Review of clinical anatomy and
physiology of the conjunctiva
Ayesha S Abdullah
20.09.2013
Learning outcome
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By the end of this lecture the students would be able
to;
 Correlate the structural organization of the
conjunctiva with its functions
 Identify important anatomical landmarks on
conjunctival photographs and histological
photomicrographs.
 Relate the clinical presentation of conjunctival
disorders with the structural organization and
physiological functions of the conjunctiva
Let us look at a case
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A 25 year old young man presented to the OPD with
the complaints of watering of both the eyes with a
feeling of grittiness and foreign body sensation for
the last 03 years. He also had gradual visual loss of
vision. His symptoms worsened over the years. He
had a history of chemical injury to his eyes 03 years
ago.
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What questions come to your mind?
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Why the feeling of grittiness and foreign body
sensation in the eyes?
Why the gradual visual loss?
What keeps the ocular surface moistened?
When we look around in different directions why
don’t we get the feeling of the ocular surface
beneath the eyelids and in front of the eye rubbing
against each other?
Some more questions
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What is conjunctiva?
A mucous membrane covering the under surface of the
lids and anterior part of the eyeball upto the cornea
Histologically what are the layers of the conjunctiva?
Epithelium
Submucosa/stroma/substantia propria
What kind of epithelium should the conjunctiva have?
Stratified epithelium
Why?
Exposed ocular surface, vulnerable to subtle trauma
excessive movement of the eye and rubbing of the
surfaces
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What keeps the conjunctiva moist & lubricated?
Tear film
Which type of secretary cells and glands are responsible
for this function?
Goblet cells and accessory lacrimal glands
Where are these cells located?
Throughout stratified columnar epithelium
What else is there in the submucosa?
Outer lymphoid layer; macrophages, mast cells, polmorphs,
eosinophils and aggregates of lymphocytes, IgA
Inner fibrous layer; collagen fibers, blood vessels,
fibroblasts and accessory lacrimal glands
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What are follicles?
Aggregates of lymphoid tissue with in the
submucosa/substantia propria
A reaction to infections or hypersensitivity response
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What are papillae?
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Hyperplastic conjunctival epithelium with central
core vessel surrounded by infiltrate separated from
each other by fibrous septa- seen in allergic &
bacterial conjucntvitis
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Topographically, what are the different parts of the
conjunctiva?
Palpebral
Bulbar
Forniceal (fornix)
Plica semilunaris & caruncle
Limbus
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Bulbar
conjunctiva
Plica
semilunaris &
Caruncle
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Forniceal
conjunctiva
Tarsal
conjunctiva
Marginal
conjunctiva
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Should the epithelium be the same or different in
different parts of the conjunctiva?
It should be different
Stratified columnar epithelium 2 – 5 cells.
At limbus change into stratified squamous non keratinized
epithelium.
At lid margin non keratinized stratified squamous epithelium
changes into keratinized stratified squamous epithelium
Why?
Different role of each part
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Should it be keratinized or non-keratinized? Why?
Non-keratinized to aid maintenance of smooth
surface, less friction during ocular and lid movements
What keeps it non-keratinized?
Normal ocular surface environment
Vitamin A
When could it get keratinized? what would
happen?
Tarsal
conjunctiva
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Limbus
Marginal
conjunctiva
Bulbar
conjunctiva
Forniceal
conjunctivacrypts of
Henle
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Plica semilunaris
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Caruncle
stratified squamous epithelium
with few goblet cells
focal surface
keratinization
hair follicles
(arrow 12),
sebaceous
glands (arrow
13) and adipose
tissue (arrow 15).
Clincially it appears like this
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What is the blood supply of the conjunctiva?
Why is it so richly supplied with blood vessels?
Which general physical examination draws from the
rich pink colour of the palpebral conjunctiva?
What unconventional role do conjunctival blood
vessels perform?
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Blood supply
Arterial supply;
 Posterior conjunctival arteries derived from arterial
arcade of lids which is formed by palpebral branches
of nasal and lacrimal arteries of the lids.
 Anterior conjunctival arteries derived from the anterior
ciliary arteries – muscular br. of ophthalmic artery to
rectus muscles.
Venous drainage;
 Palpebral and Ophthalmic veins.
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Should there be a nerve supply?
What kind?
Name the nerves?
Should there be lymphatic drainage?
Where would the lymphatics drain?
If the lymph nodes are palpable/enlarged what is
it called?
What does lymphadenopathy signify?
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PHYSIOLOGY
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Smooth surface.
Secretes mucin and aqueous component of tear film.
Highly vascular: supplies nutrition to the peripheral
cornea.
Aqueous veins drains from anterior chamber
maintenance of IOP.
Lymphoid tissue helps in combating infections.
Basic secretion—reflex secretion.
Summarize
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How is conjunctiva organized structurally?
What are major functions of conjunctiva?
Protection –physical, immunological
Smooth and healthy ocular surface
Nourishment for the lids and cornea
Role in aqueous drainage
Smooth, controlled and free ocular movements.
Summarize
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How does the structure and function correlate with the
clinical symptoms and signs?
Discharge, watering
Dry eyes
Follicles and papillae
Anemia
Jaundice , would you be able to see it if the
conjunctiva were opaque?
Lymphadenopathy
Tumours and cysts