ANATOMY AND

PHYSIOLOGY OF
CONJUNCTIVA
PRESENTATION LAYOUT
• Anatomical structure and function
• Blood Supply and Lymphatic
• Nerves Supply
• Clinical Correction
CONJUNCTIVA - ANATOMY
• The conjunctiva of the eye provides
protection and lubrication of the eye by
the production of mucus and tears.
• Conjunctiva is a translucent mucous
membrane which lines the
Posterior surface of eyelids and
Anterior aspect of eyeball
Anatomical Structure and Function
PALPEBRAL CONJUNCTIVA (- lines the
lids )
1. Marginal Conjunctiva
Extends from lid margin to 2 mm on
the back of the lid upto a shallow
groove called sulcus subtarsalis

It is actually a transition zone

between skin and the conjunctiva
proper.
2. Tarsal Conjunctiva
thin transparent and highly vascular

Firmly adherent to the whole tarsal plate in the upper eye lid

In lower eyelid it is adherent to only half width of tarsus

Tarsal glands are seen through it as yellow streaks

3. Orbital part of palpebral conjunctiva
lies loose between tarsal plate and fornix
BULBAR CONJUNCTIVA
Thin transparent and lies over underlying
structures and thus can be moved easily
1. LIMBAL CONJUNCTIVA
A 3mm ridge around the bulbar
conjunctiva around the cornea.

2. SCLERAL CONJUNCTIVA
• Separated from anterior sclera by
episcleral tissue and Tennon’s capsule
 Tear film

Bulbar Conjunctiva

In the area of limbus the conjunctiva, tennon’s capsule and episcleral tissue are fused into a dense tissue
Which is strongly adherent to the underlying corneo-scleral junction.
Conjunctival fornix
• Its joins the bulbar conjunctiva with the palpebral conjunctiva
• It can be subdivided into superior, inferior, medial and lateral
fornices.

superior inferior medial lateral

STRUCTURE OF CONJUNCTIVA
• HISTOLOGICALLY IT CONSISTS OF
THREE LAYERS NAMELY EPITHELLIUM,
ADENOID LAYER AND FIBROUS LAYER
• 1. EPITHELLIUM
• It consists 2 – 5 layered non
keratinized epithelium
• It contains goblet cells which
constitute about 10% of epithelium
The layer of epithelial cells in conjunctiva varies from region to region and in its different
parts as follows

A. Marginal conjunctiva
• 5 layered stratified squamous type of epithelium

B. Tarsal conjunctiva
• 2 layered epithelium superficial layer of cylindrical cells and a deep layer of flat cells

C.Fornix and bulbar conjunctiva have 3 layered epithelium a superficial layer of cylindrical
cells middle layer of polyhedral cells and a deep layer of cuboidal cells

D. Limbal conjunctiva consist 5 to 6 layered of stratified squamous epithelium . Limbal

stem cells are present in basal layer
2. ADENOID LAYER

• Also called lymphoid layer

• It mostly developed in the fornics
• It is not present since birth but develops after 3 to 4 months of life
3. FIBROUS LAYER

• It consist of an meshwork of collagenous and elastic fibres

• It is thicker than the adenoid layer except in tarsal conjunctiva.
• Nerve Supply and Blood Supply will occur here.
GLANDS OF CONJUNCTIVA
• Contains two types of gland
1. Mucin secretary glands .
This gland secrete mucus which is essential for
wetting the cornea and conjunctiva .

This include
• Goblet cells ( the unicellular glands located
within the epithelium )
• Glands of henle ( present in the tarsal
conjunctiva)
• Glands of manz ( found in limbal conjunctiva )
2. Accessary lacrimal glands .
These are
Gland of Krause present in subconjunctival
connective tissue of fornices about 42 in the
upper fornix and in the lower fornics .It secretes
tears on surface of conjunctiva

Gland of wolfring present along the upper border

of superior tarsus snd along the lower border of
inferior tarsus . It secretes electrolyte, fluid and
protein.
BLOOD SUPPLY OF CONJUNCTIVA
• Peripheral Arterial Arcade
• Marginal Arcade of eyelid
• Anterior Ciliary Arteries
• Palpebral Conjunctiva and fornices are supplied by branches from the
peripheral and marginal arterial arcades.

• Bulbar Conjunctiva is supplied by two sets of vessels

Posterior branches of the Arcades
Anterior branches of Anterior Cillary Arteries.

VENOUS DRAINAGE
Veins from the conjunctiva drain into the venous plexus of eyelids and
some around the cornea into the anterior ciliary veins.
Lymphatic of the Conjunctiva
-responsible for draining excess fluid and waste products from the eye
-Arranged in two layers
A. Superficial
B. Deep

Lymphatics drain into;

LATERAL SIDE MEDIAL SIDE
 Pre-auricular Lymph nodes  Submandibular Lymph nodes
NERVE SUPPLY OF CONJUNCTIVA
• A circumcorneal zone of conjunctiva is supplied by the
branches from long ciliary nerves which supply the
cornea.
• Rest of the conjunctiva is supplied by the branches from
i. Lacrimal
ii. Infra-trochlear
iii. Supra-trochlear Trigeminal-Ophthalmic nerve
branches
iv. Supra-orbital and
v. Frontal nerves.
CLINICAL CORRECTIONS
• Inflammation of conjunctiva
• Degenerative Condition of conjunctiva
• Symptomatic Conditions of conjunctiva
• Cysts and Tumours of conjunctiva
INFLAMMATION OF CONJUCTIVA

• Termed as ‘conjunctivitis’ -most common cause of red eye

• PAPILLAE

Due to hyperplasia of normal

vascular system, appear as
elevated polygonal hyperemic
areas
• FOLLICLES

Due to localised aggregation of

lymphocytes in the subeithelial
adenoid layer
-not seen in babies before 2-3 months
of age
• MEMBRANES

-coagulated exudates adherent to

inflamed conjuctival epithelium

-pseudomembranes can be easily

peeled off
CHEMOSIS

-oedema of conjunctiva
due to exudation from
abnormally permeable
capillaries
SUBCONJUCTIVAL HAEMORRHAGE

-blood collects under conjuctiva due to rupture of

small blood vessels
Classification of conjuctivitis
A. Based on onset B. Based on type of exudates

-acute -serous
-hyperacute -catarrhal
-chronic -purulent
-mucopurulent
-membranous
C. based on conjuctival response D. based on aetiology

-follicular -infective
-papillary -allergic
-granulomatous -keratoconjuctivitis
-traumatic
-irritative
 Differential diagnosis of common conjuctivitis
Feature Bacterial Viral Allergic Chlamydial

Congestion Marked Moderate Mild to moderate

moderate
Chemosis ++ +- ++ +-

SH +- +- - -

Discharge Purulent/ watery Ropy/watery mucopurulent

mucopurulent
Papillae +- - ++ +-

Follicles - + - ++

Pseudomemb +- +- - -
rane
Preauricular + ++ - +-
DEGENERATVE CONDITIONS
• Degeneration:
- physiologic decomposition of tissue elements and deterioration of
tissue functions

-a common condition

-has little effect on vision and ocular functions

Common ocular degenerations include:

a.PINGUECULA

b.PTERYGIUM

c.CONCRETIONS
Pinguecula
Pterygium
• Double pterygium
 Concretions
• Small, yellow white deposits in the
palpebral conjuctiva

• Epithelial inclusion cysts filled with

epithelial and keratin debris

• Usually asymptomatic or c/o FB

sensation
Symptomatic Conditions of Conjunctiva
• CHEMOSIS
swelling of conjunctiva due to;
-local inflammatory condition including conjunctivitis, corneal ulcer,
endophthalmitis, acute meibomitis, orbital cellulitis, acute dacrodenitis.

• SYSTEMIC CAUSES
These include severe anaemia, heart failure
• Sub- conjunctival Haemorrage
Causes- trauma, inflammation of the conjunctiva, scurvy, malaria,
typhoid.
Symptoms – Redness, pain
Treatment - cold compression, lubricating eye drops
• Discolouration of conjunctiva
In the palpebral region and fornix, it looks pinkish because of
underlining fibrovascular tissue
CAUSES – dicolouration by various local and systemic diseases such as;
- Red discolouration
- Yellow discolouration – may occur due to bile pigment in jaundice,
blood pigment in malarian yellow fever
- Greyish Discolouration – may occur due to kajal(Gajalu nasalu ankha),
and mascara in female
- Brown pigmentation – due to melanocytic pigmentation
Cysts and Tumours of conjunctiva

A. CYSTS
• Congenital cystic lesion
• Lympathetic cyst of conjunctiva
• Retention Cyst – which occur due to blockage of duct of accessory
lacimal gland
B. TUMOURs of Conjunctiva
Classifications;
a) Pigmented tumour
b) Non-Pigmented tumour
Tisssue of benign malignant
origin

Epithelial surface papilloma Squamous cell

carcinoma

glandular adenoma adenocarcinoma

Connective tissue fibroma sarcoma

vascular hemangioma angiosarcoma

Reticular system Lymphoid lymphosarcoma

hyperplasia
Pigment cells naevus melanoma
Non-Pigmented Tumour
• Congenital Tumour
1. Dermoids- which occur usually at the limbus
2. Lipodermoid- usually found at the limbus or outer canthus
3. Squamous cell carcinoma
Pigmented tumour

NAEVUS
• Present in 1st two decades • 30% are almost non pigmented
• Sharply demarcated and slightly elevated
REFERENCES
• Rahul ko Brahmastra Book
• Google Baba
THANK YOU ;)