Anatomy Of Lacrimal System

Dr Ashwini
 Lacrimal apparatus

• It is concerned with the tear formation and

transport.
• Lacrimal passage includes :
• LACRIMAL GLAND
• LACRIMAL PUNCTUM
• LACRIMAL CANALICULI
• LACRIMAL SAC
• NASOLACRIMAL DUCT
 Development

LACRIMAL GLAND

*Begins to develop between 6-7th wks. of gestation.

*Form as series of epithelial buds, which grow
superolaterally from superior fornix of conjunctiva into
the underlying mesenchyme.
*Buds branch and canalize --> form ducts and alveoli
With the development of
levator palpabrae superioris,
gland divides into orbital
and palpebral parts.

Lacrimal gland do not

function fully until 6wks
after birth

*Newborn infants do not

produce tears while crying.
Lacrimal sac and nasolacrimal duct

• By the end of 5th wk the nasolacrimal groove

forms as a furrow between the nasal & maxillary
prominence

• In the floor of the groove, nasolacrimal duct

develops from the linear thickening of ectoderm

• Dilates superiorly to form the sac

• Solid cord separates from adjacent ectoderm and sinks
into mesenchyme
• Cords canalize forming NLD and lacrimal sac at its
cranial end
• Canaliculi form similarly from invaginated ectoderm
continuous with distal cord
• Caudally duct extends intranasally exiting within inferior
meatus
• Canalization is usually complete around time of birth

Applied anatomy

• Failure of caudal end to completely canalize results in

congenital NLD obstruction
 Lacrimal
gland

Main Accessory

1.Glands
Orbital of Krause

2.Glands
Palpebral
ofWolfring
 Main gland
ORBITAL PART
• It is large about the size
almond, lies in the fossa
for lacrimal gland, formed
by orbital part of frontal
bone
• It has 2 surfaces: Superior
in contact with frontal
bone, inferiorly lies over
Levator palpebrae
superioris muscle
• There are about 10-12
ducts which open in the
PALPEBRAL PART

• It is small and consists

of only 2 or 3 lobules
and lies along the ducts
of orbital part.
• Inferiorly lies in relation
to the suporior fornix.
• posteriorly continuous
with orbital part.
Accessory glands

• It is responsible for basal tear film

secretion
Glands of Krause – they are microscopic
structures located in the junction of tarsus
and palpebral conjunctival fornices
• More in the upper fornix 40-42 than lower
fornix 6-8
Glands of Wolfring–they are less in number
present along the upper border of superior
tarsus(2-5) and lower border of inferior
fornix(2-3).
• Structure of the lacrimal
gland

• The gland is Tubuloacinar

• The glandular tissue consists
of acini and ducts arranged in
lobes and lobules
• Acini are lined by single layer
pyramidal cells which are
surrounded by flattened
myoepithelial cells
• Pyramidal cells are serous
type with eosinophilic
secretory granules and
nucleus.
• ducts are lined by 2layers of
epithelial cells inner thick
cylindrical and outer flattened
Blood supply and histology

• Main lacrimal gland is supplied by lacrimal

branch of ophthalmic artery
• Veins drain into ophthalmic vein
• Lymphatics drain to
pre auricular lymph nodes
Nerve supply
 PUNCTUM
• These are small round openings situated on
an elevated area on each eyelid called
papilla located at the junction of lacrimal
and ciliary part of eyelid
• Upper punctum about 6mm from inner
canthus
• Lower punctum about 6.5mm from inner
canthus
Canaliculus
• Each canaliculus has two parts vertical and
horizontal
• Vertical is about 2mm and horizontal about
8mm (upper),8.5mm(lower).They are at
right angles to each other and about 0.5
mm diameter.
• At the junction,it is dilated,called ampulla.
• Each canaliculus may open separately or
form a common canaliculus (lacrimal sinus
of Maier) to open into middle of lateral
surface of sac.
• Valve of Rosenmuller
Lacrimal sac

• Located in lacrimal fossa, formed by

lacrimal bone and frontal process of
maxilla.
• Bounded by anterior and posterior lacrimal
crest
• Enclosed by lacrimal fascia
• Dimensions- when distended can be
10-15mm length, 5-6mm width, volume
about 20c.mm.
Parts

• Fundus- part above the canaliculi

opening(3-5mm)
• Body – central part (10-12mm)
• Neck- narrowest part continues as
nasolacrimal duct
Relations

• Anteriorly -Lacrimal fascia and few fibres

of inferior oblique
• Lacrimal fibres of orbicularis oculi
• Medial palpebral ligament-covers upper
part of sac(least resistance in lower part)
• Angular vein- crosses MPL about 8mm
from medial canthus
• Posteriorly – lacrimal fascia,lacrimal
fibres of orbicularis and septum orbitale
Nasolacrimal duct

• It is the continuation of sac inferiorly

runs downwards, backwards and
outwards.
• About 15-18mm in length
• Opens into inferior meatus of nasal cavity
• Upper part is narrowest
• Below guarded by valve of Hasner
• Lies within the bony canal of maxilla
• 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 entering the lacrimal
sac.
Structure
• Double-layered Epithelium
• The superficial layer composed of
columnar cells, the deep layer is of
flattened cells.
• Fibroelastic tissue of the sac becomes
continuous with that of the canaliculi.
• Plexus of vessels is well developed
around NLD, forming a erectile tissue
resembling in structure with that on
inferior concha.
• engorgment of these vessels cause
• Vessels
• Artery supply:Superior and inferior
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.
• Nerve supply : Infratrochlear and anterior
superior alveolar nerves.
Applied aspects of lacrimal gland

• Disorder of secretion –
• HYPERSECRETION :-
• Primary Hyperlacrimation –d/t direct stimulation
of the lacrimal gland eg.cysts, tumor

• Reflex Hyperlacrimation – Results of sensory

branches of 5 cranial nerve d/o irritation of
th

cornea or conjunctiva.

• Central Lacrimation- ( Psychial lacrimation)- seen

in emotional stage hyterical lacrimation.
 Congenital anomalies of lacrimal
gland
* Alacrimia – congenital deficiency or absence of tear
secretion.
Riley day syndrome
Acoustic neuroma
Anhydrotic Ectodermal dysplasia

* Aplasia of lacrimal gland – may lead to congenital

alacrimia.
Congenital Anomalies of the lacrimal
passage

1. Ectasia of lacrimal passage :- due to failure of normal

fusion of nasal and maxillary process.

2. Atresia of Lacrimal Passage :- Failure of canalization .

3. Congenital occlusion of NLD :- more common in lower

end ,causes epiphora
• In the foetus , NLD is a solid cord & gets canalized later.
• In about 30% cases this canalization is delayed or is
absent at lower end.
• During embryogenesis Canalization of solid columns of
ectodermal cells takes place by degeneration and
shredding of central cells.

• Debris of these cells if remains may occlude sac and may

cause congenital mucocoele,

• Incomplete canalization causes blockage of NLD may

leads to congenital dacryocystitis.
Anomalies Of The Lacrimal Passage

• Congenital absence of punctum- d/t failure

or incomplete outbudding of nasolacrimal
core.

• Punctal stenosis.

• Supernumerary puncta and canaliculi.

• Dacryoliths -acquired NLD blockage.

Swelling in Lacrimal Gland

• a) Dacryoadinitis:- Inflammation of lacrimal

gland

• b) Mikulicz’s syndrome:- Bilaterally symetrical

enlargement of lacrimal & salivary gland.

• c) Dacryops:- cystic swelling in upper fornix due

to retention of secretions following blockage of
Lacrimal duct.

• d) Tumors :- Pleomorphic adenoma is the

commonest.
REFERENCE

• Wolf”s Anatomy of the Eye and Orbit.

• Anatomy and Physiology of Eye A K
Khurana
Thank you