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of tears ( the main lacrimal gland and accessory lacrimal glands) and its
transport. The lacrimal passage includes: puncta, canaliculi, lacrimal sac and
nasolacrimal duct.
Lacrimal gland :
It is an exocrine gland located in the superior lateral quadrant of the orbit, within the
lacrimal gland fossa. It appears as a pinkish gray collection of lobules in the lateral
portion of the eyelid.
Consists of two parts, the levator palpebrae superioris muscle, divide the lacrimal
gland into two lobes :
1- orbital lobe: situated in a fossa in the outer part of the orbital roof. The orbital lobe
is the larger approximately 20mm long, 12mm wide, and some 5mm thick.
2- palpebral lobe, situated in the outer part above the superior fornix (conjunctival
sac ).
On eversion of the upper eyelid, the palpebral lobe may be visualized in the supero-
lateral fornix, on the conjunctival surface of the eyelid.
The ducts of the lacrimal gland , 6 to 12 ducts open into the external part of the
superior fornix 4 to 5 mm above the tarsus in the posterior lamella of the eyelid.
- The gland is made of many acini that drain progressively larger tubules. These
tubules are tributaries of larger ducts.
The main lacrimal gland produces about 95% of the aqueous component of tears.
The accessory lacrimal glands of Krause and wolfring, produce the remainder 5%.
The accessory lacrimal gland :
There are approximately 20 to 40 accessory glands of Krause in the superior
conjunctival fornix.
Fewer accessory glands are present in the lower eyelid .
Several accessory lacrimal glands of wolfring are found along the superior tarsal
border in the upper eyelid.
Precorneal tear film :
Consists of the following layers :
1- outer lipid layer : 0.1 micron thick, 1.5% of the tear film.
2- Middle aqueous layer, 0,7 micron thick, 95% of the tear film.
3- Inner mucin layer, 0.3 micron thick, 3.5% of the tear film.
Outer lipid layer :
Produced primarily by the meibomian glands which are located within
the upper and lower eyelids, and to a lesser extant by the glands of Zeiss
and Moll.
Functions :
1) Retard evaporation of the aqueous layer.
2) Increase surface tension of the tear film, this in turn draws water
into the tear film and thickness the aqueous layer.
3) Lubricate the eyelids.
Dysfunction : may result in an evaporative dry eye.
Middle aqueous layer :
Is secreted predominantly by the main lacrimal gland . Additional contributers to this
layer are :
- The accessory lacrimal glands of Krause and Wlfring.
- The corneal and conjunctival epithelium.
It consists of proteins, electrolytes, and water.
Functions :
1) Has antibacterial function due to the presence of tear proteins such as IgA,
lysozyme, and lactoferrin.
2) Abolish any minute irregularities of the anterior corneal surface.
3) Wash away any debris and noxious stimuli.
Deficiency of this layer results in an hypo secretive dry eye.
Inner mucin layer :
This secreted by the conjunctival Goblet cells, also by the crypts of
Henie, the glands of mans, and the conjunctival and corneal epithelium.
Functions :
1) Watering of the cornea.
2) Lubrication.
3) Helps maintain and intact tear film for 15 to 35 seconds between
blinks.
Deficiency of this layer may produce hypo-secretive and evaporative dry
eye.
The tear film is mechanically spread over the ocular surface through a
neuronally controlled blinking mechanism and after a period of time is
cleared through the nasolacrimal system.
The three factors required for effective resurfacing of the tear film are:
1) Normal blink reflex.
2) Congruity between the external ocular surface and eyelids.
3) Normal corneal epithelium.
Functions of the tear film:
The parasympathetic and sympathetic nerves are the efferent portion of a reflex arc
that is stimulated by sensory nerves in the cornea and conjunctiva that form the
efferent part of the reflex.
Stimulation of sensory nerves in the ocular surface by thermal, mechanical, or
chemical stimuli activates the parasympathetic and sympathetic nerves to stimulate
lacrimal gland to secrete protein, electrolytes, and water.
Stimulation of the optic nerve as by bright light also induces reflex lacrimal gland
secretion.
Electrolytes and water are also produced by corneal and conjunctival epithelium,
which is significant source of electrolytes and water in the tear film ( it’s surface is
much larger than the cornea) .
Goblet cells secretion is stimulated by activation of the sensory nerves in the
conjunctiva and cornea. By reflex action these nerves stimulate the parasympathetic
and sympathetic nerves around the Goblet cells.
Tears secreted by the main and accessory lacrimal glands pass medially
across the ocular surface.
A variable amount of the aqueous component of the tear film is lost by
evaporation, this is related to :
- The size of the palpebral aperture.
- The blink rate.
- The ambient temperature.
- The humidity.
The remainder of the tears drain as follows:
The tear drainage :
1) Tears flow along the upper and lower marginal strips and enter the upper and
lower canaliculi by capillary and also by suction.
About 70% of tears drain through the lower caniliculus, and the remainder through
the upper.
2) With each blink, the pretarsal ( palpebral ) orbicularis oculi muscle compresses
the ampullae, shorten the horizontal canaliculi, and closed and moves the puncta
medially.
Simultaneously the lacrimal part of the orbicularis muscle contracts and expands the
lacrimal sac, thereby creating a negative pressure which sucks the tears from
canaliculi into the sac.
3) When the eyes open, the muscles relax, the sac collapsed, and a
positive pressure is created, which forces the tears down the nasolacrimal
duct into the nose. Gravity also plays a role.
4) The puncta moves laterally, the canaliculi lengthen and fill with tears.
Orbicularis muscle has an important contribution in the lacrimal outflow.
The nasolacrimal duct is narrower in females, accounting for female
predominance of nasolacrimal obstruction.
Schirmer test :
This is used when aqueous deficiency is suspected in the absence of signs of karato-
cunjunctivits sicca.
The test involves measuring the amount of wetting of a special filter paper 5mm
wide, and 35mm long. The test can be performed with or without topical anesthesia,
when performed without anesthesia (Schirmer 1 ), it measures total secretion, basic
and reflex. In practice, however, topical anesthesia reduces reflex secretion but does
not abolish it completely.