Lacrimal Glands

Conjunctiva
Tenon Capsule
Vascular of The Orbit
Dhita Dewi Alviane, MD.
Contents
• Lacrimal Glands and Excretory System
• Lacrimal Gland
• Accessory Glands
• Lacrimal Excretory System
• Conjunctiva
• Caruncle
• Plica Semilunaris
• Tenon Capsule
• Vascular Supply and Drainage of The Orbit
Lacrimal Gland and Excretory System
Lacrimal Gland
• Location & separated from the orbit by fibroadipose tissue
• Parts : orbital and palpebral lobes, by the lateral horn of the levator
aponeurosis
• Smaller palpebral lobe seen in superolateral conjunctival fornix
• Isthmus of glandular tissue may exist between the palpebral lobe and the
larger orbital lobe
Highlight : Because the lacrimal excretory ducts of the orbital and
palpebral lobes pass through the palpebral portion of the gland, biopsy
of the lacrimal gland is usually performed on the orbital portion to
avoid sacrificing the ducts.
Lacrimal Gland and Excretory System
Lacrimal Gland and Excretory System
- The lacrimal glands are exocrine glands that
produce a serous secretion.
- Each gland’s body contains 2 cell types (Fig 1-39):
- Glandular epithelial cells (line the lumen)
- Myoepithelial cells (surround parenchyma &
covered by a basement membrane)
Lacrimal secretions : contain the aqueous component of
the tear film and include lysozymes, lactoferrin, and
immunoglobulin A.
- Aging (structural & functional alteration) lacrimal
gland : associated w/ dry eye
- Arterial supply : Lacrimal artery (branch of
ophthalmic artery)
- Innervation
- Main : sensory innervation – lacrimal nerve (from
CN V1)
- Additional : receives secretomotor cholinergic,
vasoactive intestinal polypeptide (VIP)-ergic, and
symphathetic nerve fibers
- Has a complex neuroanatomy (reflex &
psychogenic stimulation)
Lacrimal Gland and
Excretory System

Accessory Glands
• The accessory lacrimal glands of
Krause and Wolfring are located
at the proximal marginof the
tarsus or in the fornices.
• . They are cytologically identical
to the main lacrimal gland and
receive similar innervation.
• These glands account for
approximately 10% of the total
lacrimal secretory mass.
 Lacrimal Excretory System

- Drainage system : Upper and lower puncta, lacrimal

canaliculi, lacrimal sac, & nasolacrimal duct
Puncta : small, diameter +/- 0.3 mm, openings on eyelid
margin, located on the extreme nasal border of the eyelids, at
their junction with the inner canthus. Inferior puncta +/- 6.5
mm from medial canthus, Superior puncta +/- 6.0 mm from it.
Puncta are directed posteriorly into the tear lake at the inner
canthus. The ampulla is a slight dilation at the angle of the
canaliculus, just beyond the punctum.
Lacrimal Excretory System
• These openings lead to the lacrimal canaliculi, the
lacrimal sac, and finally the nasolacrimal duct,
then leads to the nose.
• In 90% of people, the canaliculi join to form a
common canaliculus prior to entering the lacrimal
sac.
• Fibers of the tarsal orbicularis oculi muscles
surround the canalicular system and lacrimal sac
 tears come in and down the duct with blinking
HIGHLIGHT : A persistent membrane over the valve of
Hasner : associated with tearing and discharge in
infants with nasolacrimal duct obstruction.
• Histology :
• Lacrimal puncta & canaliculi : nonkeratinized
stratified squamous epithelium  merge w/
epithelium of the eyelid margins
• Near lacrimal sac, epithelium differentiates into 2
layers: superficial columnar layer & deep, flattened
cell layer
• Goblet cells & occasionally cilia are present
Conjuctiva
• Three geographic zones : palpebral conjunctival (PC),
forniceal conjunctiva (FC), & bulbar conjunctival(BC)
• PC : cover lid’s inner surface, adheres firmly to the
tarsus. Blood supply by branches of the marginal
arcades of the eyelids.
• FC : The tissue becomes redundant and freely movable.
Continuous, circular sac-look, discount at caruncle &
the plica semilunaris.
• BC : freely movable but fuses with the Tenon capsule as
it inserts into the limbus. Blood supply by Anterior
ciliary arteries
• The conjunctiva is reflected at the cul- de- sac and
attaches to the globe.
• Vascularization
• PC : branches of the marginal arcades of the eyelids.
• FC : The superior peripheral arcade, running along the
upper border of the eyelid, sends branches proximally
• BC : Anterior ciliary arteries
• The limbal blood supply derives from the ciliary arteries
through the anterior conjunctival arteries.
 Conjuctiva
• Innervation : derived from the
ophthalmic division of CN V
• Histology
• The conjunctiva is a mucous
membrane consisting of
nonkeratinized stratified squamous
epithelium (2 – 5 layers) with
numerous goblet cells (unicellular
mucous glands) and a thin, richly
vascularized substantia propria
containing lymphatic vessels, plasma
cells, macrophages, and mast cells
• Lymphoid layer / adenoid layer
extends from the bulbar conjunctiva
to the subtarsal folds of the eyelids.
 Conjuctiva
• In places, specialized aggregations of
conjunctiva- associated lymphoid
tissue (CALT) correspond to mucosa-
associated lymphoid tissue (MALT)
elsewhere and comprise collections of
T and B lymphocytes under lying a
modified epithelium.
• These regions are concerned with
antigen processing.
• The thickness of the conjunctival
epithelium varies from 2 to 5 cells.
The basal cells are cuboidal and
evolve into flattened polyhedral
cells as they reach the surface.
 Conjuctiva
• The goblet cells (unicellular mucous glands) :
concentrated in the inferior and medial
conjunctiva, especially in the region of the
caruncle and plica semilunaris.
• They are sparsely distributed throughout the
remainder of the conjunctiva, absent in the
limbal region
• Caruncle : small, fleshy, ovoid, attached to
inferomedial side of plica semilunaris. It’s a
modified skin, contains sebaceous glans and
fine-colorless hairs. Epithel : non-keratinized
stratified squamous
• Plica Semilunaris : narrow, highly vascular,
crescent-shaped fold of conjunctiva, lateral
to and partly under caruncle. Its epithel is
rich of goblet cells. Its stroma contain fat and
nonstiated muscle
/ Tenon Capsule
• The connective tissues form
sleeves around the
penetrating extraocular
muscles, creating pulleys
suspended from the
periorbita. These pulleys
stabilize the position of the
muscles relative to the orbit
during eye movements.
• The connective tissues form
sleeves around the
penetrating extraocular
muscles, creating pulleys
suspended from the
periorbita. These pulleys
stabilize the position of the
muscles relative to the orbit
during eye movements.
Tenon Capsule
Vascular of the orbit
Arterial Supply of The Orbit
• Blood supply to the orbital arises primarily from the ophthalmic artery (the first branch
off of the internal carotid artery). The ophthalmic artery has many branches which may
be separated into 2 groups: *Orbital Group *Ocular Group
• Orbital Groups :
• Lacrimal artery (supplies the lacrimal gland, lateral upper and lower eyelids and conjunctiva.)
• Supraorbital artery: supplies the superior rectus and levator palpebral muscles  passes through
the supraorbital foramen and its terminal branches supply the eyebrow and forehead.
• Anterior ethmoidal artery: supplies the superior oblique muscle, anterior and middle ethmoidal
cells, frontal sinus, lateral wall nose, and nasal septum.
• Posterior ethmoidal artery: Passes through the posterior ethmoidal canal, supplying the posterior
ethmoidal cells.
• Internal palpebral artery: Terminal branches include superior and inferior medial palpebral
arteries. These vessels supply the lacrimal sac and eyelids creating an anastomosis with the two
lateral palpebral branches from the lacrimal artery.
• Frontal artery: Leaves the orbit at its medial angle above the trochlea and supplies the forehead
and scalp creating an anastomosis with the supraorbital artery terminal branches.
• Nasal artery: Supplies the superior lacrimal sac and nose.
Arterial Supply of The Orbit
Arterial Supply of The Orbit
 Arterial Supply of The Orbit
• Ocular Group
The posterior ciliary vessels originate from the ophthalmic artery and supply the entire
uvea, the cilioretinal arteries, the sclera, the margin of the cornea, and the adjacent
conjunctiva.
• Short posterior ciliary artery: Supply the choroid and cilliary processes.
Approximately 16–20 short posterior ciliary arteries and 6–10 short ciliary nerves
enter the globe in a ring around the optic nerve (Fig 1-19)
• Long posterior ciliary artery : Supply the anterior segment and form
anastomoses/collateralization with extraocular muscles branches. Usually, 2 long
posterior ciliary arteries and 2 long ciliary nerves enter the sclera on either side of
the optic nerve, close to the horizontal meridian. They course anteriorly in the
suprachoroidal space, terminating at the major arterial circle of the iris. (Fig 1-20)
Anterior Ciliary Arteries : also arise from the ophthalmic artery, supply (in pairs) the
superior, medial, and inferior rectus muscles (Figs 1-20). Anastomose with the long
posterior ciliary arteries at the major arterial circle of the iris. (Figs 1-20, 1-21)
Arterial Supply of The Orbit
 Arterial Supply of The Orbit
• Ocular Group (cont’d)
• Central retinal artery: Branches off of the
posterior 1/3 of the ophthalmmic artery and
enters the dural sheath of the optic nerve
about 13mm behind the globe. Supplies the
retina.
• Muscular arteries: Splits into superior and
inferior branches. The superior branch
supplies the levator palpebral muscle, superior
rectus, superior oblique and a portion of the
lateral rectus. The inferior branch supplies the
medial rectus, inferior rectus and inferior
oblique. This inferior branch also gives off
most of the anterior ciliary arteries.
Vascular of the orbit
• Vortex Veins
• The vortex veins drain the venous system of the choroid, ciliary body, and iris
(see Fig 1-19).
• Each eye contains 4–7 (or more) veins. One or more veins are usually located
in each quadrant and exit 14–25 mm from the limbus, between the rectus
muscles.
• The ampullae of the vortex veins are 8–9 mm from the ora serrata and are
visible by indirect ophthalmoscopy.
• A circle connecting these ampullae corresponds roughly to the equator and
divides the central or posterior fundus from the peripheral or anterior
portion. The vortex veins join the orbital venous system after leaving the eye.
(Fig 1-23).
Vascular of the orbit,
Veins
Vascular of the orbit, Veins
• Superior Ophthalmic Vein: Provides the main venous drainage of the orbit.
Originates in the superonasal quadrant of the orbit and extends posteriorly
through the medial part of the superior orbital fissure into the cavernous
sinus.
• Inferior Ophthalmic Vein: Originates at the floor and medial wall of the
orbit and provides drainage for the inferio orbit.
• Vortex Veins: Venous drainage of the uveal tract and pierce the sclera
posterior to the equator of the globe. Superior vortex veins (lateral and
medial) drain into the superior ophthalmic vein and the inferior vortex
veins (lateral and medial) drain into the inferior ophthalmic vein.
(Fig 1-23)
Sources
• AAO Fundamentals and Principles of Ophthalmology, 2019-2020 Basic
and Clinical Science Course (BCSC) Book 2
• https://eyewiki.aao.org/Vasculature_of_orbit