The anatomy and physiology of lacrimal

system By Dr Suraj Kushwaha

Introduction

The lacrimal apparatus comprises

• Lacrimal glands, and
•Lacrimal passages, which include: puncta, canaliculi,
lacrimal sac and nasolacrimal duct.

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The lacrimal system

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Lacrimal passages

1. Lacrimal puncta
 These are two small, rounded or oval openings on upper and
lower lids, about 6 and 6.5 mm, respectively, temporal to the
inner canthus.
 Each punctum is situated upon a slight elevation called
lacrimal papilla which becomes prominent in old age.
 Normally, the puncta dip into the lacus lacrimalis (collection
of tear fluid in the inner canthus).

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2. Lacrimal canaliculi
 Superior and inferior canaliculi join the puncta to the lacrimal sac.
 Each canaliculus has two parts: vertical (1–2 mm) and
horizontal (6–8 mm) which lie at right angle to each other.
 The horizontal part converges towards inner canthus to open in the
sac.
 The two canaliculi may open separately or may join to form
common canaliculus which opens immediately into the outer wall
of lacrimal sac.
 A fold of mucosa at this point forms the valve of Rosenmuller
which prevents reflux of tears.
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3.The lacrimal sac
• 10–12 mm long and lies in the lacrimal fossa between the anterior and
posterior lacrimal crests.
 It is a cystic structure lined with columnar epithelium. It is situated in the lacrimal
fossa formed by the lacrimal bone and the frontal process of the maxilla.
 The lacrimal bone and the frontal process of the maxilla separate the lacrimal sac
from the middle meatus of the nasal cavity.
 In a dacryocystorhinostomy (DCR) an anastomosis is created between the sac and
the nasal mucosa to bypass an obstruction in the nasolacrimal duct.
Size: When distended, lacrimal sac is about 12–15 mm in length and 5–6 mm in
breadth with a volume of about 2 cc
Parts: It has got three parts: fundus (portion above the opening of canaliculi),
body (middle part) and the neck (lower small part which is narrow and continuous
with the nasolacrimal duct).
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4. Nasolacrimal duct (NLD)

Dimensions and location. It extends from neck of the lacrimal sac

to inferior meatus of the nose. It is about 15–18 mm long and lies in a
bony canal formed by the maxilla and the inferior turbinate.
Direction of the NLD is downwards, backwards and laterally.
Externally, its location is represented by a line joining inner canthus to
the ala of nose. The upper end of the NLD is the narrowest part.
Numerous membranous valves are present in the NLD, the most
important is the valve of Hasner, which is present at the lower end of
the duct and prevents reflux from the nose.

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Lacrimal Glands
• These are serous glands situated at the upper and outer angle
of the orbit, in a depression known as the fossa for the
lacrimal gland.
• Each gland is approximately the size and shape of an almond.
It is composed of secretory epithelial cells.
• Anteriorly the gland is divided into two parts—the upper
orbital part and the lower palpebral part.
• The ducts of the lacrimal gland which are about 12 in number
open in the fornix of the upper lid.
• The glands secrete tears composed of water, salt and
lysozyme, a bactericidal enzyme. 10
Accessory Lacrimal Glands
• These are very small glands of exactly the same structure as
the lacrimal glands.
1. Glands of Krause—These are microscopic glands lying
beneath the palpebral conjunctiva between fornix and the edge
of tarsus.
These are about 42 in the upper fornix and 6–8 in the lower
fornix.
2. Glands of Wolfring—These are few in number, present near
the upper border, of the superior tarsal plate and along the
lower border of inferior tarsus. 11
Structure, blood supply and nerve supply
• All lacrimal glands are serous acini, similar in structure to the salivary glands.
Microscopically these consist of glandular tissue (acini and ducts), connective
tissue and puncta.
• Blood supply. Main lacrimal gland is supplied by lacrimal artery which is a
branch of ophthalmic artery.
• Nerve supply includes:
1.Sensory supply comes from lacrimal nerve, a branch of the ophthalmic division of
the fifth nerve.
2.Sympathetic supply comes from the carotid plexus of the cervical sympathetic chain.
3.Secretomotor fibres are derived from the superior salivary nucleus (pons) → greater
petrosal nerve → synapse at pterygopalatine ganglion → zygomatic
nerve → lacrimal nerve → lacrimal gland.
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 Fluid covering the
cornea and called it
precorneal film.
 consist of three layers,
which from posterior to
anterior are mucus layer,
aqueous layer and lipid or
oily layer.

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1. Mucus layer.

 It is the innermost and about 0.2 mm thick stratum of the

tear film.
 It consists of mucin secreted by conjunctival goblet cells and
glands of Manz.
 It converts the hydrophobic corneal surface into hydrophilic
one.

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2. Aqueous layer.
 The bulk of tear film (7.0 mm) is formed by this
intermediate layer which consists of tears secreted by the main
and accessory lacrimal glands.
 The tears mainly comprise of water and small quantities of
solutes such as sodium chloride, sugar, urea and proteins.
 Therefore, it is alkaline and salty in taste. It also contains
antibacterial substances like lysozyme, betalysin and
lactoferrin.

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3. Lipid or oily layer.
• This is the outermost and thinnest (0.1 mm) layer of tear
film formed at air-tear interface from the secretions of
meibomian, zeis, and moll glands.
• This layer prevents the overflow of tears, retards their
evaporation and lubricates the eyelids as they slide over the
surface of the globe

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Functions of tear film

1. Keeps moist the cornea and conjunctiva.

2. Provides oxygen to the corneal epithelium.
3. Washes away debris and noxious irritants.
4.Prevents infection due to presence of anti-bacterial
substances.
5. Facilitates movements of the lids over the globe.

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 Secretion of tears

 Tears are continuously secreted throughout the day by

accessory (basal secretion) and main (reflex secretion)
lacrimal glands.
 Reflex secretion is in response to sensations from the cornea
and conjunctiva, probably produced by evaporation and
breakup of tear film.
 Hyperlacrimation occurs due to irritative sensations from
the cornea and conjunctiva.
 Afferent pathway of this secretion is formed by fifth nerve
and efferent by parasympathetic(secretomotor) supply of
lacrimal gland. 20
Elimination of tears From the lacrimal gland
• The tears flow downwards and laterally across the ocular
surface.
• A variable amount of tears is lost by evaporation from the
ocular surface.
• The remainder of tears flow along the superior and inferior
marginal strips and collects as lacus lacrimalis in the inner
canthus from where it is drained by the lacrimal passage
into the nasal cavity
• About 70% tears is drained via inferior canaliculus and 30% via
the superior canaliculus by an active lacrimal pump mechanism
constituted by the fibres of orbicularis. 21
 Cont…
• With each blink, the pretarsal orbicularis oculi muscle compresses the ampullae,
shortens and compresses the horizontal canaliculi, and closes and moves the puncta
medially, resisting reflux.
• Simultaneously, contraction of the lacrimal part of the orbicularis oculi creates a positive
pressure that forces tears down the nasolacrimal duct and into the nose, mediated by
helically arranged connective tissue fibres around the lacrimal sac.

•When the eyes open, the canaliculi and sac expand, creating negative pressure that
draws tears from the canaliculi into the sac.

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Elimination of tears by lacrimal pump mechanism 23
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