COATSOFEYEBALL(SCLERACONJUNCTI

VA,
AND
CORNEA)
SCLERA(tunicaalbugineaoculi)
Thescl
erai
stheopaquewhi t
ewal loftheey ethatencl
osestheposter
iorfour-f
ifthsof
thegl
obesur
face.I
tist
heopaque,
fibr
ous,pr
otect
ive,
out
erl
ayeroft
he 
humaneye cont
aining
mai
nly
 col
l
agen 
andsome 
elast
icf
i .
ber

Thescl
eraisper
forat
edbymanynervesandv
essel
spassi
ngt
hrought
hepost
eri
orscl
eral
for
amen,
thehol
ethati
sformedbythe 
opt
icnerv
e.

Atthe 
opti
cdi
sc 
theoutert
wo-t
hir
dsofthescl
eracont
inueswi
tht
hedur
amat
er(
out
ercoatoft
he
br
ain)vi
athedur
alsheat
hoftheopti
cnerv
e.

Theinnerthi
rdjoinswit
hsome choroi
dal 
ti
ssuet
oform aplat
e(laminacr
ibr
osa)acr
osst
heopt
ic
ner
vewi t
hperforati
onsthr
oughwhichtheopti
cfi
ber
s(fasci
cul
i)pass

Fr
om out
ert
oinner
most
,thef
ourl
ayer
soft
hescl
eraar
e:

1. Epi
scl
era

2. St
roma

3. Lami
naf
usca

4. Endot
hel
i
um

Thescl
erai
sopaqueduet
othei
rr
egul
ari
tyoft
heTy
peI
 col
l
agenf
iber
s,asopposedt
othenear
-
uni
for
mthi
cknessandpar
all
elar
rangementoft
hecor
neal
col
l
agen.

The 
col
lagen 
oft
hescl
erai
scont
inuouswi
tht
he 
cor
nea.

Mor
eov
er,
thecor
neabear
smor
e mucopol
ysacchar
ide 
toembedt
hef
ibr
il
s.

CLI
NICAL
 Yel
lowi
ngoft
hescl
erai
sav
isual
sympt
om of
 j
aundi
ce.

 I
nver
yrar
ebutsev
erecasesofki
dneyf
ail
ureandl
iv
erf
ail
ure,
thescl
eramayt
urnbl
ack.

 I
ncasesof
 Ost
eogenesi
sImper
fect
a,t
hescl
eramayappeart
ohav
eabl
uet
int
.

 Thebl
uet
inti
scausedbyt
heshowi
ngoft
heunder
lyi
nguv
eal
tract(
chor
oidandr
eti
nal
pi
gmentepi
thel
i
um)
.
CONJUNCTI
VA

Iti
sathin,
semit
r entmuc
anspar ousmembr anethatcov
erst
hei
nnersur
faceoft
he
eyel
idandthewhit
epartoftheeyebal
l(SCLERA)
The 
conjunct
ivaisa mucousmembr ane,si
milartomucousmembr anes el
sewher
ein
thebody,whosesur f
aceiscomposedofnonker ati
nizi
ng 
squamousepi theli
um,
i
ntermixedwithgoblet(mucus)cel
l
s,Langerhans'cell
s(dendr
it
ic-appeari
ngcel
ls
expr
essingclassIIanti
gen)
,andoccasi
onaldendriti
cmelanocytes.

I
thas3par
ts:

Bulbarconjuncti
va.
 Thisporti
onoft heconj
uncti
vacover
stheanteri
orpartoft
he 
scl
era
(t
he" whi
te"oftheeye).Thebul barconj
unct
ivastopsatt
hejunct
ionbetweenthescl
era
andcornea; i
tdoesnotcov erthe cor
nea.

 Cover
ingtheey ebal
l
.
 Thi
n,t
ranslucentandloosel
yat
tachedt
otheunder
lyi
ngscl
erabyTENON’
S
CAPSULE.
  Conj
unct
ival
li
mbus1mm ant
eri
ort
ocor
neal
li
mbus.

Palpebralconjuncti
va.
 Thi
spor
ti
oncov er
stheinnersurf
aceofbotht
heupperandl
ower
eyeli
ds.(Anotherter
mf ort
hepalpebr
alconj
uncti
vaistarsal
conj
unct
iva.
)

 Cov
eri
ngt
hel
i
ds

 Fi
rml
yadher
ent

 Hi
ghl
yvascul
ar

 Ext
remel
ythi
n

 St
rongl
yboundt
othet
arsal
plat
e

Fornicealconj
unct
iva.
Formsthej
uncti
onbet
weenthebul
barandpalpebral
conjuncti
vas:I
tisl
ooseandfl
exi
ble,
all
owi
ngthef
reemovementofthelidsandey
ebal
l

 Cov
eri
ngt
hel
i
ds

 Thr
owni
ntof
olds

 Tr
ansi
ti
onal
regi
onbet
weenpal
pebr
alandbul
barconj
unv
cti
va

 Super
iorf
orni
x

 10mm f
rom l
i
mbus

 I
nfer
iorf
orni
x-8mm f
rom l
i
mbus

 Lat
eral
for
nix–14mm f
rom l
i
mbus

 Medi
all
yabsent
.

BLOODSUPPLY
Ant
eri
orconj
unct
ival
art
eri
esder
ivedf
rom t
heAnt
.ci
l
iar
yar
ter
ies
Post
eri
orconjuncti
valar
ter
iesderi
vedfrom t
heArter
ial
arcadeofl
i
dswhi
chi
sfor
med
bypal
pebral
Br anchesofnasalandlacr
imalart
eri
esofli
ds:

VENOUSDRAI
NAGEPal
pebr
alandopht
hal
micv
eins

FUNCTI
ON/
PHYSI
OLOGYOFCONJUNCTI
VA
  I
talsocont
ri
butest
o i
mmunesur
vei
l
lance 
andhel
pst
opr
eventt
heent
rance
of
 micr
obes 
int
otheeye.

 Theconj
unct
ivahel
pslubri
cat
ethe ey
e byproduci
ng 
mucus 
and 
tear
s,al
thougha
smal
lerv
olumeof t
ear
s thant
he 
lacri
mal gl
and.

 Smoot
hsur
face.

 Secr
etesmuci
nandaqueouscomponentoft
earf
li
m.

 Hi
ghl
yvascul
ar:
suppl
i
esnut
ri
ti
ont
otheper
ipher
alcor
nea.

 Aqueousv
einsdr
ainf
rom ant
.chamberf
ort
hemai
ntanenceofI
OP.

CLI
NICALSI
GNI
FICANCE
Disordersoftheconjunct
ivaand 
cornea 
arecommonsourcesofey ecomplaint
s,i
n
parti
cularbecausethesurf
aceoftheeyeisexposedtovari
ousexternali
nfl
uencesand
i
sespeci all
ysuscepti
blet
o tr
auma, 
i
nfect
ions,chemi
cal
irr
it
ati
on,
 all
ergi
creacti
ons,
and dryness.

 Theconj
unct
ival
micr
ovascul
arhemody
nami
csar
eaf
fect
edby
 di
abet
ic
reti
nopathy
 (DR)
,hencecanbeusef
ulf
orDRdi
agnosi
sandmoni
tor
ing,and
discr
iminat
ingst
agesofDR.

 Ty
peI
Idi
abet
es 
i
sassoci
atedwi
thconj
unct
ival
 hy
poxi
a, 
incr
easedav
eragebl
ood
v
esseldi
amet
er,
andcapi
ll
aryl
oss.

 Theconj
unct
ivacanbeaf
fect
edby
 tumor
s whi
chcanbebeni
gn,
pre-
mal
i
gnantor
mal
i
gnant
.

 Si
ckl
e-cel
lanemi
a i
sassoci
atedwi
thbl
oodv
essel
sludgi
ng,
alt
eredbl
oodf
lowand
bl
oodv
essel
diamet
er,
andcapi
l
lar
y mi
cro-
haemor
rhages.

 Hy
per
tensi
on 
isassoci
atedwi
thani
ncr
easei
nthe 
tor
tuosi
tyof
 bul
barconj
unct
ival
bl
oodv
essel
sandcapi
l
lar
yandar
ter
iol
eloss.

 Car
oti
dar
ter
y occl
usi
oni
sassoci
atedwi
thsl
owerconj
unct
ival
bloodf
lowand
appar
entcapi
l
lar
yloss.

 Wi
thage,
theconj
unct
ivacanst
ret
chandl
oosenf
rom t
heunder
lyi
ngscl
era,
leadi
ng
t
othef
ormat
ionofconj
unct
ival
fol
ds,
acondi
ti
onknownas 
conj
unct
ivochal
asi
s.
 Lept
ospi
rosi
s,ani
nfect
ionwi
thLept
ospi
ra,
cancause 
conj
unct
ival
suf
fusi
on,
whi
ch
i
schar
act
eri
zedbychemosi
s,andr
ednesswi
thoutexudat
es.