Conjunctiva Anatomy and Pathology: A Comprehensive Overview, Study notes of Ophthalmology

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Dr

Parul

Ichhpujani

Assistant

Professor

Deptt.

Of

Ophthalmology,

Government

Medical

College

and

Hospital,

Sector

Chandigarh

Subdivision of Lectures APPLIED

ANATOMY

 Parts  Structure  Glands SYMPTOMATIC

CONDITIONS

 Hyperaemia  Chemosis  Ecchymosis  Xerosis  Discoloration DEGENERATIVE

CONDITIONS

 Pinguecula  Pterygium  Concretions

INFLAMMATIONS

OF

CONJUNCTIVA

Infective

conjunctivitis

Bacterial

Chlamydial

• Viral

Allergic

conjunctivitis

Granulomatous

conjunctivitis

CYSTS

AND

TUMOURS

Palpebral

conjunctiva

Marginal conjunctiva extends from the lid margin to about

mm on the back of lid up to a shallow groove, the sulcus subtarsalis. Tarsal conjunctiva is firmly adherent to the whole tarsal plate in the upper lid. In the lower lid, it is adherent only to half width of the tarsus. Orbital part of palpebral conjunctiva lies loose between the tarsal plate and fornix.

Bulbar

conjunctiva

 Lies loose over the underlying structures and thus can be moved easily.  It is separated from the anterior sclera by episcleral tissue and Tenon's capsule. 

A 3

mm ridge of bulbar conjunctiva around the cornea is called limbal conjunctiva.  In the area of limbus, the conjunctiva, Tenon's capsule and the episcleral tissue are fused into a dense tissue which is strongly adherent to the underlying corneoscleral junction.  At the limbus, the epithelium of conjunctiva becomes continuous with that of cornea

Histologically

Three layers (1) epithelium, (2) adenoid layer, and (3)fibrous layer

Blood

supply

of

conjunctiva

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 lacrimal, infratrochlear, supratrochlear, supraorbital and frontal nerves.

Injection

 Dilation of the conjunctival vasculature

Papillae  Non ‐ specific and less diagnostic  Conjunctival epithelial hyperplasia  Central vascular core, Surrounded edema and inflammatory cells  Fibrous septa  GPC

Follicles

Raised,

gelatinous,

oval

lesions

about

1mm

in

diameter

found

usually

in

the

lower

tarsal

conjunctiva

and

upper

tarsal

border,

and

occasionally

at

the

limbus.

Each

follicle

represents

a

lymphoid

collection

with

its

own

germinal

centre.

Unlike

papillae,

the

causes

of

follicles

are

more

specific

(e.g.

viral

and

chlamydial

infections).

Pterygium^ •

Greek word pterygion meaning "wing".

Elastoid degeneration - Causes: Sun (uv light), wind - Usually nasal side - Also called as

Surfer's eye”

Rx: Surgery: Excision with conjunctival autograft - When to consider surgery? Corneal astigmatism, visual axis involvement and cosmetic reasons

Basophilic degenerations Kissing Pterygium

Pinguecula

 Benign  Composed of collagen and elastin

Subconjunctival

hemorrhage

Causes:  spontaneous, or  rubbing of the eye,  vomiting,  coughing,  elevated blood pressure,  or, rarely, bleeding disorders. Recommend no rubbing, and no exercise or bearing down.