The lacrimal apparatus comprises the structures concerned with the

formation 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:

1) Serves to smooth out irregularities in the corneal surface ( allow sharp image
focused on the retina).
2) Serves as the primary source of oxygen for the cornea, oxygen of the
atmosphere is dissolved within the tears and is available for uptake by
corneal epithelium cells to support the normal aerobic metabolism of the
corneal epithelium.
3) Tears serves as a lubricant between the lids and the corneal surface.
4) Tears contain at least three anti-bacterial substances such as lysozyme,
betalycin, ( IgA ), and lactoferrin , that protect the ocular surface against
infection.
5) The flushing action of the tears across the ocular surface helps to
remove exfoliating cells, debris, and foreign bodies.
6) The mucin network over the conjunctiva serves to entrap debris
and foreign bodies, aiding in their elimination.
7) Tear film plays a role in healing of central wounds of the avascular
cornea, providing pathway for white blood cells from limbal and
conjunctival circulation to reach central cornea.
The balance between production of tear film constituents, their distribution over
the ocular surface, and their elimination through the lacrimal passages is essential
in maintaining a normal ocular surface.
Decrease in aqueous tear production may give karato-cunjunctivits sicca.
Block of the outflow of tears can be create a stagnant tear film, a situation more
favorable for microbial colonization of the ocular surface.
Aqueous tear production usually decreases with age.
Lacrimal passage :
A) Lacrimal punctum : one on each eyelid, and situated near the posterior border
of the lid margin, 6mm from the medial canthus. Normally the face slightly
posteriorly and can be inspected by everting the media aspect of the lid.
B) Canaliculi : one on each eyelid commences at the punctum, pass vertically from
the lid margin (the ampullae ) for about 2mm , and then turn medially, and run
horizontally for about 8mm to reach the lacrimal sac. The superior and inferior
canaliculi most often unite to form the common canaliculi which opens into the
wall of the lacrimal sac.
C) Lacrimal sac : is about 10mm long, lies in the lacrimal fosse, the upper
part of the sac is known as the fundus, the lower end narrows as it
open into the nasolacrimal duct.
D) Nasolacrimal duct : is about 12mm long, and is the inferior
continuation of the lacrimal sac.
It descends and opens in the inferior nasal meatus, below the inferior
turbinate bone. The opening of the duct is partially covered by a mucosal
fold named ( valve of Hasner ).
Innervation of lacrimal gland :
1) Parasympathetic nerves :from the facial nerve which predominate, produce
acetylcholine as a neurotransmitter.
2) Sympathetic nerves : are sparsely distributed ( surround the vessels ), and
produce norepinephrine as a neurotransmitter.
3) Sensory nerves : from the trigeminal nerve and are the least prevalent.

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.