolaterally, a surface indication
a line from medial canthus to first upper molar.
38. The valves
They are folds of mucous
membrane with no
valvular function.
The most constant is the
'valve' of Hasner at the
lower end.
It prevents sudden blast of
air (when blowing the
nose) from entenng the
lacrimal sac.
39. Structure
Double-layered Epithelium
The superficial layer composed of columnar
cells, the deeper cells being flatter.
The membranous wall of the sac is of
fibroelastic tissue, the elastic element being
continued around the canaliculi.
40. Around the nasolacrimal duct is plexus of
vessels, forming erectile tissue like that on the
inferior concha.
Engorgement of these vessel obstruct the duct.
The course of the lacrimal sac and duct can be
demonstrated by dacryocystography
41. Vessels
Artery supply : palpebral branches of the
ophthalmic, angular and infraorbital arteries and nasal
branch of the sphenopalatine.
Venous drainages : Angular and infraorbital vessels
above, below into the nasal veins
Lymphatic drainage: submandibular and deep cervical
nodes.
Nerves
Infratrochlear and anterior superior alveolar nerves.
42. The tear film overlays corneal and conjunctival
epithelia.
Tears produced by the ocular surface epithelia
and adnexa.
Thickness of up to 40 µm,
Volume of tears covering the ocular surface
range from 2.74 ± 2.0µL to 7 µL
43. For mucous and aqueous layers, secretion is
regulated by neural reflexes.
For the lipid layer, the blink itself regulates
release of pre-secreted meibomian gland .
Tear secretion is balanced by drainage and
evaporation.
Drainage is regulated by neural reflexes ,causing
vasodilation and vasoconstriction of blood sinus.
Evaporation depends blink rate and
temperature, humidity, and wind speed.
44. To protect the cornea from drying;
To maintain the refractive power of the cornea;
To defend against eye infection;
To allow gas to move between the air and the
avascular cornea;
To support corneal dehydration (assisted by the
tear film hyperosmolality).
45. Consists of four layers
Glycocalyx
Mucous layer
Aqueous layer.
Lipid layers
46.
47. Structure
The glycocalyx is a network of polysaccharides that project
from cellular surfaces.
Mucins are classified into secreted and membrane-spanning
mucin.
Secreted mucins are either gel-forming or small soluble
Function
The membrane-spanning mucins function to hydrate the
ocular surface and serve as a barrier to pathogens.
Membrane-spanning mucins appear to be altered in dry eye
48. Structure
The mucous layer backbone is the gel-forming
mucin , synthesized and secreted by conjunctival
goblet cells.
Function
To resistance of the eye to infection by providing
protection against microorganisms.
Mucins serve as wetting agents that keep the apical
epithelia hydrated.
49. Lacrimal gland produce aqueous layer.
Other ocular surface epithelia also contribute to the
aqueous layer, eg. conjunctiva, accessory lacrimal
glands
7µm thick.
Without the lubrication , the shearing forces
produced on blinking will cause accumulative
ocular surface damage.
50. Composed of water, with many solutes, including
dissolved mucins, electrolyte sand proteins.
The osmotic pressure : concentrations of
sodium, potassium and chloride ions.
The tear film’s osmotic pressure is important in
the control of cornea–tear film water flux.
Bicarbonate and carbonate : pH
buffering, maintaining the pH at 7.3–7.6 when the
eyes open & 6.8 eyes closed.
51. Aqueous layer function
Aqueous deficiency dry eye.
Protection from bacterial infection
Reflex secretion washes away noxious
substances.
Protects against changes in pH.
52. Meibomian glands, modified sebaceous glands, that
line the upper and lower eyelids.
Meibomian gland lipids are stored in vesicles.
The secretory product contains a complex mixture
of lipids and proteins and is termed meibum.
Meibum is released on to the ocular surface in small
amounts with each blink.
0.1m in thickness
53. Function
Hydrophobic barrier to prevent tear overflow.
The meibom forms a water-tight seal of the
apposed lid margins during sleep.
Reduce tear evaporation .
Lipids enhance the stability of the tear
film and provide a smooth optical.
54.
55. Conjunctival fornices, preocular tear film, and
marginal tear strips.
Marginal tear strips are wedge shaped tear
menisci, borders of upper and lower lids.
Apposed lacrimal puncta dip into marginal
strip of tears
Anterior limit of the marginal strip is the
mucocutaneous junction of the lid,
56.
57. Tears are lost from the conjunctiva sac by
absorption, evaporation, and nasolacrimal
system.
This is related to the size of the palpebral
aperture, the blink rate, ambient temperature
and humidity.
58. Tears flow
the upper and lower marginal strips → upper and
lower canaliculi (capillarity+suction)
Eyes close
Pretarsal orbicularis oculi compresses the
ampullae+ shortens and compresses
canaliculi+puncta medially.
Lacrimal part of the orbicularis oculi, contracts →
compresses the sac,(positive pressure) tears →
nasolacrimal duct → nose.
Eyes open
Muscles relax → canaliculi and sac expand(negative
pressure)+capillarity= tears into sac.